The BBC3 programme “Glamour Models, Mum and Me” focuses on the dilemmas facing a 14 year old girl whose mother is a plastic surgery obsessed glamour model. Cosmetic surgery of various types is always in the news, with elective surgery portrayed as almost the norm. Amidst rising concern about the regulation of cosmetic surgery, we look at the (patchy) existing regulation in place and what needs to be done to give it “teeth”.

The National Confi dential Enquiry Into Patient Outcome and Death (NCEPOD) has published a review, “On the face of it”, which highlights the following concerns:

  • In theory, clinics and hospitals which carry out cosmetic surgery within the UK are regulated by the Care Quality Commission (CQC) (or its equivalent in the devolved administrations). In practice, NCEPOD found little evidence of any monitoring of standards.  
  • Insuffi cient experience is posing risks to patient safety. Many clinics offer procedures which are carried out infrequently. As a result, the surgeons carrying out these procedures are unfamiliar with them. More formal training should be required with prescribed levels of competence and accreditation for specifi c procedures.  
  • Whilst surgeons are regulated by the General Medical Council (GMC), this is problematic as the UK does not recognise cosmetic surgery as a speciality in its own right. Cosmetic surgeons are calling for regulation to require surgeons to be registered as specialists in a particular area of cosmetic surgery. This would enable patients to choose an appropriate specialist.  
  • Insuffi cient time or consideration is being given to the emotional consequences of appearance-altering surgery. Psychological assessment may form an important part of the patient’s care but is not routinely offered. This leaves vulnerable patients at risk.  
  • Regulation is required to prevent fi nancial inducements being used to infl uence the process of informed consent.  
  • Better regulation of advertising is needed - patients are lured into risky surgery with unscrupulous advertising and unrealistic promises.  

RPC comment - What next?

  • The industry needs clearer, more robust regulation, and fast, not only to protect the patient but also reputable providers and those insuring medical practitioners. It is likely that this will be introduced, but not in the foreseeable future.  
  • The introduction of clear common standards similar to those in place governing the voluntary members of The British Academy of Cosmetic Practice. The Royal College of Surgeons is establishing a multi-disciplinary group to provide clear standards to the GMC and CQC and is to publish its fi ndings in Summer 2011.
  • Practitioner registration based on a threshold level of experience. This should reduce claim numbers because experienced surgeons make less errors. Greater knowledge of a practitioner’s level of expertise will enable medical malpractice insurers and defence organisations to refi ne underwriting processes so that premiums can be adjusted depending on the area of cosmetic surgery and level of risk.