Advising patients on cosmetic surgery

GPs have a key role in advising patients on the consequences of cosmetic surgery, says Professor Simon Kay.

GPs can help patients considering cosmetic surgery in a number of ways, including determining whether a patient is suitable for surgery and advising them on the health and financial consequences. They can also provide help in choosing a surgeon and support the patient through the outcomes of surgery.

Cosmetic surgery has changed in scope immensely over the last 20 years. The traditional areas of facial rejuvenation, breast surgery and abdominoplasty have been joined by surgery following massive weight loss (increasingly prevalent), thigh and arm reduction, liposuction and even genital surgery.

Surgery for men has increased greatly also.

Choosing surgery
When considering suitability for surgery a GP's knowledge of a patient can be very valuable, not only because they have information about their health and medication use, but also because they are well placed to recognise any psychological issues and to assess the patient's ability to consider the decision in the context of other life events.

GPs are also often able to advocate caution and sensible evaluation of the options before offering advice on how to choose a surgeon.

Surgeons who frequently move around the country, or internationally, are less easily evaluated or held to account than a surgeon rooted in the local medical landscape. A local surgeon is more easily researched, and almost always more easily contacted.

For similar reasons it is unwise to consider surgery abroad because it may be difficult to access adequate medical care should there be complications, and because there is a risk of thromboembolism associated with combining surgery and travel.

In addition, the NHS is likely to offer only the minimum of care to patients with complications arising from private cosmetic surgery abroad.

Some patients may already have a particular surgeon in mind when they come to their GP seeking more information.

Accreditation
Consultant plastic surgeons with NHS appointments will almost always be on the specialist register of the GMC. In addition, they should already be known to local GPs and can offer all the security of established surgical practice.

The FRCS in plastic surgery is desirable. Some surgeons will have specialist qualifications such as FRCS (OMFS) for oral and maxillofacial surgery, appropriate for some aspects of practice.

Membership of the British Association of Plastic, Reconstructive and Aesthetic Surgeons also requires specialist qualifications.

Other organisations for related specialties such as ENT and maxillofacial surgery have appropriate or similar standards. These include the British Association of Aesthetic Plastic Surgeons, the British Association of Oral and Maxillofacial Surgeons and the British Association of Otorhinolaryngologists.

Patients and GPs should be careful to assess organisations not on this list as some have emerged to act as commercial referral agencies, and not to represent core surgical specialties.

Discussion between a GP and the patient after their first consultation with a surgeon may be helpful. On some occasions GPs may help a patient to seek a second opinion, something that many patients find difficult to do on their own.

This is an example of the important advocacy role of the GP, who is independent, objective and able to protect the patient from hasty decisions or from feeling pressured into complying with a surgical plan without hearing options from other surgeons.

In most cases this will not be needed, but no surgeon should resent such intercession by the GP. Instead, they should welcome it, recognising the enduring relationship and bond of trust between patients and their GP.

Complications
After surgery, the GP's support is often invaluable. Every surgeon should have a support facility to care promptly for patients with complications arising from surgery.

However, patients with wound infections, wound care and medical complications may present to their GP first.

Each surgical care team should give their patients simple instructions on how to be contacted and should be prepared to share care with the GP or relieve the GP of the duty where possible. This professional liaison can be invaluable to the patient.

Professor Kay is consultant plastic surgeon in Leeds and vice president of the British Association of Plastic Aesthetic and Reconstructive Surgeons.

Qualities to seek in a cosmetic surgeon

  • Good reputation.
  • Practices locally.
  • On specialist GMC register.
  • Suitable qualification (FRCS Plast or equivalent).
  • Approachable and prepared to discuss qualifications and experience.
  • Open to second opinion.
  • Practising in a reputable well-equipped accessible hospital.

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