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No longer the preserve of the rich and famous, cosmetic surgery and laser skin treatment, has become a more socially acceptable way to hold back the years or amend your appearance. 

The past five years has seen a 50 per cent increase in procedures carried out in the UK. However its popularity has unfortunately meant the rise of unprofessional clinics and the introduction of aggressive marketing techniques to entice customers.

Cosmetic surgery may be big business, but its offerings, from breast reductions, liposuction, and laser skin treatment, to the seemingly straightforward Botox injections, are potentially dangerous medical procedures that need to be carried out by experts. Going to the clinic with the 'gift of the gab' can have serious consequences.

Where do I start?

Your GP should be your first port of call if you are considering surgery. He or she can recommend a reputable surgeon or practitioner in your area. While certain operations can be carried out on the NHS, for example, a breast reduction if the size and weight of your breasts is resulting in back problems, it is more likely that your GP's referral will be to a local surgeon in a private hospital or clinic.

Although a GP should be happy to talk to you about cosmetic surgery and laser skin treatment, some people don't like to ask as they are worried about wasting a doctor's time when they're not ill. 

If you feel embarrassed to discuss procedures with your GP, it can be tempting to answer an advert in the back of a magazine or on the internet, you're anonymous, these clinics will be used to requests like yours, and the adverts picturing amazing transformations can be incredibly persuasive. But according to Douglas McGeorge, Consultant Plastic Surgeon and member of the British Association of Aesthetic Plastic Surgeons (BAAPS), responding to this type of advertising is definitely not the best way to find your surgeon:

"Most reputable clinics don't use adverts in the back of newspapers encouraging people to come along. If you see any adverts with pictures of 'before and after', be very wary of going there because the chances are they are not mainstream procedures."

What type of research should I do?

If you want to avoid your GP, you'll need to invest some time in research. Fully trained practitioners should be listed on the General Medical Council's specialist register. You can check this on the GMC website. All doctors setting up as cosmetic surgeons for the first time from April 2002 must also be on the GMC's specialist register. BAAPS also have a list of people who are recognised as formerly trained.

Gather information from newspapers, magazines and the internet, noting down the names of any practitioners who are mentioned or quoted. Learn as much as you can about the kind of procedure you think might suit you.

Talk to friends. Someone who has had a positive experience of a similar operation is the most reliable advertisement for a good surgeon. Bear in mind that while some people will be happy to discuss their new nose / increased bra size, others may be reluctant to talk openly about plastic surgery.

When you've found out as much as you can about the practitioner and clinic, book a consultation. The first practitioner you see doesn't have to be the one you go with. It's really important that you feel comfortable with him / her as you'll need to talk honestly about what you are hoping to achieve and why. And of course some operations require more intimate conversations and examinations than others.

Do compare prices, but don't make a decision based on this factor alone. Don't rush your research, invest plenty of time in your choice of surgeon and procedure. Even for a minor operation, there can be serious risks involved and a hasty decision could result in irreparable damage.

What should I ask?   

Don't be afraid to ask a practitioner about his / her qualifications, experience and specialities. You could check whether they give lectures or have written articles on their subject.

Think of all the questions you have about the procedure you're interested in and write them down. Make sure you're satisfied with the answers you've been given before the consultation is over.

Ask about everything that is going to be done to you and insist they be frank about any possible risks or side effects associated with the procedure. Don't forget to find out what sort of aftercare will you need.

What should I look out for?

When you are booking a consultation with a clinic, make sure you see the actual practitioner who will be operating on you. In some clinics, the first person to see any prospective patients is a 'counsellor'. If a counsellor is trying to sell you a procedure, you should be suspicious, especially if they are trying to persuade you to have more treatment than you originally planned. Be sure about what you want to have done and stick to it.

Check the facilities in the clinic, are there doctors in the building all the time? What other operations do they carry out there? Make sure that the clinic you are in is the one where you will have your operation. Be wary if after you've had a consultation and paid a fee you are then taken somewhere else to have the procedure.

Bear in mind that prices do vary. To give an accurate price, a practitioner will need to have a full consultation with you and gather all the facts that may affect the length and complexity of the procedure. If someone is offering it quicker and cheaper, there is usually a reason.

When you've decided on a practitioner, leave plenty of time after the consultation before you book in for a procedure. Don't feel under any pressure to make a quick decision; a reputable clinic will encourage you to take some time to think it through.

what can I do if I'm not happy with the results?

The first thing to do if are not happy with your experience is to take the matter up with the practitioner who carried out the work. Your practitioner may offer to correct the work with further procedures or to return the fees you paid. Another option would be to ask a different practitioner to look at the work you've had done and check whether you have cause for complaint. A reputable practitioner will be able to say if what has happened is a recognised complication or limitation of a procedure that should have been discussed with you at a consultation, or if the practitioner was at fault.

For example, in a proportion of people who have breast enlargements, the scar that forms around implants may tighten, making the breast go rounder and firmer. According to Douglas McGeorge, this is a genuine limitation of healing that will affect a proportion of people. It should be identified as a risk before surgery, but it doesn't mean the surgery wasn't carried out correctly.

If the practitioner giving a second opinion says your procedure hasn't been done professionally, they might be prepared to correct the work themselves or to refer you to another practitioner known to be competent in doing so. Except for a few rare cases, most problems in cosmetic surgery can be sorted out amicably with a good outcome.

If you are not happy with the way in which your clinic or practitioner has dealt with your concerns then you may wish to take the matter further. The Healthcare Commission can take action against a hospital, clinic or salon if they think the establishment breaches the standards it should meet. The Advertising Standards Authority can advise about how to complain about misleading or offensive advertising. The Medicines and Healthcare products Regulatory Authority can help with complaints about prescription-only medicines such as Botox or about implants (for example, breast implants which are regulated as medical devices) that have not performed as well as they should.





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