A forthcoming review of cosmetic practices aims to make treatment safer and improve aftercare

A LONG time coming. That’s the verdict of one of Scotland’s top plastic surgeons to the news that the government has ordered a major review into cosmetic procedures. Launched in response to the PIP breast implant scandal, it is expected to usher in tighter regulations in an industry that some fear has been surprisingly lax for far too long.

Ken Stewart goes as far as comparing it to the Wild West. The plastic surgeon, who is based at Spire Murrayfield private hospital but also carries out work on the NHS, says, “It is long overdue. I hope it will involve a tightening up of the industry in order to improve ethical standards and improve standards of care for patients.

“There is a lack of regulation and a Wild West approach out there. Any qualified doctor, under the current legislation, can pick up a scalpel. There’s nothing to stop someone with no surgical experience or training to do surgical procedures. Equally, there’s nothing to stop nurses injecting products which they have no experience or knowledge of.

“I know everyone’s against legislation these days,” he adds, “but this is a classic situation where more regulation is required in order to protect the interests of the public.”

The review couldn’t come at a better time. A recent survey shows that many people consider the cost of surgery far more important than the qualifications of the person wielding the knife. When 1,762 were asked about getting ‘work’ done – not just breast enlargement but anything from a nose job to a facelift, eyelid lift, liposuction or even non-surgical procedures such as Botox – two thirds said they would consider cost as a factor. However, only half of those questioned said they would take the qualifications of their practitioner into consideration, and fewer than half were concerned about the quality of their aftercare.

It also indicated that the problems with PIP implants had put many women off surgery in the first place, with 45 per cent of those who might have considered it before saying they had changed their minds. This compares to 24 per cent of men.

“The recent problems with PIP breast implants have shone a light on the cosmetic surgery industry,” says Professor Sir Bruce Keogh, the NHS medical director leading the review.

“Many questions have been raised – particularly around the regulation of clinics, whether all practitioners are adequately qualified, how well people are advised when money is changing hands, aggressive marketing techniques and what protection is available when things go wrong.

“I am concerned that too many people do not realise how serious cosmetic surgery is and do not consider the life-long implications – and potential complications – it can have.”

He has called on all those who have had a cosmetic procedure, particularly those who have had a bad experience, to get in touch. His recommendations are expected to be presented to the government by March next year.

But could the changes lead to an increase in cost and, as a result, more people going abroad for sub-standard work? “I don’t think prices will go up,” says Stewart, “I think they will stay the same. There’s currently plenty of well-qualified plastic surgeons and plenty of internal competition between them.

“I’m not suggesting for one minute that plastic surgeons should be the only ones allowed to carry out cosmetic procedures,” he adds. “All we’re asking for is that people who do cosmetic procedures are suitably qualified to do so and haven’t just been on a weekend course.”

As for those tempted to go overseas, he says, “My colleagues and I see a lot of them coming back with complications. Not all of them, but there are significant numbers. I would hope the regulations will improve the quality of care so that people will realise the benefits of staying here, in safe hands.”

The PIP implants were a very different thing altogether, he continues. “That was a criminal action on the part of a manufacturer. Also, reputable surgeons used PIP implants completely oblivious to the grade of silicone that had been used. Equally, it was the reputable end of the market that first spotted the complications and stopped using the implants early on, whereas other, less reputable, providers continued using them until they had no other choice.”

But in a crowded market, how can you be sure your surgeon is at the better end? “Go to your GP and ask who the most reputable plastic surgeons in town are,” says Stewart. “You can go to the British Association of Aesthetic Plastic Surgeons website (www.baaps.org.uk). It has very high ethical and audit standards. If people come to see me, I often show them photographs of previous work. If they ask, I’ll try to put them in touch with previous patients. A lot of people go online,” he adds, “but you have to be very careful what you do on the internet.”

On the other hand, how do you spot a bad one? “You want to make sure your care provider has a good track record for doing that type of operation,” says Stewart. “Ask if they used PIP implants and, if so, did they treat all the patients for free when they had problems. If the answer is no, I wouldn’t have treatment from them.”

• To add your voice to the review, log on to www.dh.gov.uk/publichealth