We were recently invited by Theo Reed from Salford University in Manchester for an interview as part of his course on the Science of Humans. He came up with some interesting questions on Plastic Surgery which we thought would be interesting to share…

What does your job entail on a day to day basis?

I divide my time between a cosmetic and a NHS practice so I will have clinics in which I see patients with advanced skin cancer and those who need breast reconstruction or mastectomies due to a high lifetime risk of cancer and then after hours I will be in Private practice and see patients for breast surgery, body contouring and facial rejuvenation surgeries

What sort of cosmetic procedures do you offer?

I offer a full range of procedures from Botox and fillers to what is known as a Mummy Makeover in which a woman has surgery on her abdomen and breasts (and sometimes with liposuction in key areas) to return her to her pre-baby figure. I do the full range of breast surgery and use the latest technology in the form of 3D scanning software in virtual reality so that patients can see what different implants will look like on them before their surgery.
If I were unhappy with the way I looked, what would happen during my consultation?
I would check you were fit and well by getting details of any medications, allergies, your smoking status and history of any previous surgery. We would have a full discussion about the specific things you did not like. A surgeon should never make suggestions or point out areas that they want to fix.

I would then examine you and discuss all your options for the improvement of the area including doing nothing. You would then be provided with a letter detailing the consultation, full printed information sheets including Frequently Asked Questions and a General Information sheet as well as an informed consent document that clearly spells out all the potential risks of the procedure. You would then have a second consultation in which you could ask any further questions that you would like answered before any surgery was booked in.

If a surgery would have serious implications or would make a patient look worse – are you able to refuse?

Yes, of course. Safe surgery is my absolute priority.  That is why it is important to have an individual consultation so that both you and I can ask questions and discuss whether you are in the right place to make a good decision, have realistic expectations of your results and would benefit from any surgery.

Do you think there is such a thing as having too much surgery?

Again its all about safety and realistic expectations. I screen people for the condition known as Body Dysmorphic Disorder using an online questionnaire and these people are refused surgery and sent back to their GP for counselling.

Have you ever experienced patients who are addicted to surgery? (Obviously leaving out any details due to patient confidentiality)

No, as I follow the above procedure and eliminate these types of patients

Are there any systems/warnings in place help people who are addicted to surgery?

I use the BDD screen and I will refer to a doctor in Psychology if a patient is shown to be on this scale.

Do you ever face any moral dilemmas with people thinking plastic surgery is unnatural, or are you just happy making people feel better about themselves?

I am very happy to enhance both patients’ body confidence and self confidence and this is overall what happens in most cases, but it is essential to follow a rigorous and ethical process to ensure people with expectations that cannot be met do not go ahead with surgery.
The overall media profile of my specialty is not realistic. In my 20 year’s experience, the vast majority of my patients are not addicted or unreasonable and they have safe surgery. Most of my cosmetic surgery work in the NHS is treating patients who have had either then trauma of cancer or the trauma of burns and therefore have a very sensible and grounded view on these matters. All doctors sign up to a code of conduct from BAAPS also. There are many judgements people make on others who seek to have surgery but my job is to ensure that have expectations that can be met, they are safe to have surgery, they do not have BDD and to care for them to the best of my ability. 

In the future, from your personal opinion…

Do you ever think the prices of procedures will drop to a point where anyone can afford to get surgery with ease?
Probably not as litigation is increasing and the cost of our annual insurance premiums and hospital fees are very high so the actual cost to the surgeon is high before the actual operation commences.

If this happens… could cosmetic surgery become the norm?

See above

Would this change be appreciated by you, or do you think it would cause problems?

See above

How far do you think the world will go in terms of new procedures… possibly surgery to add extra limbs etc? (First example that popped into my head!)

This may well happen and BAPRAS actually has a salamander as its logo as it is able to perform this feat. We have moved ahead with hand and face transplants and this has helped those who were in dreadful situations.
Burn injuries have not advanced greatly in recent years and we still cannot grow a patient new, good quality skin. This would be an enormous advance. Control of rejection by the immune system would allow transplants without having to take strong immune suppressant tablets.
Robotics is advancing to replace lost limbs and this would obviate the need for surgery. So I think the advances are very exciting. Plastic surgery always innovates and works to solve problems other surgeons cannot and this is how it was born after the second world war when airmen had horrific injuries and it is how the founders established the principles we still use to this day.

Have you got any advice for anyone who is considering cosmetic surgery?

Yes, do your homework. That means research your options of the different surgery options and also the different surgeons. They should ideally hold an NHS appointment covering similar areas to what they offer privately which means that their skills are up to date and they have lots of experience in their field. They should be registered with BAPRAS and or BAAPS. they should have good online reviews on sites like Google and Realself. They should be happy to show you examples of their work and they should listen to you in the consultation and not put any pressure on you to have the surgery.

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