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Cosmetic surgery patients at more risk than ever

A special edition of the journal, Clinical Risk, published today by the Royal Society of Medicine, looks at how the combination of an under-regulated market, “professional greed”, increased marketing and overwhelming media hype have created a “perfect storm” that threatens patients and practitioners alike. The journal’s editor argues that cosmetic surgery patients in the UK are at more risk than ever before.

Dr Harvey Marcovitch, who commissioned leading experts in the field to write for this special issue said, “Patient safety is this journal’s main aim and there can be no area of medicine where patients in the UK are more in need of protection. We need tight control of advertising of cosmetic surgery – including internet advertising. We need proper regulation of the industry and we need both surgeons and GPs to manage patient expectation.”

In one paper, entitled ‘Clinical Risk in Aesthetic Surgery’, Nigel Mercer, consultant plastic surgeon and President of the British Association of Aesthetic Plastic Surgeons (BAAPS) argues: “We have reached a stage where public expectation, driven by media hype and, dare one say, professional greed, has brought us to a ‘perfect storm’ in the cosmetic surgical market.”

He adds, “There has been a massive increase in ‘marketing’, including discount vouchers, 2-for-1 offers and holidays with surgery! In no other area of medicine is there such an unregulated mess. What is worse is that national governments would not allow it to happen in other areas of medicine. Imagine a ‘2-for-1’ advert for general surgery? That way lies madness!”


Clinical Risk in Aesthetic Surgery:

Nigel Mercer discusses the role of the media and advertising and calls for tighter regulations in the UK, comparing this country’s lack of regulation with the Food and Drug Administration’s role in the US.

Key quotes:

“Perhaps, like tobacco, there should be a Europe-wide ban on advertising all cosmetic ‘surgical’ procedures, including on search engines…”.

“If we have to sell anything, we should sell our advice, not procedures. If we cannot self-regulate, then, like the financial institutions, regulation will eventually be imposed…”

“All cosmetic treatments are medical interventions, and every medical intervention has a complication and failure rate. Consequently, there are no ‘consumers’ or ‘clients’ but only ‘patients’…”

“Perhaps the single most important factor in reducing clinical risk in cosmetic surgery is the motive for performing any procedure must never be financial gain, so I suggest we get our act together as an industry as we are in grave danger of biting the hand that feeds us.”

France Sets Standards for Practice of Aesthetic Surgery:

French consultant plastic surgeon, Alain Fogli describes the strictly defined guidelines for cosmetic surgery in France which include:

Surgical procedures can only be undertaken by surgeons who are registered specialists and deemed competent. Possession of a general medical degree, and the fact that the practitioner is ‘experienced’ are not deemed to be sufficient qualifications

A ban on all forms and methods of publicity and advertising, direct or indirect, in whatever form, including the Internet

Minimizing Risk in Aesthetic Surgery:

Foad Nahai, President of the International Society of Aesthetic Plastic Surgeons (ISAPS) and former president of the American Society of Aesthetic Plastic Surgeons (ASAPS) describes how to minimise risk in each facet of ‘the safety diamond’: patient, facility, procedure and surgeon.

He tells readers:

“Regulations governing the training of all cosmetic surgeons are sorely needed. Governments are reluctant to become involved, as they see this issue as a ‘turf battle’ between various physician groups and not a public safety or patient safety issue. However, there is no question that this is a patient safety issue of paramount importance and I take our governments to task for not addressing it.”

Since by law any physician is allowed to practise cosmetic surgery, attempts by individual physicians or plastic surgery organisations to restrict those who are not qualified is viewed as a restraint of trade.

Improving the Safety of Aesthetic Surgery: Recommendations Following a 14-Year Review of Cases to the Medical Defence Union (1990-2004):

Consultant plastic surgeon and BAAPS Secretary, Rajiv Grover, reveals a 14-year audit of claims to the MDU which shows why patients sue.  He provides recommendations to avoid these situations such as careful pre-operative counselling, thorough documentation and exploring with the patient what degree of correction and scarring is realistic – and not being falsely optimistic about the likely outcome.

Managing Risk to Reputation:

Magnus Boyd, Partner at leading UK solicitors, Carter-Ruck suggests how doctors can protect their reputation and how the media can influence the outcome of a professional investigation or the expression of anger from a disgruntled patient.

Clinical Risk

The journal Clinical Risk aims to give both medical and legal professionals an enhanced understanding of key medico-legal issues relating to risk management and patient safety, through authoritative articles, reviews and news on the management of clinical risk. The AvMA Medical and Legal Journal and the Healthcare & Law Digest, both included within Clinical Risk, contain articles on current medico-legal issues and reports on a wide range of recently settled clinical negligence cases.

About the BAAPS

The BAAPS (, based at the Royal College of Surgeons, is a not-for-profit organisation, established for the advancement of education and practice of Aesthetic Plastic Surgery for public benefit. Members undergo thorough background screening before they can join. Information about specific procedures and surgeons’ contact details can be found on the web site, or by contacting their advice line at 020 7405 2234. Further materials can be posted to members of the public seeking specialised information.

Published on: November 16, 2009

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