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Help make cosmetic surgery safer for patients: apply for certification

05 Nov 2015

Mr Tim Mellor

The Royal College of Surgeons (RCS) has today published information about a new system of certification that will be introduced in cosmetic surgery next year. It will help distinguish highly qualified, competent surgeons who perform cosmetic surgery from those who lack experience and training.

Ever since Sir Bruce Keogh’s Review of the Regulation of Cosmetic Interventions in 2013, the RCS has led work to make cosmetic surgery safer for patients. This includes developing robust standards of training and practice for surgeons undertaking cosmetic surgery, which have been developed by the Cosmetic Surgery Interspecialty Committee (CSIC) in a number of surgical areas.

I was involved in the development of the cosmetic surgery standards as the deputy lead in aesthetic facial surgery for the British Association of Oral & Maxillofacial Surgery (BAOMS) and have been a SAC RCS Aesthetic Surgery committee member for a number of years. 

Even though I am a trained Consultant Oral and Maxillofacial Surgeon (OMFS), with more than 20 years’ experience of working in the NHS and private sector, I plan to apply for certification.

This is because, at the moment, it can be very difficult for a patient to assess a surgeon’s training and experience. Prospective patients are often advised to look for a record of surgical training and for the national surgical association they may belong to. I believe we need a more robust system to protect patients and one which they will understand.

Cosmetic facial surgery is very much a part of the surgical role and experience of OMFS.  In the NHS, I treat patients with cancer of the mouth, head and neck. I also perform reconstructive surgery of the face, jaw, skin and mouth.

The patients I treat for cosmetic surgery are predominantly female and they are primarily concerned with the effects of ageing. They may come to see me if they are contemplating having a face lift or skin tightened around their eyes, face, neck or jaw line.

I also treat younger patients who may have concerns about the look of their nose, ears, or the size of their chin.  For my patients, entrusting someone with how their face looks is an enormous and potentially life-changing decision.

I know from treating patients who have come to see me for corrective surgery following treatment elsewhere, how devastating it can be when things go wrong. One case that springs to mind involved a woman who had travelled to North Africa for a face lift. Her wounds had become infected and she had necrosis, or dead skin, around her face, when she returned home. I repaired the wounds and treated the infection but the experience was very unpleasant and distressing for her.

Another case involved a patient who had threads inserted from her temple into the middle of her face, to tighten the skin. The procedure had been performed by an aesthetic doctor, not a surgeon. She could feel the stitches through her skin and asked me to remove them and to perform a face lift.

You may ask how a voluntary system of certification would protect these patients. Those of us who have studied, trained and worked as surgeons, know how much training and experience is required to perform an operation successfully. Informing and educating patients about this is an important part of the process. Under the proposed new system patients will be able to search for a certified surgeon on a register on the RCS website removing some of the hurdles they have to get through to find an appropriate surgeon.

Surgeons will also only be able to apply for certification in one or more groups of closely related procedures if they are on the GMC specialist register in the area, in which they wish to practice. This will improve patient safety - we cannot all be specialists in every region of the body and a surgeon should only practice cosmetic surgery in the field they are trained in. But for patients’ protection, it is also important that surgeons only undertake procedures in an area in which they have the appropriate training, qualifications and experience

Applicants for certification will have to demonstrate evidence of their personal experience and training, in particular body areas. The well trained surgeon should not be concerned by this, and frankly, we should not support complaints from surgeons who are ineligible to apply because they only undertake one or two procedures a year. 

Certification should also help protect patients from unscrupulous ‘fly in and fly out’ surgeons who are not appropriately qualified and do not have proper insurance. If these individuals wish to be certified they will have to provide evidence of how they meet all the requirements, including providing evidence of their qualifications, training, experience and that they have insurance to practice cosmetic surgery in the UK.

Collecting information about a patient’s outcome of their cosmetic surgery is also important. Cosmetic surgery cannot record cure or survival rates, and it is very subjective, but it is important that surgeons are able to show they can deliver the outcomes the patient would hope for. This will help the surgeon to establish the importance of understanding the patient’s expectations before they agree to operate. It is as true in cosmetic surgery as other branches of surgery that a good surgeon is the surgeon who knows when not to operate.

I hope you will join me in preparing and applying for certification. Let’s protect patients and help them to identify appropriately qualified and experienced surgeons from individuals who should not be operating.

Mr Tim Mellor is a Consultant and Oral & Maxillofacial Surgeon.

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