Mismatch between Patients’ Expectations and Outcomes Requires Firmer Definition of Aesthetic/ Cosmetic Plastic Surgery Procedures.
ExpectaAesthetic/Cosmetic Surgery has increased enormously within the UK over the last fifteen to twenty years. Nearly one billion pounds per year is now spent on aesthetic/cosmetic procedures within the UK. In the late nineties more surgically non-invasive procedures became popular e.g. skin fillers. The injectable skin fillers are ‘completely unregulated’ and many experts fear that this could be a new cosmetics surgery disaster following the PIP implant scandal in the future.
There is a clear increase in private clinics and doctors/surgeons who are offering aesthetic/ cosmetic procedures, and solicitors are seeing a significant increase in the number of patients who have been treated negligently. The Independent Healthcare Advisory Services defined aesthetic/cosmetic surgery in 2006 as ‘operations and procedures that revise or change the appearance, colour, texture, and structural position of the bodily features to achieve what the patient perceives to be thought desirable’.
We also though see a common mismatch between the patient’s expectations and what the providers can achieve via positive advertising and models. This is clearly very dangerous since many patients are not given a realistic enough impression of what can be achieved with different treatments and surgery.
We have seen an increase in litigation within aesthetic/cosmetic surgery since the beginning of 2000. This has possibly occurred due to an increase in patient’s expectations but clearer definitions are necessary with regards to outcome. Not every patient can be helped with aesthetic/ cosmetic surgery. If a patient cannot anticipate the outcome in aesthetic/cosmetic surgery then this treatment should clearly not be offered in order to avoid the mismatch between the patient’s expectations and the provider.
The Medical Defence Union has also seen a large increase in litigation with cosmetic/aesthetic plastic surgery. One fifth of claims in plastic surgery involve consent issues and the most common reason for bringing a claim is dissatisfaction of aesthetic outcome.
The British Association of Plastic Reconstructive Aesthetic Surgery do clearly support firmer definition of procedures and ninety-seven percent of plastic surgeons did indeed support a National Implant Register which was implemented as of 1 January this year.
Many cosmetic/aesthetic procedures do however seem to fall entirely outside the regulations which are in place. Of all cosmetic/aesthetic procedures which are performed the non-surgical invasive procedures take up 75 %.
Patients receive dermal fillers via GPs or even dentists and this does of course lead to a very unclear picture without definition, and it makes it even more difficult for serious plastic surgeons who are members of established plastic surgical organisations, to have an impact on the current climate and to protect patients from organisations which are creating unrealistic impressions of what is achievable within cosmetic/aesthetic surgery.
In February 2014 the Department of Health published the Governments response to the review of the regulation of cosmetic interventions. Some work is already underway on a number of the recommendations. The Royal College of Surgeons is setting up a committee to ensure standards for cosmetic surgey and will work together with the General Medical Council. A review will take place with regards to training of providers of some non-surgical procedures. A breast implant registry is in the process of being set up.
However, Plastic Surgical Organisations say that this is not enough. The Royal College of Surgeon’s remit does not extend to non-surgical healthcare professionals, such as GP’s, nurses or dentists which may undertake certain cosmetic procedures, also the breast implant registry has been set up as a voluntary registery and without compulsion.
Indemnity insurance for plastic surgeons has also increased enormously over the last ten years and clearly this has happened as a secondary effect to the increase of litigation in cosmetic and aesthetic surgery. There are clearly many serious well educated plastic surgeons within the UK that can offer aesthetic/cosmetic treatments to patients wherefore it is more important to make patients aware that not everyone who conducts cosmetic/aesthetic treatment may indeed have the background which is also vital. The understanding of whether a patient at all can be helped or not with aesthetic/cosmetic procedures takes a lot of experience. Some patients will clearly not benefit from treatment and in any event may though instead have underlying problems which would continue even if cosmetic/aesthetic procedures are conducted.
It is clear that doctors and nurses need to refrain from treating such patients since one is in fact indeed just otherwise giving false hope, which is not what should be done. Risks and complications do always need to be taken into consideration before offering aesthetic/cosmetic procedures. It is even more difficult to turn patients away from treatments which will not lead to the desired results but this is where the medical profession has more responsibility, and with the support of a legal representative one is hoping to see more improved patient selection in order to have a higher percentage of positive outcomes and reduced litigation.
Lena C. Andersson M.D., Dr. med. Consultant Plastic Surgeon