Managing expectations

Mr Searle highlighted that the outcome of cosmetic surgery is not binary – unlike other types of surgery, there is no objective "good result". So much depends on a patient’s perception and expectation and it is when these are inadequately managed that claims arise. The initial consultation between the patient and the surgeon is crucial in terms of managing the patient’s expectations.

The following challenges exist:

  1. Focus on outcome - people considering cosmetic surgical procedures have a natural tendency to focus on outcome and underplay the risks of surgery. Practitioners must therefore ensure people are managed as patients and not consumers and emphasis is given to explaining the risks of a procedure.
  2. Discounts - patients considering cosmetic surgical procedures are being pressured into agreeing to surgery by being offered discounts. It is important patients are given time to reflect on a procedure.
  3. Psychosocial factors - practitioners are failing to identify psychosocial factors (such as having a procedure to address relationship problems, unrealistic expectations of outcome and dissatisfaction with previous cosmetic surgery) and are proceeding with ill-advised surgical procedures. It is important that practitioners perform face-to-face consultations with all patients themselves. Whilst all British Association of Aesthetic Plastic Surgeons (BAAPS) members do so, there is a serious concern that when a patient attends a consultation with someone other than a surgeon, for example a sales advisor, they risk being misinformed about the surgery they wish to have.

The only way is ethics?

Mr Searle emphasised that claims for clinical negligence arise where there is a mismatch between a surgical result and a patient’s satisfaction. Success depends on the planning of the surgery and it is essential to ensure the patient understands the procedure, risks and likely outcome and that informed consent is obtained. It is important that decision making is not skewed by profit.

The surgeon has an obligation to ensure a patient is suitable for surgery. It is reassuring that BAAPS members turn away one in five potential patients where they deem the procedure to be unsuitable or unnecessary, the patient to have unrealistic expectations for surgery or for medical reasons.

It is important that providers and practitioners take all reasonable steps to ensure that only the right surgery is performed on the right patient by the right surgeon. The initial consultation is critical for this. The following steps should help to both reduce clinical negligence claims and assist in defending those that arise:

  • The surgeon carrying out the surgical procedure should also carry out the initial consultation.
  • He should make clear and detailed written notes evidencing discussions:
    • Surrounding the patient’s expectations for surgery.
    • Concerning the risks of the procedure, to include surgical risks (e.g. anaesthetic, bleeding, infection) and the possibility of an unsatisfactory aesthetic outcome (e.g. scarring).
    • About the long term financial implications of surgery. For example, in the case of implants, patients should be aware of the need for future investigations such as scans and treatment such as removal/replacement of an implant.
  • The surgeon should follow up the consultation in writing, summarising the discussion and options given.
  • He should offer second consultations where necessary, and abide by the two week "cooling-off" period recommended by the General Medical Council.

Department of Health review

It should be noted that the "Review of the Regulation of Cosmetic Interventions", published by the Department of Health in April 2013, has made detailed recommendations to ensure that patients choosing to undergo cosmetic intervention are informed and empowered.

Read the Review of the Regulation of Cosmetic Interventions report on the website

The Government has indicated that it will respond to the review in detail over the summer.