Page last updated at 06:00 GMT, Wednesday, 3 February 2010

Dangers of 'lax' cosmetic surgery rules

Mr Nigel Mercer
VIEWPOINT
Nigel Mercer
British Association of Aesthetic Plastic Surgeons President

Cosmetic Surgery. Cristina Pedrazzini/SPL
Always check out your surgeon

Cosmetic surgery is growing in popularity with the British Association of Aesthetic Plastic Surgeons alone carrying out more than 36,000 procedures last year.

But in this week's Scrubbing Up, top cosmetic surgeon Nigel Mercer, says unqualified practitioners are taking advantage of 'lax' rules and explains why regulation is vital.

The cosmetic industry is a branch of medicine and, as such, should not just be about making money.

We are speaking about people's lives and people do die from cosmetic interventions.

There is a campaign by the British Association of Aesthetic Plastic Surgeons (BAAPS) to bring an end to the "un-regulated mess" in the market in surgical and non-surgical procedures and it will continue.

Regulation needed

BAAPS has a code of conduct for members, which is policed rigorously.

Members must submit their audit figures and we do our utmost to practice what we preach.

An example of the urgent need for enforceable regulation comes from the IHAS newsletter this month, which states that podiatrists, physiotherapists and veterinary surgeons have enquired about injecting botulism toxin for cosmetic reasons!

The GMC (General Medical Council) and the CQC (Care Quality Commission) together regulate doctors and hospitals/premises where the treatments are performed, but there is no regulatory body for businesses involved in the 'industry'.

The IHAS (Independent Healthcare Advisory Service) has been speaking to the government and a form of "Joint Regulation" is going to be launched this year.

The IHAS is, however, funded by the businesses involved in the industry and those businesses owe their first loyalty to their shareholders, not to patients.

On the BBC 'The One Show' showed that their code of practice is entirely voluntary and has no teeth.

In the absence of any British law regulating who can do what, and where, BAAPS has been calling for an official regulator (OffCos) to be set up, which does have teeth.

Safeguarding patients

In contrast to the UK, there are laws that limit who can do what, to whom and where in France and Denmark and the same is likely to happen in Mexico and Spain, yet still the British government shies clear of improving regulation to safeguard patients.

Some of the press releases and web sites almost seem to deify surgeons

There is a British Potato Council so why not an OffCos? Surgeons can do more harm than potatoes!

An example of the urgent need for enforceable regulation comes from the IHAS newsletter this month, which states that podiatrists, physiotherapists and veterinary surgeons have enquired about injecting botulism toxin for cosmetic reasons!

This is madness.

The public must also beware the marketing that goes on in the cosmetic industry and the outrageous claims that can be made by the PR machines of some businesses and some surgeons.

A ban on advertising would be practically impossible, but regulation is eminently feasible.

"Two for One", time limited offers and non-refundable deposits put pressure on patients to embark in haste on a course that they may regret.

Those involved may say that the patient has been thinking about the procedure for some time, but it is often the consultation with the surgeon that gives the patient the information on which they make their decision.

There should be no time pressure put on making that decision.

In fact, the GMC states that the patient must have a two week cooling off period to think it over.

Such offers are pure marketing, designed to attract market share and so are immoral in any branch of medicine.

Check qualifications

We are not selling groceries!

It should be made illegal to put offers like this in any marketing or on any web site (and web sites are marketing!), in the same way that it is illegal to advertise prescription medicines in the UK.

Doctors should sell advice not operations and must practice what they preach

Some of the press releases and web sites almost seem to deify surgeons.

Rest assured, there are no "super surgeons" and it makes me angry to think that the public are being sold an impression that may not be completely correct.

The message to any prospective patient is 'to do your homework'.

It takes two clicks to check your cosmetic surgeon's qualifications on the Internet (http://www.baaps.org.uk/ and http://www.gmc-uk.org/).

Any surgeon performing cosmetic surgery should be on the Specialist Register of the GMC, but remember that the UK government refuses to recognize cosmetic surgery as a specialty, although it is the biggest surgical business in the UK and earns the country tens of millions of pounds in revenue.

Surgery marks. Pic:Cristina Pedrazzini/SPL
Patient safety must come first
If a surgeon is not listed on the Specialist Register, they have not received a full surgical training in the United Kingdom, end of story.

Would a woman go to see an untrained, self taught hairdresser by just walking off the street?

So why do the same with a surgeon?

There is no registerable qualification in cosmetic surgery anywhere in Europe or America, and that needs to change.

Update needed

There are no specialties such as 'Facial Plastic Surgery' or 'Cosmetic Surgery'. They do not exist in law.

The cosmetic surgery industry is a child of the 80s and 90s, and the law has not just failed to keep pace with regulation and training, it has been left behind in the middle of the last century.

By and large, if a surgeon has to tell you how good they are… beware!

In addition, in the UK, any one can do any thing to any one else, so long as they do not claim to be something they are not. Yet, in the UK, only a qualified vet can operate on an animal but, as the law stands, your vet could do your facelift so long as you agree to it.

Unfortunately, listing on the specialist register still does not mean expertise and unfortunately, even doctors can be out to make a 'fast buck'. Doctors should sell advice not operations and must practice what they preach.

The safety of the patient must be a doctor's first and foremost consideration. There are safe ways to practice, which should be followed, and the profit motive should not come into the patient safety equation.

So, consider a recent press release about a cosmetic surgeon, which states that the surgeon in question has been responsible for developing many cosmetic surgery procedures.

The GMC states that any information that appears in print about the services a doctor provides must be verifiable, truthful and they must not make claims that they are better than any other practitioner.

Botox.Pic caption:Joti/SPL
Botox - getting rid of lines

Despite this claim, the surgeon's name does not seem to be listed in medical citation databases, or Google, linked to any of the major techniques in use today.

No matter how technically good, a surgeon should not make unverifiable claims, which give the public the clear impression that he/she is better than any other surgeon, as this press release is clearly trying to do.

By and large, if a surgeon has to tell you how good they are… beware! Most of the surgeons I would have operate on me are safe surgeons, well known and respected in the profession, and do not have to crow about it.

They have built excellent practices by the quality of their results.

Whilst they may have a website, they do not have to blow their own trumpet in the outrageous ways I have illustrated.

Are the surgeons who make such outlandish claims not embarrassed by what is put out in their name?

If BAAPS members they would be censured and made to correct their information.

Unfortunately, the only way to regulate surgeons outside the voluntary frame work is to report them to the GMC, and sometimes that is just too late.

We come back again to the need for an industry regulator who can penalise surgeons and businesses who behave unacceptably in the public's and/or the profession's eyes..

'OffCos' and legal recognition for cosmetic surgery as a specialty are needed.




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