Cosmetic Surgery: Royal College of Surgeons guidance is welcome, but regulation is required

19 February 2013

In the last few years, the popularity of cosmetic surgery has greatly increased. Many people are tempted to opt for procedures which can, when performed safely, give them excellent results. However, regulation of the cosmetic surgery industry in the UK is in a worrying state. Unhappily, there are no accurate statistics relating to how many cosmetic surgeries are carried out in the UK. Figures from The British Association of Aesthetic Plastic Surgeons indicate that 43,039 cosmetic surgery procedures were carried out by its members in 2011. The total number of cosmetic surgeries carried out in the UK as a whole is likely to be 130,000. It is estimated that around 5% of these procedures end with botched results.

The situation is so concerning that the NHS medical director, Sir Bruce Keogh, is conducting a major review of cosmetic surgery in the UK. The Royal College of Surgeons (RCS) has published preliminary guidance in the form of The Professional Standards for Cosmetic Practice report, with a full review expected in March this year.

The new guidance published by the RCS makes recommendations that will shock many for not already being in place. 

For example, the report proposes an end to the current fashion for “botox parties” and “filler parties”. These take place in private homes and many of the treatments are administered by beauticians, who have no medical training. The report recommends that cosmetic procedures such as these should be carried out on medical premises and be administered by licensed doctors, or registered dentists or nurses.

Alarmingly, the majority of female genital cosmetic surgeries take place in the private sector. The most common of these surgeries is a labiaplasty. The surgery carries significant physical risks, such as bleeding, infection and scarring but little is known about the long term effects of this surgery. The Royal College of Obstetricians and Gynaecologists (RCOG) has “strong concerns” about this type of surgery and  note that high levels of anxiety about body image when appearance is in the normal range should trigger psychological referral. Under the present system, where these surgeries are often carried out in the private sector for “little or no medical benefit” (the words of Dr Tony Falconer, President of the RCOG), there is concern that these patients do not receive psychological help which they may need.

The report also recommends that doctors who perform cosmetic surgery procedures are trained plastic surgeons, on the General Medical Council specialist register. Certainly, it is hard to identify another area of medicine where a surgeon performing an operation need not have specialist training. Our clinical negligence lawyers often see cases where cosmetic surgery procedures have been carried out at private clinics, be it breast augmentations, rhinoplasties or liposuction, including “smart lipo” procedures, such as “laser lipo”. It can be profoundly shocking for clients to discover that that these procedures have been performed by doctors who are not qualified to work as consultants in the NHS.

Sadly, it often falls to the NHS to picks up the pieces when cosmetic surgery at private clinics goes wrong. Appearing on a recent Channel 5 documentary “Botched Up Bodies”, which examined this issue, cranio-facial surgeon Niall Kirkpatrick at The Chelsea and Westminster Hospital spoke of the problems of the lack of regulation of cosmetic surgery in the private sector: 'If we do not act to regulate the private sector this is the future for the NHS. The strain is just too much, not only on the NHS – hospitals and GP’s – but on the economy. Private cosmetic surgery is rife for abuse without proper regulations; this is a serious problem that will not go away.'

The government should act quickly to stop such invasive procedures being carried out in an essentially unregulated environment. This current situation is not in the interests of the patients or indeed the medical profession. The recent recommendations from the Royal College of Surgeons are a welcome step, but unfortunately at the moment these are just guidelines. Until the sector is adequately regulated, patients’ lives continue to be put at risk for the sake of profits. Steve Cannon, chairman of the working party and RCS council member has been quoted as saying: ‘as the majority of cosmetic procedures are not available on the NHS, we must ensure that commercial interests do not compromise patient safety. With the demand for cosmetic surgery and non-surgical treatments rising year on year, it is crucial that the highest level of professionalism is maintained amongst practitioners.’

Kingsley Napley LLP frequently handles enquiries from clients who have concerns about cosmetic surgery they have received. If you would like advice regarding a potential claim, please contact the Clinical Negligence and Personal Injury team on 020 7814 1200 or by emailing us at

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