Why use a Plastic Surgeon?

Finding the right doctor can be difficult if you do not know what to look for, but it is key to making the correct decision about plastic surgery. Sadly, there are practitioners who monopolise this confusion by not making their qualifications clear to patients.

One big issue for many people is that a cosmetic surgeon, an aesthetic practitioner and a cosmetic doctor are not the same as a Board-Certified Plastic Surgeon. Whilst cosmetic surgery is a significant part of plastic surgery, cosmetic surgeons can only perform cosmetic and not reconstruction procedures. Plastic surgeons have qualifications in plastic surgery, reconstructive surgery and cosmetic/aesthetic surgery.

Tagliocozzi (1545-1599), one of the pioneers of plastic surgery clarified the role of plastic surgeons in the 16th century:

"We restore, rebuild, and make whole those parts which nature hath given, but which fortune has taken away. Not so much that it may delight the eye, but that it might buoy up the spirit, and help the mind of the afflicted.” 

Tagliocozzi (1545-1599)
Dr Anne Dancey

A 2017 report in Plastic and Reconstructive Surgery, found that people were confused between the terms “plastic” and “cosmetic” surgeons. In a survey of 5,135 people, 87 percent believed that surgeons had to have special credentials and training to perform cosmetic procedures or to advertise themselves as aesthetic, cosmetic, or plastic surgeons. More than half were unsure what the requirements were to be “board certified.”

The results demonstrate the need to eliminate confusing medical marketing in order to have a transparent system, where informed patients are assured a safe and aesthetically acceptable outcome by the best qualified surgeon for their needs.

Two types of Plastic Surgery

If you are still not sure what the difference is, here is what you need to know. First, there are two types of plastic surgery:

  • Reconstructive plastic surgery: This treats parts of the body affected aesthetically or functionally by infection, tumours, disease, congenital defects, developmental abnormalities, or trauma.
  • Cosmetic plastic surgery: This enhances or reshapes parts of the body, which are essentially normal.

Reconstructive plastic surgery may be covered under insurance, whereas cosmetic plastic surgery is elective and not usually covered.

Having a breast reconstructed after a mastectomy is a reconstructive procedure that only a plastic surgeon/oncoplastic surgeon should perform. Having a breast lift (augmentation) is a cosmetic procedure that could be performed by a plastic or cosmetic surgeon.

A plastic surgeon seamlessly addresses both function and appearance to give the best result for the patient. The best results require a surgeon, who is adequately trained and experienced to consider the patient as a whole, and address both these areas.

What ‘qualified’ actually means

Board-Certified or Specialist Registered plastic surgeons have been credentialed by the Royal College of Surgeons England (RCS Eng) and the General Medical Council (GMC).

UK plastic surgeons complete at least 6 years of specific plastic surgery training after completing 3 years of general surgery training. They have also undergone a fellowship in their subspecialisation and passed the examination in plastic surgery. Furthermore, UK plastic surgeons who undertake cosmetic surgery must now obtain a certificate in cosmetic surgery once they are a consultant, to ensure they meet the cosmetic standards.

Cosmetic surgery is not a recognised speciality and therefore, surgeons may not have board or Royal College of Surgeons certification to ensure they meet the required standards and have the relevant experience. Hence, any doctor (from a dermatologist to an oral surgeon) can call themselves cosmetic surgeons as, unfortunately, this is not regulated.

Medical marketing mania

An issue of considerable concern arises when individuals, unaware of the distinctions among surgeons, seek cosmetic procedures from practitioners who lack specific expertise in cosmetic surgery. These non-specialist doctors may possess only a restricted array of cosmetic treatment modalities.

Consequently, patients might not receive comprehensive information regarding the full spectrum of available options, and they may not benefit from adept management of potential complications. The notion that an unqualified surgeon can undertake cosmetic surgery procedures, fraught with significant risks, is indeed remarkable.

What patients can do

  • Check your surgeon’s credentials:  If the surgeon has UK qualifications they should be on the Specialist Register of the General Medical Council and a member of the British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS) or the British Association of Aesthetic Plastic Surgeons (BAAPS). Consider the surgeon’s academic credentials, including what they have published in peer-reviewed scientific journals.
  • Do your research: If it sounds ‘too good to be true’ it generally is. Never feel pressurised into committing to surgery or any medical procedure because of a ‘discount’ or ‘special offer’.
  • Talk to a past patient: Try and talk to people who have had the procedure that you are considering. Independent online review websites are useful but preferably discuss this decision with someone you know or have met. It is easy to produce fake online reviews.
  • Be prepared for your consultation: Make sure to ask any questions you have about the procedure you are interested in. It is important that your consultation should be with the surgeon who will be performing your procedure. If you can, bring a close friend or family member to support you and help remember the information. A good surgeon will always offer you a second consultation to rediscuss surgery and send you a comprehensive letter about the surgery and alternative options after a consultation.
  • Medical Malpractice Insurance: Do ask for details and confirmation that your surgeon has appropriate medical malpractice insurance. Most regulated and clinics have a statutory responsibility to ensure that all their surgeons with practicing privileges are suitably insured.
  • Be open-minded: It is important to bear in mind that the procedure that you enquire about may not be the most suitable for you. The surgeon will discuss any alternative options, along with all associated risks and the pros and cons.
  • Meet the team, look round the hospital: Ask the surgeon if you can meet the team who will be looking after you. It is important that you gain a visual perspective of where you will be staying and who will be caring for you. Do not be afraid to ask questions concerning any matter with regards to your care.
  • See your GP: It is always a good idea to discuss your plans with your family doctor/GP as they know your medical history and can advise in general about the implications of surgery.
  • Take your time: A good surgeon will not take a booking on the day of consultation but will offer you a ‘cooling off’ period so that you can thoroughly consider your options. Never be pressured or induced into electing for surgery.
  • Get a price: The hospital should offer a fixed price package, which will include hospital, surgeon and anaesthetist’s fees, as well as any implant costs and aftercare. If insured, you must confirm that your proposed surgery is covered within the policy you hold with your insurance company, given the different policies insurance companies offer.
  • On-going support: Ask how many post-operative visits are included within the aftercare package and make sure you will have the follow up appointments with the surgeon who performed your surgery.

Registered plastic surgeons can only operate in properly regulated facilities and can only perform procedures in the clinic or hospital for which they have practising privileges. They must have transfer privileges to at least one local hospital in case of an emergency.