Opinion Piece – Cosmetic Surgery

This article was first published in The Lawyer, 3 Sept 12

With a major review of cosmetic surgery and procedures underway, a recent survey showed that many people consider the cost of surgery more important than the qualifications of the people undertaking it or the aftercare provided.  Of course, as we saw with the PIP implant story earlier this year, when it all goes wrong, suddenly the focus swings away from price and back to some form of quality assurance and redress.

Professor Sir Bruce Keogh who is leading the Department of Health review into cosmetic surgery has this month asked people to give their views and share their experiences of the industry and cosmetic procedures. His call for evidence raises important questions about practice and improvements that are needed in this sector.

At the end of his review we can expect a set of recommendations covering regulation of these procedures going forward.  Having been involved in healthcare regulation for many years I think one of the key problems is that some of the cosmetic services the Keogh review is intended to include are provided by non-healthcare professionals. Tooth whitening for example, is offered by boutiques, not just dental professionals, whilst some drugs and devices such as dermal fillers are being used other than in accordance with their licence. The current system is fragmented, with loopholes for organisations and individuals wanting to avoid regulation. Consumers do not know how to seek out accredited providers and, given the range of practitioners who carry out cosmetic procedures, from beauticians and tattooists to specialist surgeons, coming up with a way of regulating and accrediting this range of individuals is complex. For that reason a broader and potentially more flexible accreditation may be required. It seems unlikely that a price sensitive public will tolerate the total professionalisation and medicalising of these treatments, even if that would be best for our safety.

There are good arguments for accrediting not just the person involved in providing the cosmetic treatments but the entire localised system delivering that service; the clinic, outlet or treatment centre.  Such a framework would allow for checks to include not only the people involved (their qualifications, training, licensing etc), but also the devices they use (such as implants or chemicals), the equipment, premises and record keeping.  I would also suggest that it includes review of insurance arrangements and a minimum commitment to aftercare.

We have learned over time what ATOL and ABTA mean when we book our holidays. I believe it could be possible, with a clear enough campaign to educate consumers about a recognised accreditation mark, to enable them to know what to look for when seeking assurance.

Of course someone would need to provide and pay for a structure that accredited, dealt with those who claimed false accreditation, processed complaints and removed accreditation from providers who ceased to maintain the necessary standards.  If the accreditation status gives a clear branding benefit, and consumers are persuaded of the value of purchasing treatment from an accredited provider, then the sector may be prepared to develop a form of self regulation.  There is a small window of opportunity for the industry to take the lead on this issue but a lack of cohesion and recognition of the imperative to act quickly may leave the sector subject to an imposed regime of regulation in the future.

Sarah Ellson is a partner and head of Fieldfisher's Public and Regulatory Law Group