Comment: Regulating cosmetic surgery will stop the butchers
By Ann Clwyd MP
“I think the operating table was a dental chair," someone wrote to me recently, describing their experience of liposculpture in a London clinic.
"They asked me to turn over onto my stomach, but the chair was the wrong shape and it was very difficult. At some stage during the operation I woke up. I was in tremendous pain and began screaming. They were still taking fat from my legs. The doctor told me afterwards that he had to continue with me awake or my legs would have been uneven.”
It turned out subsequently that the ‘cosmetic surgeon’ was a general practitioner. He had performed a surgical operation without any surgical training and had administered a general anaesthetic without an anaesthetist.
I also read recently about a children’s writer. She has been left with blurred vision from botched laser eye surgery at a private clinic. After a five year battle she has finally received £250,000 compensation but has permanent scarring.
Such incidents are too common.
I first introduced a ten-minute bill on the regulation of cosmetic surgery in 1994. That bill generated huge publicity and hundreds of letters. The issue of breast implants has received even more attention of late following the PIP implant scandal in 2010/2011.
Unfortunately, despite calls from a wide range of organisations, not much has changed since the mid-1990s. As a result, thousands of women have continued to face the horrific consequences of unregulated cosmetic surgery.
At some time in our lives, most of us have wanted to change something about ourselves. Huge pressure is put on women in particular, but increasingly on men, too, to change their looks.
Private sector clinics offer a multitude of cosmetic procedures to achieve the perfect shape and wrinkle-free face. “Too thin, too fat, never just right”, that’s the message. Cosmetic surgery, including breast implants, continues to be a growing industry.
In 2011, members of the British Association of Aesthetic Plastic Surgeons (BAAPS) conducted almost 45,000 surgical procedures, over 10,000 of which were breast enlargements for women. Between 2002 and 2011, the number of boob jobs rose by 324% and is continuing to increase. As are facelifts, tummy tucks, and nose jobs.
They also operated on over 4,000 men, with nose jobs and man-boob jobs the two most popular procedures. This is an increase of 219% in cosmetic surgery for men since 2002. This does not include procedures carried out by people who are not members of the association; those undertaken abroad; or those not yet classified as a cosmetic procedure.
Many people face exploitation by private sector clinics and even cowboy surgeons, if they are unable to receive treatment through the NHS. Most of the botched surgery or mistakes are then rectified by the NHS, as we have seen with the removal of PIP implants.
“In no other area of medicine is there such an unregulated mess. Imagine a ‘2-for-1’ advert for general surgery? That way lies madness," said the previous president of the British Association of Aesthetic Plastic Surgeons, Nigel Mercer, in 2009.
There are a number of areas of regulation needed to reduce the risk to patients:
An Implant Register – In 1998, the then government accepted the recommendation of an independent review body on silicon breast implants to establish a national breast implant registry. I was part of that process and took part in several meetings at the Department of Health. But the register was abandoned in 2006.
I propose that we now need a register for all types of implants, used in all areas of the body, including breasts, cheeks, pecs and buttocks. This would allow better monitoring of outcomes and problems as they occur, which would have been very useful in the recent PIP cases.
Advertising – Many clinics gain much of their business from advertising in national newspapers and women's magazines. They ask: “Is cosmetic surgery only for the rich and famous?” And answer: “Not any more, it is a lifestyle choice!”
Some offer significant discounts and there are even special deals on websites.
In the Daily Mail recently there was a piece headed, “Plastic surgeons offer ‘buy one get one free’ deals on breast enlargements and nose jobs.”
Private clinics are now also advertising via Twitter – one even suggested women add a ‘boobjob’ to their Christmas present list.
Misleading images and claims are used, despite tighter guidelines, by the Advertising Standards Authority.
Therefore, a ban on cosmetic surgery advertising should be introduced, as happened in France in 2005 and as called for by the British Association of Aesthetic Plastic Surgeons.
If cosmetic surgery is considered to be a form of medical procedure, which it undoubtedly is, then it should not be advertised, as is the case with prescription medicines.
Non-surgical procedures – A further issue of concern is non-surgical cosmetic procedures. Injected fillers like botox currently only need a CE mark, such as for fridges and they are therefore heavily marketed in the UK. While in the USA, the FDA categorises them as medical device implants requiring approval.
The medical profession has always been controlled and regulated by strict ethics. But the voluntary codes of practice have been breached by some operators to make quick, easy money.
Register of practitioners – We also need compulsory registration of all those who practice aesthetic medicine and use lasers.
Similarly, only doctors or nurses who are qualified to do so should be able to advise patients about cosmetic surgery. At the moment, initial consultations can be undertaken by a hard-sell receptionist, and doctors in private practice who do not have specific experience are able to offer treatment for which they are not qualified.
Facilities should also be licensed and regulated by an independent body, such as the Care Quality Commission.
An independent review found that 70% of clinics in the private cosmetic sector are effectively unregulated and less than half (44%) of operating theatres were properly equipped in 2010.
OffCos – Given all of the issues and lack of regulation in the area of cosmetic surgery, it would seem imperative to establish an official regulator of cosmetic surgery, OffCos, as proposed by the British Association of Aesthetic Plastic Surgeons to ensure registration and regulation of all cosmetic surgeons and practitioners in the UK.
Or perhaps we should consider a cosmetic surgery licensing body with a different type of structure and operating as a financial guarantee scheme, such as ATOL, which provides financial protection for flights and air holiday packages.
The problem has been swept under the carpet for far too long, and it has now been almost 20 years since I first called for greater regulation of private cosmetic surgery. The current system of self-regulation, largely by the private surgeons and clinics themselves, is clearly not working.
It is a complex subject, but too many people are suffering and being disfigured at the hands of cowboys, who have been given a free rein to abuse the British public's trust in the voluntary system of medical ethics.
"The public has been misled and cheated for too long by practitioners falsely claiming to be surgeons, without having the training and qualifications required," said the president of the British Association of Aesthetic Plastic Surgeons, Mr Fazel Fatah.
"The issue is at the very centre of patient protection and the public deserve the peace of mind that doctors who carry out surgery are qualified and trained for that purpose."
The responsibility clearly lies with the government to take action as soon as possible to stop any more innocent people being subjected to this butchery at the hands of some greedy, unscrupulous, and incompetent people and to introduce the kind of regulation for cosmetic surgery that is long overdue.
Anne Clwyd is the Labour MP for Cynon Valley
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