A combination of an under-regulated market, "professional greed," increased marketing, and overwhelming media hype have created a "perfect storm" that threatens cosmetic surgery patients — and practitioners alike. This is the take-away from a special issue of the UK-based journal, Clinical Risk, published by the Royal Society of Medicine.

The journal’s editor argues that cosmetic surgery patients in the UK are at more risk than ever before, saying that patient safety is woefully lacking in the country’s cosmetic surgery field. "We need tight control of advertising of cosmetic surgery, including Internet advertising," says editor Dr Harvey Marcovitch. "We need proper regulation of the industry and we need both surgeons and GPs to manage patient expectation."

In one paper, titled "Clinical Risk in Aesthetic Surgery," consultant plastic surgeon and President of the British Association of Aesthetic Plastic Surgeons (BAAPS) Nigel Mercer argues: "There has been a massive increase in ‘marketing’, including discount vouchers, 2-for-1 offers and holidays with surgery. In no other area of medicine is there such an unregulated mess. What is worse is that national governments would not allow it to happen in other areas of medicine. Imagine a ‘2-for-1’ advert for general surgery? That way lies madness"

Mercer discusses the role of the media and advertising and calls for tighter regulations in the UK, comparing this country’s lack of regulation with the FDA’s role in the US.

Key quotes from the issue:

"Perhaps, like tobacco, there should be a Europe-wide ban on advertising all cosmetic ‘surgical’ procedures, including on search engines…".

"If we have to sell anything, we should sell our advice, not procedures. If we cannot self-regulate, then, like the financial institutions, regulation will eventually be imposed…"

"All cosmetic treatments are medical interventions, and every medical intervention has a complication and failure rate. Consequently, there are no "consumers" or "clients," but only patients."

"Perhaps the single most important factor in reducing clinical risk in cosmetic surgery is the motive for performing any procedure must never be financial gain, so I suggest we get our act together as an industry as we are in grave danger of biting the hand that feeds us."

French plastic surgeon Alain Fogli describes the strictly defined guidelines for cosmetic surgery in France, which include the following:

Surgical procedures can only be undertaken by surgeons who are registered specialists and deemed competent. Possession of a general medical degree, and the fact that the practitioner is "experienced" are not deemed to be sufficient qualifications. In addition, he recommends a ban on all forms and methods of publicity and advertising, direct or indirect, in whatever form, including the Internet.

Foad Nahai, President of the International Society of Aesthetic Plastic Surgeons (ISAPS) and former president of the American Society of Aesthetic Plastic Surgeons (ASAPS), describes how to minimise risk in each facet of ‘the safety diamond’: patient, facility, procedure and surgeon.

"Regulations governing the training of all cosmetic surgeons are sorely needed. Governments are reluctant to become involved, as they see this issue as a "turf battle" between various physician groups and not a public safety or patient safety issue," he writes. "However, there is no question that this is a patient safety issue of paramount importance and I take our governments to task for not addressing it."

By law, any physician is allowed to practise cosmetic surgery; therefore, attempts by individual physicians or plastic surgery organizations to restrict those who are not qualified is viewed as a restraint of trade.

Consultant plastic surgeon and BAAPS Secretary Rajiv Grover reveals a 14-year audit of claims that shows why patients sue. He provides recommendations to avoid these situations such as careful preoperative counselling, thorough documentation, and exploring with the patient what degree of correction and scarring is realistic — and not being falsely optimistic about the likely outcome.

[Source: BAAPS/Medical News Today/ASAPS]