Cosmetic Surgery Standards FAQ
All our FAQs for surgeons and providers can be found below. If you are looking for patient information please visit our patient care pages
- Is female genital cosmetic surgery (FGCS) covered?
- Is male genital cosmetic surgery (MGCS) covered?
- Is refractive surgery included within the scope of your work?
- Why are hair transplant procedures not included?
- Why are dental cosmetic surgical procedures not included?
- Who is leading on the Keogh recommendations relating to non-surgical cosmetic interventions?
Is female genital cosmetic surgery (FGCS) covered?
Not at the current time, but procedures may be included in the future. We are aware of the ethical issues regarding FGCS, in particular the ambiguity around the legal status of some of these procedures. We appreciate that for some patients FGCS may benefit the physical and emotional well-being of the individual concerned, and may therefore be medically indicated. We recommend surgeons to consult The Royal College of Obstetricians and Gynaecologists (RCOG) web site before considering performing FGCS.
Not at the current time. Procedures may be included within the scope of our work in the future, subject to endorsement by the British Association of Urological Surgeons (BAUS).
No. The Royal College of Ophthalmologists (RCOphth), as the professional body for setting the standards for this area of practice, is leading the work to improve standards in refractive surgery.
The RCOphth defines refractive surgery as an operation to reduce a person’s dependence on spectacles or contact lenses, or improve their quality of vision. It is intended to improve a patient’s quality of life so they can lead a healthy, active lifestyle.
Examples of procedures include:
- laser corneal reshaping (laser eye surgery)
- incisional corneal surgery (astigmatic and radial keratotomy)
- corneal implants (presbyopic inlays and ring segments)
- scleral expansion and laser surgery for correction of presbyopia
- refractive cataract surgery and lens exchange (multifocal, accommodating, toric and conventional intraocular lenses)
- secondary and piggyback intraocular lens implantation
- phakic intraocular lens implantation
We recognise that hair transplants are categorised as level 1b treatments under the definitions in RCS Professional Standards for Cosmetic Practice (January 2013). However, the majority of practitioners who currently perform these procedures come from a non-surgical background, and we cannot set standards for non-surgeons. For that reason, Health Education England (HEE) is covering these procedures within its programme of activity.
Keogh’s review noted that there remain concerns about cosmetic dentistry and suggested that ministers may wish to consider a further review in this area. The three UK faculties of Dental Surgery and the Faculty of General Dental Practice (FGDP) support this recommendation, as does the College.
Therefore at the present time our remit does not extend to dental cosmetic surgical procedures.
The scope of our work, as recommended in the Keogh Review and set by the government response, does not extend to non-surgical cosmetic procedures for example Botox, dermal fillers and chemical peels.
Health Education England (HEE) has been leading the programme of work related to non-surgical cosmetic procedures. You can find out more about HEE’s work on their website.
- I have been performing cosmetic surgery for years, why should I apply to be certified?
- Do individuals performing cosmetic surgery in the NHS need to certify?
- Will surgeons from abroad be able to apply for certification?
- How does certification assess the quality of care provided?
- What if my appraiser does not perform cosmetic surgery?
- Why is there a requirement to provide evidence of professional behaviours?
- What will the masterclass cover?
- Who will deliver the masterclass?
- Why does certification include a requirement to have indemnity insurance which covers cosmetic practice in the UK?
- How will general surgeons and ophthalmic surgeons provide evidence of a declared specialist interest?
- What will the case review involve?
- Will certification be underpinned by legislation/regulation?
This new system of certification will make the cosmetic surgery industry safer for patients and enhance the reputation of the profession.
We urge all eligible surgeons who perform cosmetic surgery to apply to be certified so they can demonstrate high professional and clinical standards in their area of practice. This is an opportunity for surgeons to show the quality of the care they offer.
We have set the standards required in order to perform cosmetic surgery independently in the private sector. It will be for each NHS Trust to decide whether they want to include this requirement when employing surgeons to perform cosmetic surgery.
Yes. They will need to meet the same requirements as a UK based surgeon in order to certify.
Revalidation is the mechanism that the General Medical Council (GMC) uses to ascertain whether or not a doctor is up to date and fit to practice in their chosen field. In order to certify, a surgeon will need to demonstrate that their outcome results have been discussed as part of whole-practice appraisal and revalidation. In addition, surgeons will need to demonstrate they are compliant with Competition and Markets Authority's (CMA) requirements in relation to information about performance.
We recognise that in some cases revalidation is carried out by colleagues who do not practice in the same area of interest. To support the appraisal and revalidation process we will produce specific guidance for appraisers of surgeons undertaking cosmetic surgical procedures.
The Keogh review highlighted that the area of professional behaviours and communication is frequently the subject of concern and complaints from patients. There are complex issues for cosmetic surgery in the private sector, such as consent, patient selection, ethical marketing and continuity of care.
Therefore demonstration of knowledge and skills in this area is included as an integral part of the certification process.
Professional and ethical aspects of practice including the relationship with the patient are the most common reason for unsatisfactory outcomes in cosmetic surgery. The content of the masterclass will focus on these aspects of practice and will reflect the GMC standards for all doctors who offer cosmetic interventions and the RCS supplementary standards for cosmetic surgery (both currently in development).
It will trace the journey of the cosmetic surgery patient and identify the specific points where there is risk of a poor outcome, the more common reasons for patient dissatisfaction and strategies to reduce risk. The masterclass will cover areas such as consent, management of patient expectations, ethical marketing, record keeping and revision surgery. It aims to encourage reflection on practice, shared learning and exchange of experience with other surgeons.
Further details will be available shortly.
Why does certification include a requirement to have indemnity insurance which covers cosmetic practice in the UK?
It is a legal requirement and a condition of holding a licence to practice that a doctor has appropriate indemnity cover so that their patients will not be disadvantaged if they make a claim about the clinical care they have received in the UK. In order to certify, surgeons will therefore be required to have professional indemnity insurance, which specifically covers their cosmetic practice.
How will general surgeons and ophthalmic surgeons provide evidence of a declared specialist interest?
Surgeons will be asked to provide information on the full scope of work, including but not limited to their cosmetic practice, and to share their job plan which was valid during their most recent appraisal.
Surgeons will be asked to provide reviews of four complex cases in which they particpated and the learning they achieved. Further detail will be available in due course.
Certification will be introduced as a voluntary process. Patients and services will be able to search for a certified surgeon on the RCS website. In time, we hope that certification will link to the GMC’s proposals for credentialing and we are lobbying the government to make this necessary legislative change.
We believe that the overwhelming reason for creating a credential is to protect patients. We support GMC credentials in areas of medicine which fall outside recognised medical specialties or in areas where there is a lack of existing regulation and patients are vulnerable, such as cosmetic surgery. To ensure alignment with current curricula requirements it is our view that credentials should only be developed by the relevant medical royal college or faculty, along with their associated Specialist Advisory Committees.
Serious or persistent failure to follow the GMC's guidance puts a doctor’s registration with the GMC at risk.
We want providers of cosmetic surgery to use certified surgeons. The Care Quality Commission (CQC) is the independent regulator of health and adult social care services in England. The CQC makes sure services provide people with safe, effective, compassionate, high-quality care and CQC will take our standards into account when inspecting and rating services.
- Who is responsible for collecting these data?
- How do the Clinical Quality Indicators for Cosmetic Surgery link with the CMA requirements?
- Some of these data items are not in the CMA requirements; do I still need to collect them?
- What if I can’t collect some of the items within the RCS dataset?
- Will the College be collecting these data?
- Who will be analysing these data?
- Will I receive a report on these data items for my service?
- How have the data items listed in Clinical Quality Indicators for Cosmetic Surgery been developed?
Who is responsible for collecting these data?
All services that provide cosmetic surgical care within the UK should be working towards collecting these data items. These items relate to surgical procedures only, not procedures such as Botox injections or dermal fillers.
The mandatory data items are listed as Competition and Market's Authority (CMA) requirements, and in this case the responsibility lies with the service provider.
The RCS dataset includes additional items that have not been mandated by the CMA. These data items are recommended as best practice and both surgeons and providers of cosmetic surgery should work towards collecting these as soon as possible, to ensure that appropriate data are collected to support audit and quality improvement. These data should be used for personal appraisal and will also support monitoring as part of the CQC’s inspections.
Read more about the CMA's requirements and PHIN.
The Competition and Markets Authority (CMA) requirements for data collection for independent healthcare providers are more extensive than those listed in the RCS Clinical Quality Indicators for Cosmetic Surgery and are legally mandated.
There are additional items listed in the RCS dataset that have not been included within CMA requirements. These data items are recommended as best practice. If you or your service is not able to collect these data, you should be working towards doing this as soon as possible.
Where the items are the same as those within the CMA requirements this is noted within the document.
You are not legally required to collect all the data items listed in the RCS dataset for cosmetic surgery, although this is recommended as best practice.
Data items that are also listed as CMA requirements are mandatory.
Others are considered best practice. If you or your service is not able to collect these data, you should be working towards doing this as soon as possible.
No. The Royal College of Surgeons, in collaboration with the relevant surgical specialty associations, has set the standard for data collection that will support quality improvement and reflect best pracfice in cosmetic surgical care, but we will not be collecting these data.
The Clinical Quality Indicators for Cosmetic Surgery sets out how data collection is anticipated for each metric. Many of these items will be included in routine collection by service providers that will be submitted to PHIN. PHIN will then be publishing specific performance measures on a monthly basis from April 2017 at a service and consultant level.
Data items listed which state ‘local collection’ should be collected and analysed locally through audit.
Reports reflecting practice at service and clinician level will be available for those data items that are being collected by PHIN from April 2017 and this will be in the public domain. Those items listed as ‘local collection’ will have to be reported on locally.
For further information go to the PHIN website.
The data items have been developed by consensus. Representatives from key surgical specialty groups and other stakeholders have been involved including patient representatives, the Care Quality Commission (CQC) and the Private Healthcare Information Network (PHIN).
- Do I need to pay to use these tools within my practice?
- What is the research evidence for the use of Q-PROM rather than other PROM tools?
- What tool should I use for my procedure?
- Why are you only recommending Q-PROMs for selected procedures?
- Do I have to collect pre-operative and post-operative Q-PROM data from patients?
- How should I collect Q-PROMs data?
- Can I translate the Q-PROMs into a new language?
- Can I delete or change the wording in any of the Q-PROM questionnaires?
- Can I add any items to the Q- PROMs?
- Who helps patients to complete the questionnaire in clinic?
- What should I do if the patient has trouble understanding a question?
- What should I do if the patient does not want to answer some or all of the questions or refuses to do so?
- What should I do if a patient asks why the Q-PROM has to be filled out on more than one occasion (if administering pre and post-operatively)?
- How do I score my completed questionnaires?
- What if we cannot obtain the post-operative forms from the patients?
- What do I do if there are data missing from the completed questionnaires?
- What do I do if a patient has selected more than one response to a question?
- What do I do if a patient has selected ‘not applicable’ or written ‘not applicable’ on the questionnaire?
- Do I need local ethics board approval to use Q-PROMs?
- How do I find out more about Q-PROMs and their developer?
- Why are you not recommending the use of a generic PROM tool?
Memorial Sloan Kettering Cancer Center does not charge clinicians or non-profit researchers for the use of these scales Others should contact the developers directly to request permission.
A summary of a meta-analysis of all available PROMs for cosmetic surgery has been carried out by The University of Oxford Patient Reported Outcome Measurement Group in 2013.
Further research is listed in the back of the service user manuals.
The Q-PROMs that have been identified for use within cosmetic surgical practice are:
- BREAST-Q – Augmentation mammoplasty
- FACE-Q – Rhinoplasty
- FACE-Q – Blepharoplasty
- FACE-Q – Rhytidectomy
- BODY-Q – Abdominoplasty
- BODY-Q – Liposuction
Q-PROMs were chosen because research exists that supports their reliability and validity of use within cosmetic practice. Q-PROM tools have been developed and validated for use in some of the most common cosmetic surgical procedures performed within the UK (according to latest figures within the British Association of Aesthetic Plastic Surgeons’ (BAAPS) annual audit). However not all procedures will be covered with these tools.
You do not have to capture both pre-operative and post-operative Q-PROM data from patients, although this will allow for most effective measurement of impact. The most important Q-PROM is the post-operative questionnaire, which can be analysed alone to develop a database of scores that can then be linked to different patient demographics and types of surgery.
Q-PROMs tools should be completed by the patient and ideally collected pre and post-operatively.
Post-operative questionnaires should either be emailed or posted to patients approximately three months post-surgery. The post-operative version includes all the pre-operative items in addition to items that address unique post-operative issues (e.g. scars).
For translation of the Q-PROM questionnaires scales contact Mapi Research Trust at PROinformation@mapi-trust.org This organisation will provide you with a current list of available languages of each module, and if a language is not available, they will provide the guidelines for linguistic validation and translation.
No, you cannot delete or modify any items in Q-PROM questionnaires. There are three main reasons why deleting or modification is not allowed:
- This would nullify the psychometric properties of Q-PROM questionnaire scales.
- It would then not be possible to score the questionnaire and you would not be able to compare findings with those of others.
- Changing the questionnaires is prohibited under copyright laws.
No, you cannot add any items in Q-PROM scales for the same three reasons that you cannot delete or modify these (see above).
You may however ask any additional questions that you wish as long as they are separate from the Q-PROM scales. You cannot consider these questions to be part of the Q-PROM.
The Q-PROM scales are designed for patients to complete themselves and it is important that providers and surgeons do not influence the way patients complete the tools. All patients should answer the questions based on their own understanding of the items.
You can help by asking them to explain why they are having difficulty responding, and read the question verbatim for them. Do not try to explain what the question means, rather suggest that the patient uses their own interpretation of the question.
Do not rephrase the question. If they are still having difficulty completing the form, advise them to leave out that question.
What should I do if the patient does not want to answer some or all of the questions or refuses to do so?
Patients have a right to refuse to complete the questionnaires.
You can explain that the data obtained from the PROM tools will allow the service to improve its quality and ensure that patients are getting the best treatment options.
Patients can also use it to guide questions they may have about the planned procedure and the likely benefits for them. You can emphasise that the Q-PROMS are quick and simple to complete.
If the patient does not like a particular question, or thinks it is unnecessary or inappropriate, they can write their comment on the Q-PROM form.
It is still possible to score all the Q-PROMs questionnaires with missing data.
What should I do if a patient asks why the Q-PROM has to be filled out on more than one occasion (if administering pre and post-operatively)?
Explain that patients must complete the same Q-PROM at additional visits in order to see if their answers change with time. This will give a more complete picture of how their health-related quality of life and satisfaction changes over time.
Each answer that is ticked by a patient has a corresponding Q-PROM score.
Add together the scores from all answers in the Q-PROM tool to produce a total Q-PROM score.
Convert the Q-PROM score to a Rasch score (scored 0 to 100).
The greater the value of the Rasch score, the greater the patient satisfaction or health related quality of life.
It is important to note that a single pre and post-operative score for an individual patient cannot be interpreted, beyond a general indication of improvement.
More scores over time would need to be included or the scores for all patients having the same procedure interpreted together.
Memorial Sloan Kettering Cancer Center has devised an automated scoring system (Q-Score) which is provided free of charge on their website. Currently this is only available for BREAST-Q but they are in the process of developing similar scoring systems for the BODY-Q and FACE-Q.
There is further advice about implementing PROMs in practice, scoring and analysis available within the service user manuals.
It may be difficult to obtain post-operative Q-PROM surveys from patients. We suggest you stress the importance of the completion of this form at the pre-operative stage and send them a reminder two weeks after the survey is sent, to prompt completion. It is always best practice to check via the NHS Spine or an alternative system prior to sending out surveys, especially if a significant period of time has lapsed since the patient was last seen, in order to identify any patient who has died in the intervening period.
Missing data should be left as a ‘blank’.
If the patient has selected more than one response to a question the patient has not responded properly to the question and the response should be left as a ‘blank’.
What do I do if a patient has selected ‘not applicable’ or written ‘not applicable’ on the questionnaire?
If the patient has indicated their response to a question is ‘not applicable’ leave this section blank in your scoring table.
If your intent is to collect Q-PROMs data for research purposes, a local ethics board must review your methods, patient recruitment, consent and privacy. If you are administering the Q-PROMs tools for clinical care, ethics board approval is generally not required. If in doubt, contact your local ethics board.
These PROM tools have been developed by Dr Andrea Pusic, MD, of Memorial Sloan Kettering Cancer Center. Further information and contact details are available within the service user manuals.
We acknowledge that it is best practice for a generic and procedure specific PROM to be collected at the same time, in order to measure patient outcomes. However, at present there is insufficient evidence for the use of any one 'generic' PROM tool in cosmetic surgery. For this reason we have not specified that a generic PROM be routinely used at this time. We will raise the requirement for further research in this area as a priority.
Further information or questions...
Telephone 020 7869 6120 to speak with a member of the project team