Cosmetic surgery

What are your qualifications?

Any doctor can call themselves a cosmetic surgeon, so you need to be sure that you'll be seen by someone who has the necessary qualifications. Even Fellows of the Royal College of Surgeons (with FRCS after their name) might not have any specialist training in performing cosmetic procedures. You should find out whether your surgeon is in the plastic surgery section of the General Medical Council's (GMC) specialist register - see www.gmc-uk.org or phone 08453 573456. To be on this register, they have to complete six years of specialist training and obtain a 'FRCSplast' qualification.

What organisations are you a member of?

Members of the British Association of Plastic Surgeons all have specialist training in plastic and reconstructive surgery and may also carry out cosmetic work. Members of the British Association of Aesthetic Plastic Surgeons (BAAPS) will have further specialist training in cosmetic surgery. You can confirm whether a surgeon is a member of these associations by contacting the GMC. Details of BAAPS members are also available at www.baaps.org.uk

What results can I expect and how long will they last?

Make sure your surgeon is clear about what you should expect and don't accept broad terms like 'significantly better'. The effect of cosmetic surgery is not permanent. The effects of a facelift, for example, can last for up to 10 years, depending on the elasticity of your skin, your age and how much your skin is exposed to the sun. Over time, the effects of breast implants will diminish and the breasts will sag. If you have had any kind of implant, check how long they will last and whether they will need to be replaced at a later date.

How much will it cost and are there any other fees?

Beware of 'free' consultations and avoid booking fees or non-refundable deposits. Make sure that it's clear what is and isn't included in the fees quoted. You should always be free to change your mind about surgery, so there should be no financial penalties for cancelling your operation.

Our data on prices charged at private hospitals show that you should expect the following costs, depending on the extent of the surgery:

• nose reshaping - £1000 to £5075
• facelift - £650 to £7,860
• breast augmentation - £965 to £5,628
• breast reduction - £3000 to £6000
• tummy tuck - £3,000 and £6,000

How long will it take to recover and what kind of aftercare do I need?

Your surgeon should provide details on how much bruising, swelling, scarring and pain you can expect, what you should be doing to look after yourself and advise you on the care and removal of any stitching. Make sure you are made aware of all the risks and possible side effects.

Do you ever recommend counselling?

Everyone has different reasons for wanting to change their appearance, but having cosmetic surgery might not necessarily be the best option for you. Surgery should be avoided if you have recently experienced life events such as moving house, changing job, losing a loved one, the break-up of a relationship or the arrival of children, and a good surgeon is likely to refer you for counselling rather than operate.

What experience do you have of this procedure?

Even qualified plastic surgeons might not have extensive training and experience in some procedures. Of the 344 plastic surgeons on our consultant database, 128 said they specialise in cosmetic surgery. On the whole, surgeons who specialise in the area and have conducted many operations will have a greater success rate. Ask how many operations your surgeon performs each year and how they measure results.

Questions for nose surgery (rhinoplasty)

Of the 344 plastic surgeons on our consultant database only 13 said they specialised in cosmetic rhinoplasty. Ear, nose and throat surgeons may also perform nose reshaping, but if your surgeon is not on the specialist register for plastic surgeons you should check that they have the necessary specialist training and experience in the procedure.

Will a bone graft be required?

Sometimes you will need additional framework for the nose underneath the skin. Manufactured implants are available, but a bone graft or cartilage from another part of your body is another option. There are various advantages and disadvantages for each approach, so make sure your surgeon tells you exactly what they are proposing and why.

Do I need a general anaesthetic, and how long will I stay in hospital?

Most surgeons prefer to do rhinoplasty operations using a general anaesthetic, so you will need to stay in hospital at least overnight. For larger reconstructions, and if a bone graft from the hip or chest is required, you might need to stay longer. If you only need a small implant, a local anaesthetic might be sufficient and you will not need to stay in hospital.

What are the risks and what is your complication rate?

Make sure you are made aware of all the risks and possible side effects - for example, in some cases patients will experience heavy nose bleeding shortly afterwards which may require treatment in hospital. For some patients the nose doesn't look right, so a further operation (revision) might be required. The revision rate is about 5 per cent, and all swelling will need to have settled before further surgery is carried out, which could be more than 6 months later. Some hospitals or clinics will record complication rates, although this might be done anonymously. Ask your surgeon what their complication rate is and get them to explain how and why any problems have occurred. It might be difficult to confirm what they tell you but misrepresentation is a very serious offence.

Specific questions for face lifts

According to our consultants database, 24 out of 344 plastic surgeons say they specialise in cosmetic facial surgery.

Do I need a general anaesthetic?

Most surgeons prefer to do facelift operations using a general anaesthetic, so you will need to stay in hospital at least overnight. It's possible to use a local anaesthetic and intravenous sedation, but you should still be advised to stay the night in hospital.

What techniques do you use?

There are a variety of techniques used by surgeons, so find out what options are available and the advantages and disadvantages of each. For example, an endoscopic facelift uses fine telescopic instruments to work under the skin. A facelift works better for the lower half of your face, so your surgeon might suggest an endoscopic browlift if you have sagging eyebrows or wrinkles on the forehead. Loose skin with fine wrinkles, freckles and rough areas could benefit more from a chemical peel or laser resurfacing.

What are the risks and what is your complication rate?

Make sure you are made aware of all the risks and possible side effects. Bleeding under the skin - or haematoma - occurs in 3 per cent of cases and a further operation might be required to stop the bleeding. Minor hair loss might occur with an endoscopic browlift. In rare cases, there could be damage to the facial nerves, causing numbness that can be permanent. Ideally, you should be given written information about the operation so you can take it home and consider it carefully. Find out what complications your surgeon has encountered and how frequently they have occurred.

What experience do you have with this procedure?

Even qualified plastic surgeons might not have extensive training and experience in certain procedures. On the whole, a surgeon that has carried out more surgery or specialises in the area will have a greater success rate. Ask how many operations your surgeon performs each year and how they measure results.

Specific questions for breast surgery

Of the 344 plastic surgeons on our consultant database, 108 said they specialised in breast surgery. Ask how many operations your surgeon performs each year and how they measure results.

Will I have a general anaesthetic?

Breast enlargements are usually carried out under a general anaesthetic, but it is possible that could be treated as a day case under local anaesthetic. Breast reduction will always involve general anaesthetic and you might need to stay in hospital for few days.

What kind of implant is available?

Breast implants have an outer layer of silicone but might be filled with silicone gel, salt water or soya bean oil. Some implants are round and others shaped more like a natural breast. There are now low-bleed breast implants available but no-bleed implants are stiffer and might not be so comfortable. There is also no evidence to show that one kind of implant is more likely to rupture than another, but there are advantages and disadvantages for each type. Get your surgeon to outline your options. There is no evidence of a connection between breast implants and breast cancer or any other serious health condition, but discuss any concerns with your surgeon.

What are the risks and what is your complication rate?

Make sure you are made aware of all the risks and possible side effects. Some degree of silicone leakage occurs in around 10 per cent of cases, which can be painful. Treatment or temporary removal of the implant might be required. Scar tissue around the implant might also cause pain and discomfort and require a further operation. Ideally, you should be given written information about the operation so you can take it home and consider it carefully. Find out what complications your surgeon has encountered and how frequently they have occurred.

Questions for tummy tucks (abdominoplasty)

What kind abdominoplasty should I have?

The extent of the abdominoplasty depends on how much excess skin and fat needs to be removed, and your surgeon should show which kind of procedure is suitable for you. A mini-abdominoplasty leaves a low scar and the navel is not disturbed. With an extended abdominoplasty, surplus skin and fat are also removed, so the scar extends around the flanks and on to the lower back. An endoscopic abdominoplasty is used to tighten the muscles of the abdominal wall, and no skin is removed.

Is liposuction suitable?

Liposuction may be carried out during an abdominoplasty or as a separate procedure before or after the operation. Liposuction alone should always be considered before you choose to have an abdominoplasty, so make sure your surgeon explains all your options.

Who is the anaesthetist and what is their experience?

A standard abdominoplasty is a major procedure so you will need a general anaesthetic and two to four days in hospital.

What are the risks and what is your complication rate?

Complications occur in less than 1 per cent of cases, but make sure you are made aware of all the risks and possible side effects. Blood and serum can accumulate after the drains have been removed and might need further drainage or aspiration. Healing can be slow - especially if you are overweight and smoke - and dressings might be needed for a few weeks. There will be numbness in the lower abdominal wall after surgery, but this could be permanent. There will be significant scarring, so ask your surgeon exactly where your scars will be and how noticeable they will be. Ideally, you should be given written information about the operation so you can take it home and consider it carefully. Find out what complications your surgeon has encountered and how frequently they have occurred.

Useful links

British Association of Aesthetic Plastic Surgeons

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