BBC News Health Reporter
Plastic surgery aimed at making people look more beautiful could end up leaving them scarred and deformed, unless they do their homework properly, surgeons are warning.
Surgeons must be carefully vetted
The British Association of Aesthetic Plastic Surgeons (BAAPS) has produced a series of guidelines warning people contemplating cosmetic surgery to take their time and go to reputable and approved surgeons.
Simon Withey, consultant plastic surgeon, and member of BAAPS, said he is regularly called upon to try to repair botched surgery.
"Every day we will see people who have had problems from operations. In some cases you can do revisional surgery, but in some cases they are scarred for life."
"Someone I saw went to a clinic in Eastern Europe. She wanted an operation on her eyelid to tighten it up. She chose her surgeon very carefully and got a professor of ocular surgery.
"But when I saw her she had a scar halfway up the lid and cheek. It brought the lower lid down and the whites of her eyes were showing. It was hideous.
"Her eyelid will not close properly and she is at risk of scarring to the eye.
"She can't afford to have the restoration work done privately, so I am having to do it on the NHS."
Mr Withey said another patient had liposuction on her legs in South Africa. Her surgery was so radical that her legs were left badly dimpled and in need of more fat to fill them out.
"She has already had two operations, but her legs will never be right again," he said.
Another had a UK operation on her nose, but Mr Withey said she suffered great skin loss and her nose had been left badly deformed.
"We can always improve it, but it will never be anywhere as nice as her original nose. It will always be scarred."
Mr Withey, a member of the London Plastic Surgery Association, said patients must ensure they are fully aware of the risks of surgery before agreeing to it.
"Most of us who care for our patients will spend two or three sessions of 45 minutes each time going through what their expectations are.
Simon Withey says patients must get information
"Those people going abroad do not get that. They meet a sales person in the UK telling them how much it will cost and how long they will be in South Africa etc, but they do not get anyone talking to them about the risk.
"Plastic surgery is not formulaic, every patient is different."
He said it was in the plastic surgeon's interest, as well as the patient's, to ensure they were fully aware of any potential problems.
Make your own decisions
Know your surgeon
Get the timing right
Beware of 'free consultations'
Think about location
Talk to your GP
You can always change your mind
Take your time
"It is relatively low risk. You are not going to offer high- risk surgery for something which is going to make you more beautiful, but if you choose your patient badly or combine your treatments badly, you can have a disaster."
He said some patients, such as heavy smokers, were often not suitable for surgery as it affected the way their scars healed and that any reputable surgeon would take this into account before agreeing to operate.
Mr Withey said surgeons must be prepared to spend time with their patients before and after the operations to ensure they are happy and that they would not agree to operate on patients without an agreed "cool-off period".
"Most of us are very wary about operating on the wrong people, such as those in a fragile state of mind.
"These guidelines are a way of saying to people that this is the way that surgeons should behave."
The guidelines advise researching the background and experience of a chosen surgeon, being aware of any risks and possible side-effects and having a realistic idea of what can and cannot be achieved.
Adam Searle, consultant plastic surgeon and president of BAAPS, said consumers needed to make educated decisions about any treatments.
"There is a real need for patients to take responsibility when choosing a surgeon and to ask the right questions.
"There are many potential sources for cosmetic plastic surgery information, but not all are equally credible."
Mark Henley, consultant plastic surgeon and BAAPS member, agreed, saying: "Cosmetic surgery undertaken in appropriate circumstances is very positive and can be life-changing in a highly beneficial way.
"However, if things are not right then it is likely to be at least unsatisfactory and, at worst, disastrous for all concerned."
BAAPS is a not-for-profit organisation established at the Royal College of Surgeons for the advancement of education and practice of Aesthetic Plastic Surgery for public benefit. All members are vetted before joining.