Surgeons publish landmark standards for cosmetic practice

Only surgeons should provide cosmetic surgery and only doctors, dentists and nurses who have undertaken appropriate training should provide non-surgical cosmetic treatments such as Botox, recommends new professional standards for cosmetic practice out today. Currently certain cosmetic treatments can be administered by anyone, anywhere with no medical training.

The guidelines state that as standard practice, practitioners should discuss relevant psychological issues (including any psychiatric history) with the patient to establish the nature of their body image concerns and their reasons for seeking treatment. They should not at any point imply that treatment will improve a patient’s psychological wellbeing.

Aimed at all doctors, dentists and nurses involved in cosmetic practice, the comprehensive document entitled Professional Standards for Cosmetic Practice, focuses on the behaviour and competencies medical professionals should be expected to demonstrate when providing cosmetic procedures.

The standards, issued by the Royal College of Surgeons (RCS), state that financial deals such as time limited discounts should be banned and stringent psychological assessment promoted. They lay out the professional duty practitioners have to their patients, including the need to ensure they have a clear understanding of the risks of the procedure, outlining consequent aftercare and being transparent about costs from the outset.

Professor Norman Williams, President of the Royal College of Surgeons, said:
“While the Colleges and professional organisations involved in cosmetic practice are neither regulators nor legislators, the profession has a responsibility to provide standards to which we would expect our members to work. We have serious concerns that not all those who offer cosmetic procedures are adequately qualified, or that patients are getting accurate information prior to treatment. We hope these standards will feed into the ongoing review of the industry led by the NHS Medical Director, Sir Bruce Keogh, and improve quality of care for patients going forward.”

Developed by a working group of key professionals including surgeons, psychiatrists, psychologists and dermatologists, key points in the professional standards include:

• Practitioners have a duty to manage a patient’s expectations of how they will feel after treatment. They should not imply that patients will feel ‘better’ or ‘look nicer’, and should instead use unambiguous language like ‘bigger’ or ‘smaller’ to describe what that patient is trying to change.
• All practitioners should consider whether they should refer a patient to a clinical psychologist before proceeding with further consultations or treatments. Pre-procedure discussions should include the disclosure of relevant psychiatric history such as eating disorders and the practitioner should document any signs or symptoms of Body Dysmorphic Disorder. Psychological factors contributing to the motivation to undergo the procedure and expectations of outcome should also be assessed.
• Marketing and advertising must be honest and responsible, using only real patient photographs that have not been air brushed or digitally enhanced.
• Currently non-surgical procedures such as laser treatments or injectables can be administered by people with no healthcare qualifications whatsoever. The RCS recommends that only licensed doctors, registered dentists and registered nurses who have undertaken appropriate training should provide any cosmetic treatment.
• Only those who have qualified as a medical doctor and undertaken post-graduate surgical training should carry out invasive procedures such as breast surgery or liposuction.

Mr Steve Cannon, Chairman of the working party and RCS council member, said:
“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.”

The working group cites 2010’s National Confidential Enquiry into Patient Outcome and Death (NCEPOD) report On the face of it, which revealed a lack of consistent professional standards in cosmetic surgical practice, as the impetus for these standards. More recently, the problems with PIP breast implants exposed further shortcomings within the industry as many women were caused unnecessary distress as they struggled to track down and access their medical records to determine which implant they had received.

Mr Ian Martin, NCEPOD Clinical Co-ordinator, said:
"In 2008 we identified poor regulation, low volume practice, and deficiencies in training. We also identified poor standards of consent and unrealistic advertisements which had tended to stress the benefits of surgery without dealing sufficiently with potential side effects. The lack of standards and systematic audit was also highlighted.  We are very pleased to note that the Department of Health and Royal College of Surgeons are now taking steps to address these deficiencies in cosmetic surgical practice and support the report published today."

The standards also outline the importance of having a cooling off period between the initial consultation and treatment – giving at least two weeks for invasive surgical procedures to allow patients to reflect on their decision. It states that financial inducements, such as time limited special offers and discounts, are unacceptable and calls for measures to ensure that fees are transparent and set out in advance.

They conclude by highlighting that all cosmetic procedures should be carried out on licensed premises with resuscitation equipment readily available in the event of an emergency. The concept of ‘Botox parties’ or ‘filler parties’ are entirely at odds with these standards.

Notes to editors

A copy of professional standards can be found here.

The Royal College of Surgeons of England is committed to enabling surgeons to achieve and maintain the highest standards of surgical practice and patient care. Registered charity number: 212808

For more information, please contact the RCS press office on:

• 020 7869 6047/ 6052
• communications@rcseng.ac.uk
• Out-of hours: 07966 486 832

NCEPOD is an independent charitable organisation that reviews medical and surgical clinical practice and makes recommendations to improve the quality of the delivery of care.