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Tuesday, June 22, 1999 Published at 23:57 GMT 00:57 UK


Plastic surgery benefits 'underestimated'

Not all surgery is freely available on the NHS

Health authorities in the UK could be underestimating the benefits of cosmetic treatments, according to researchers.

A team, led by Professor Ray Fitzpatrick, of Nuffield College, concluded that many patients did receive health benefits from cosmetic surgery.

But they say the prevailing opinion is that plastic surgery and operations to reduce breast size have little real health benefit and demand for them is based on vanity.

Many health authorities routinely restrict the availability of such treatments on the NHS, while others have an outright ban on them.

But Prof Fitzpatrick's study suggests that such procedures have definite benefits for both physical and mental health.

It also reveals potential flaws in the methods health authorities use to evaluate the clinical value of certain treatments.

Difference of opinion

Prof Fitzpatrick told BBC News Online that both the public and the health service would have to re-evaluate their attitudes towards cosmetic surgery in the light of his findings.

"For many patients receiving cosmetic surgery the benefits, in terms of health and quality of life, were very substantial and from that we concluded that one should not think of this as a purely cosmetic procedure," he said.

"For example, for women who had breast reduction surgery, it became apparent to us that they were not having it for purely cosmetic reasons.

"It considerably reduced pain and discomfort and significantly improved quality of life."

Prof Fitzpatrick said he objected to the blanket bans imposed by some health authorites, because they ignored the needs of individual patients.

Flaws in quality score

The study, to be published in the Journal of Epidemiology and Community Health, examined two evaluation techniques called SF-36 and EQ-5D.

Both aim to establish how much a patient benefits from a certain treatment.

SF-36 looks at 36 factors such as alleviation of pain and the impact on mental health.

The second, which Prof Fitzpatrick is more widely used by health authorites when deciding to fund a treatment, looks at five similar areas.

Using the EQ-5D, 71 of the 198 patients questioned showed no change in their well-being.

But the same patients all reported significant improvements in physical and mental performance using the SF-36 test.

Professor Fitzpatrick said this could be worrying considering more health authorities rely on the EQ-5D.

"There needs to be a shift of perception, that cosmetic surgery is a health procedure, and then the right method has to be used to decide what is the most appropriate treatment," he said.

Balancing act

The NHS Confederation, which represents health authorities and hospital trusts, referred to the recent publication of an Audit Commission report that called on health authorities to control their spending better.

At the time of publication, the confederation warned that some treatments were already being cut as a result of tighter budgets.

A spokeswoman said that deciding which treatments should be available was a balancing act.

She said: "Cosmetic surgery may well fall into one of those difficult choices."

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