Nip and tuck

Cosmetic Surgery Live, the secret world of the scalpel has been opened up, so to speak, to ordinary men and women. The work of the NHS is largely limited to reconstruction and corrective post-surgery procedures (for instance, after a mastectomy), or congenital malformation. Other cosmetic surgery such as breast reduction or rhinoplasty is only funded if there is a proven profound psychological or physical problem, which means that 75,000 patients willingly pay for private surgery every year.

A survey carried out by the financial group Abbey found 60 per cent of women in the UK have thought about having cosmetic surgery, with breast surgery, at an average cost of 5,750, the procedure most commonly considered. But who are the specialists working in Scotland and what are their particular areas of expertise? What do they think of the rising prevalence of cosmetic surgery? And how should you go about choosing a surgeon?

Name: Maurizio and Roberto Viel

Age: 45, Roberto is younger by ten minutes

Practise at: The Consulting Rooms, 14 Moray Place, Edinburgh, EH3 6DT, 0131-225 8059, every second Wednesday; London Centre for Aesthetic Surgery, 15 Harley Street, London, W1G 9QQ, 020 7636 4272, www.LCAS.com

Qualifications: State Exam 1984 Milan, American Academy of Cosmetic Surgery, British Association of Cosmetic Surgeons, Societa Italiana di Chirurgia Estetica, Societa Italiana di Chirurgia Maxillo-facciale, International Academy of Aesthetic Surgery and Aesthetic Medicine, Sociedad Argentina de Lipoplastia, Honorary Member Royal Society of Medicine, American Academy of Anti-ageing Medicine, International Academy of Cosmetic Surgery

TWINS Roberto and Maurizio Viel established the London Centre for Aesthetic Surgery in 1990 where, among the usual range of nip, tuck and breast augmentation work, they have pioneered ultrasound LipoSelection (where a Vaser machine liquefies the fat cells before removal), and penoplasty (extension or enlargement of the penis, using fat from the abdomen or thigh).

The twins are identical, but Maurizio has had cosmetic work performed on his face, courtesy of his brother. "I have had fat injection to my cheeks, Botox, and the tip of my nose done. I think I look better and younger than him. I keep telling him that he needs Botox too."

Maurizio sees his treatment as fundamental to his work in the cosmetic surgery field. "We are dealing with beauty and aesthetics. If I was a patient and went to a surgeon who wasn’t taking care of himself I would ask: how can he take care of me?"

Brought up in Milan, the twins say their opera singer mother gifted their aesthetic sensibilities. They went on to train together at Milan University medical school, graduated on the same day and did the same residency and training. "We usually work apart but sometimes need to work together for a big breast reduction," says Maurizio.

The most popular procedures at their practice are Botox and liposuction, followed by breast augmentation, facial rejuvenation and penoplasty.

"Penoplasty is running quickly to the top for men. But of course, that’s an operation they don’t talk about," says Roberto.

With people following the example of celebrities, isn’t there a danger of everyone looking the same, with all of the men having Kevin Costner’s nose and the women J-Lo’s bottom? "No," says Roberto, "You use both your surgical knowledge but also look with an eye for beauty and that makes the result different from patient to patient, surgeon to surgeon. You must leave some natural look to the face or body so they don’t look plastic. Anyone can be a good technician but not everyone will have the gift or the proper sense of beauty."

The Viel brothers now take it in turns to see patients north of the Border at consulting rooms in Edinburgh once a fortnight. "We have a lot of clients coming from Scotland and the North of England to London, so we decided to do the consultations and aftercare in Edinburgh, although the procedures are still carried out in London," says Maurizio.

The surgeons have witnessed an increase of around 20 per cent at their Harley Street clinic in the last year. "Patients know what they can achieve because it’s a popular subject in the media and there’s no stigma or embarrassment. We want to look better, dress better, keep fit and look younger. It’s also more affordable as high street banks will give loans for it. Plus it’s less invasive, safer and less traumatic today," says Roberto.

Some of their most satisfied customers are the recipients of penoplasty. "We have been doing this operation since 1991 and it works well to help men overcome ‘locker room’ syndrome where they are embarrassed to undress in front of others because of the size of their penis. There are some men who are average size but want more, but the majority are of below average size. It doesn’t help lengthen the penis when it’s erect, but it does enlarge and thicken it so it has more girth and that applies also when it’s erect, so it will increase performance too," says Maurizio.

"A lot of people are not happy with themselves because there is a discrepancy between how they feel inside and how they look because of the way they are ageing. We put them more in tune with what is inside. We help them achieve a harmony," says Roberto.

Name: Kenneth Stewart

Age: 37

Specialist in Cosmetic Surgery, Plastic and Reconstructive Surgery

Practises at: BUPA Murrayfield Hospital, Edinburgh, also at the following NHS hospitals: St John’s, Livingston, The Royal Hospital for Sick Children, Edinburgh, Raigmore Hospital, Inverness

Qualifications: MBCHB 1990 Aberdeen, FRCS (Plast), BAPS and BAAPS member

KENNETH Stewart was invited to go on the recent Five programme Cosmetic Surgery Live, hosted by Vanessa Feltz, where the likes of Neil and Christine Hamilton and busty glamour models had their faces and careers rejuvenated live on air. He refused.

"They asked me but I have concerns about plastic surgery on the TV because it’s not like getting your garden made over or your front room done. TV tends to trivialise it and also I don’t agree with a financial incentive for people to have surgery," he says.

In common with his colleagues, Stewart finds that demand is increasing. Breast augmentation, breast reduction and tummy tucks are the operations he performs most in his private work. "I think it’s because we live in increasingly affluent times and it’s an inevitable reflection of a consumer society. You hear people moralising about it, but it’s neither good nor bad. A small procedure can transform someone’s life."

Stewart also says that changes in technique, which reduce pain and recovery time, have boosted demand. "Techniques are evolving which are less invasive, for example a brow lift used to involve a cut from ear to ear, but now it is done endoscopically. This leads to quicker recovery times and makes it more attractive," he says.

In common with his patients, Stewart has had surgery himself - to fix his nose, which he damaged playing football. "I couldn’t breath through it. But I don’t envisage having more surgery and I think I’m typical. Most patients have one thing that’s concerning them and don’t tend to come back for more," he says.

Stewart has worked in Toronto, Sydney and the capital of the surgery world, California, but is quick to point out that not all innovations in the field are US-led. "The breast uplift was invented by a Belgian and the face lift was developed in Europe. There have been many procedures developed by British surgeons, so the UK is not a backwater by any means," he says.

Mark Butterworth puts the increase in surgery down to changes in society. "TV shows ordinary people having cosmetic surgery whereas only a few years ago it was perceived as something only the rich and famous had," he says. He also says a drop in scare stories about silicon implants has led to an increase in people opting for augmentation. "The scientific evidence is that silicon is safe," he says.

Breast augmentation is the operation Butterworth performs most regularly and his average patient is a woman who has completed her family and, far from wanting to launch a career as a glamour model, just wants to regain her pre-pregnancy figure.

"Some women change dramatically with children and it’s entirely acceptable to want to be what they were like before. The level at which they’re getting things fixed, people passing them in the street wouldn’t notice."

It’s not only young mothers opting for surgery; increasing numbers in the banking and business sectors, worried about fresh-faced young things breathing down their necks, are interested. "People who want promotion at their bank or financial company feel they have to look young and it’s common for them to come for surgery," says Butterworth.

Cultural differences also play a part and what is normal on Princes Street is a far cry from Fifth Avenue. "The implants used here are perhaps half the size of those used in Texas or New York and there is a very American nose - a tiny little button with a ski ramp tip. Scottish women don’t want that, they just want a nose in proportion with their face. If they are having a face lift they say, ‘I don’t want to look like the Bride of Wildenstein’ [Jocelyn Wildenstein, the American socialite, is alleged to have spent 2 million on surgery and was recently named the world’s scariest celebrity by a plastic surgery website]. In Miami, with its large Hispanic population, women want fat injections in their backsides, whereas Edinburgh ladies do not want their bottoms any bigger - it’s just not something I find myself doing," he says.

Name: Awf Quaba

Age: 54

Specialist in Cosmetic Surgery, Plastic and

Reconstructive Surgery

Practises at: BUPA Murrayfield, and for the NHS at

St John’s Hospital, Livingston and The Royal Hospital for Sick Children, Edinburgh

Qualifications: MBCHB, FRCS (Plast)

Member of BAPS and BAAPS

Awf Quaba is the Iraqi-born surgeon reconstructing the face, neck, upper chest and hands of Hannan Shihab, the 16-year-old girl injured in an air strike on Baghdad last year. He has already performed two of what will be a complex series of operations since she was brought to Scotland.

How does Quaba feel about treating an Iraqi teenager disfigured by war at the same time as a Morningside matron who fancies a facelift? "It’s part of a spectrum that ranges from the necessary to luxury. I find it challenging to remove ugly thread veins from the legs of a lady one day and the following day to be fixing a smashed leg from a car crash. The thing about cosmetic surgery is the end point is happiness," he says.

His specialities are breast and facial/aesthetic surgery - "I have been doing them for such a long time I feel I get good results," he says, but he turns away 30 to 40 per cent of the requests. "I refuse operations I don’t feel comfortable doing, such as sex change procedures, or if I feel I can’t solve a problem - not every face can be rejuvenated and not every nose changed. There may be serious medical problems, an operation may not be technically feasible or the deformity minimal and there are some patients with dysmorphic syndrome whom you can’t help," he says.

In the 26 years since he arrived in the UK, Quaba has witnessed a change in attitudes and recently noticed an increase in men coming for procedures such as pectoral sculpting and younger people wanting liposuction. "These are the people who have seen it on TV." And while he does not condone nip-and-tell programmes, he admits he would watch it himself if he had time, "because my patients watch it and it would help in advising them".

As a left-handed surgeon, Quaba suggests left-handed people excel at artistic endeavours. "I wanted to be an architect, but circumstances in Iraq meant I couldn’t so I chose medicine. They both require an ability to think in three dimensions," he says.

n Donations for the Hannan Charitable Fund, Balfour & Manson Solicitors, 54-66 Frederick Street, Edinburgh.

Name: Annabel Bentley

Age: 33

Qualifications: Trained at King’s College London University medical school (MBBS) then trained as a surgeon (FRCS). She has experience in general, cardiothoracic, orthopaedic and plastic surgery.

Position: BUPA’s assistant medical director responsible for health information across the BUPA group. She also provides medical advice and support to HealthLine, the 24-hour BUPA nurse telephone helpline, as well as liaising with the media on current medical and consumer health issues.

Annabel Bentley is well placed to account for the rise in figures for cosmetic surgery and puts it down to greater press and TV coverage, increased access to hospitals and surgery, wider acceptability and affordability, and advances in technique with shorter recovery times.

"People’s attitudes have changed. In the past there were a lot of secret face lifts being carried out but now society is more open. Also the focus on celebrity surgery affects how ordinary people perceive their looks," she says.

She credits the general population with the ability to tell the difference between entertainment and reality television. "Most viewers are sophisticated and can work out the difference - they know hospitals aren’t really like ER or Casualty. Any policemen will tell you The Bill is not like real life," she says.

Like others working in the field, Bentley emphasises the need for realistic expectations. "People should not be fooled by celebrity magazines. Anybody could look that good if they put in that much time and effort, had a stylist, photographer and make-up artist, and often the pictures are touched up anyway."

For Bentley it is crucial that surgeons point out what is achievable. "They should also explain the benefits, side effects and complications. There is a tiny risk of dying under general anaesthetic, a five in a million chance, but people need to be aware of it," she says.

Given the risks, Bentley says people must seek out only qualified surgeons. "Patients who come along to BUPA are only seen by consultant surgeons who are specialists in their area. Most cosmetic surgeons will have trained with the NHS as plastic surgeons. The best advice, as with any serious decision, is do your research properly," she says.

She would always advise that people think long and hard before embarking on surgery. "If you are unhappy with your home life, relationship or job, having a facelift won’t give you the perfect life."

The facts about figures

What it costs

BUPA

Breast enlargement from 3,400

Breast reduction from 3,750

Ear pinning from 1,650

Eyelid surgery (lower lids) from 1,900

Eyelid surgery (upper lids) from 1,600

Eyelid surgery (upper and lower lids) from 2,850

Facelift from 4,300 to 6,000

Facelift (mini) from 2,600

Liposuction 1,800 to 4,500

Nose reshaping from 3,100

Tummy tuck from 3,900

Anti-wrinkle treatment from 250

Filler injections (eg collagen) from 250

Removal of mole from 250

Thread vein treatment from 150

These prices cover the cost of the operation, consultants’ fees, nursing care, accommodation, physiotherapy, medication and one follow-up appointment.

BMI HEALTHCARE

Each patient is assessed on an individual basis. Contact Ross Hall Hospital, Glasgow for information, 0141-303 4868.

How to CHOOSE a surgeon

While most operations are performed to high standards by fully qualified consultants, some are not. In the past 13 years, more than 7 million has been paid out in compensation for cosmetic surgery mistakes. Any doctor can claim to be a plastic surgeon, so it is best to consider the following advice.

Ask your GP who they send people to or contact the British Association of Aesthetic Plastic Surgeons (BAAPS) for a list of their members.

Ask friends who have had cosmetic surgery to recommend someone but remember, different surgeons have different specialities.

Ask private hospitals and clinics for information on the surgeons available.

When you have a first consultation ask for a surgeon’s qualifications. Check he/she is on the General Medical Council’s specialist register. Visit www.gmc-uk.orgor phone the GMC helpline on 0945 357 3456. GPs will only refer to someone who is on this register. Check whether they have just FRCS, which all surgeons have, or if they have FRCS (Plast), which is a further qualification in plastic surgery. Also check the registration details of a hospital or clinic on the Scottish Commission for the Regulation of Care website.

At the initial consultation ask what a surgeon’s specialities are and to see their "book" of photographs of similar operations they have performed. Ask how long they have been performing the procedure you want, how many operations they performed in the last year and if any of their patients needed further corrective surgery. Ask if you can speak to some of your surgeon’s previous patients. If you are having a general anaesthetic ask who the anaesthetist will be and check on them with the GMC.

Be clear about what you want to achieve and ask about realistic results, associated risks, side effects, complications and recovery time. You should be given written details of these to study at home.

Ask what is included in the price for before, during and after treatment, eg blood tests and x-rays, surgeon’s fees, charges for accommodation, the cost of care if you need to stay longer, treatment of complications and cancellation charges.

Ask what back-up facilities and staff are in place for cosmetic surgery operations.

You don’t need to make an immediate decision. Discuss it with friends, seek further medical opinions and if you decide to go ahead, allow at least two weeks between the consultation and the operation date.

USEFUL CONTACTS

Nursing and Midwifery Council, 020 7333 9333, www.nmc-uk.org

British Association of Aesthetic and Plastic Surgeons (BAAPS), www.baaps.org.uk

British Association of Plastic Surgeons (BAPS), 020 7831 5161, www.baps.co.uk

Scottish Commission for the Regulation of Care, 01382 207 100, www.carecommission.com