The Five Cs – A Cosmetic Surgery Checklist

Cosmetic surgery is becoming more and more popular in the UK.  Advances in plastic surgery, coupled with the vast range of treatments on offer, means there is now a bewildering array of cosmetic surgical interventions available to the public.

If you are considering cosmetic surgery, it is essential that you think carefully about what you want and why you want it. You need to approach all cosmetic procedures, both surgical and non-surgical, in a safe and considered way; do not rush in, take your time – no matter how urgently you want something done. It is important that you assess your options, do your research and find the right surgeon for the job. You’ll only get the result you want if you have a cosmetic procedure for the right reasons, at the right time, in the right place and with a well trained surgeon who understands your needs. 

The vast majority of cosmetic procedures end with satisfied patients. Following the process on this checklist will help you decide what is best for you and help ensure that your experience is a happy and rewarding one.

 The Five Cs - A cosmetic surgery checklist
1. Think about the CHANGE you want to see.  Do your research.  Find out all you can about the treatment/s you want.  Be precise as to the change you hope to see and the reasons why.
2. CHECK OUT potential surgeons. If you are thinking about cosmetic surgery, speak to your GP. Make sure that you find a surgeon that has the right qualifications and is on the appropriate specialist register with the GMC.  Find out about their experience of the procedure you are considering and make sure you meet them before you commit to having something done.
3. Have a thorough CONSULTATION. Your surgeon will discuss and clarify the treatment options with you and then plan your treatment.  Make sure you know the risks involved and feel comfortable with the surgeon who will be carrying out your surgery.
4. COOL off before you commit. You need to be confident about your decision to have cosmetic surgery.  So after your initial consultation, give yourself some time to decide that you want the surgery and to make sure you feel at ease with the surgeon who will be treating you.  Don’t commit to surgery if you have any doubts that either the procedure, or the surgeon is the right one for you. Often your surgeon will advise a second consultation before the final decisions are made.
5. CARE about your aftercare.  Aftercare can be just as important as the surgery itself, so make sure you know who to contact and how you will be looked after, especially if there are any complications or problems following your surgery or treatment.

1. Think about the CHANGE you want to see

The decision to have cosmetic surgery should not be made lightly.  You need to be honest with yourself about what you want to have done and what you expect it to achieve.  Are there any alternatives that will allow you to avoid surgery? 

It is also important to do your homework before going ahead.  Whether it is about finding the right treatment or ensuring the surgery will achieve the change you want, it is essential that you spend time researching and looking for information specific to the surgery you are considering. 

Start your research by visiting the Department of Health’s website.

In addition, the BAPRAS (www.bapras.org.uk) website contains useful patient information on the different cosmetic surgery options available.

2. CHECK OUT potential surgeons

How do you get the best advice?  It is essential to do your own research, but you can ask your GP to refer you to someone who is known and trusted.  Your GP knows your medical history and will have insights into local services and offer impartial advice.

You should always seek advice from an experienced practitioner. They will be able to tell you whether the surgery is suitable for you and what the risks and benefits of any particular cosmetic procedure are. Don’t opt for an organisation whose credentials are uncertain, or where cosmetic treatments are being offered on the cheap. Beware anyone trying to tie you into a surgical procedure via a non-refundable deposit and bear in mind that if you do opt for cut-price surgery, you may pay for it later. 

You should check online to find out if a surgeon is registered with GMC
(http://www.gmc-uk.org/register/search/index.asp or call 0845 357 3456) and you can also see if they are on the GMC Specialist Plastic Surgery Register.  You can also check if surgeon is a member of BAPRAS (click find a member at the top of every page on the website).

In the right hands, cosmetic surgery can be a safe and satisfying experience. In the wrong hands, it can be disastrous – so, make sure you do all you can to find a qualified and experienced plastic surgeon who specialises in what you want.

You need to be happy with your choice of surgeon; qualifications count for nothing if a surgeon makes you anxious or uncomfortable. If something does not feel right, take a step back and think things through. 

3. Have a thorough CONSULTATION

Once you have found a surgeon, you need to plan your treatment carefully.  Thorough and informative consultations should take place before surgical or non-invasive cosmetic procedures.  You should be spending one-to-one time with the surgeon who will be conducting the procedure, not a representative of a clinic or hospital.

In cosmetic surgery, the outcomes need to be agreed and decided jointly by the patient and surgeon. If this dialogue and understanding is established, everything else should flow from that. You should be prepared for the possibility that the surgeon may advise against the procedure or treatment that you are considering. A surgeon should consider what is best for you even if this means turning you down for surgery.

So, you need to clarify and discuss your reasons for wanting surgery, and your overall expectations. This process is important to help ensure that you are not approaching the procedure with an unrealistic idea of what can be achieved. Be really precise about what bothers you, for example, rather than saying “I don’t like my nose”, say exactly what you don’t like, “It’s too big, too broad at the top, or I don’t like my profile”.  This way, you can be given the best advice and are more likely to achieve the result you want.

You also need to know very clearly what you are getting into. Like any surgical procedure, plastic surgery carries risk of complications, so find out what the risks are before your surgery.

Don’t be shy about taking a list of questions to the consultation.  The purpose of the consultation is to make sure that you are given all the necessary information to make an informed decision. 

Apart from clinical information, find out about all the costs associated with the procedure and exactly what the treatment package includes. You should leave the consultation feeling reassured, but don’t feel you need to decide straight away.

4. COOL off before you commit

After meeting your surgeon it is good to have a cooling off period before a second consultation to make sure you really want the surgery.  Give yourself some time to think about your options, reflect on what you were told at the first consultation and whether the benefits outweigh the potential risks (depending on your medical history and the procedure you are considering, the risks associated with the surgery may be relatively small or could be significant). 

A second consultation will allow you to ask further questions and get a genuine feel for what’s involved.  Don’t let yourself be pressured into signing the dotted line: committing to surgery is a big step and you should feel fully confident in the treatment you’re having and the surgeon you are entrusting to carry it out. This is the time to get details of the clinic or hospital that the surgeon is recommending and to check that they are fully registered with the appropriate regulatory body in your country. In England this is the Care Quality Commission; in Northern Ireland this is the Regulation and Quality Improvement Authority in Scotland this is Healthcare Improvement Scotland; and in Wales this is the Health Inspectorate Wales.

If you don’t feel confident about any aspect of the surgery, ask more questions and give yourself time to be sure.

5. CARE about your aftercare

Having cosmetic surgery is a big decision, so make sure you are happy with the decisions that you make, and any agreements that you sign up to. It is important you know what’s included in the price you are paying for your surgery.

Aftercare is a crucial part of your recovery.  Complications post surgery can happen and you need to be able to go back to the clinic or hospital easily.  If you do experience any problems you should not have to travel far to see your surgeon. How far the clinic or hospital is from your home should play a part in your decision. 

Make sure your surgeon arranges full aftercare for you following your operation. This aftercare needs to be during your stay in hospital, then afterwards with follow-up consultations and any further treatment that may be required to resolve any problems. Good aftercare is just as important as the surgery itself, and will usually be provided by the surgeon and their personal team. You should be in no doubt who to contact at any time if you have any concerns.

Conditions that develop later in life due to accident or infection.
Lazy eye.
A preinvasive cancer involving the surface layer of the anus.
Before birth.
Rare and dangerous lesions that occur in the scalp, head and neck region. Often triggered by puberty, there is often a visible swelling in the skin which is blue in colour.
This is surgery to fuse a joint.
The procedure whereby liquid contents of a swelling can be removed with a needle.
Reconstruction of the ear using the patient’s own tissue.
This is the most common form of skin cancer. It grows locally and does not spread elsewhere in the body. It is usually cured by simple removal.
A colloquial term for prominent ears.
A condition caused by infection of by a reduced blood supply to the facial nerve.
A benign condition is one that is not usually serious or harmful.
When clefts occur on both sides of the mouth.
Microtia affecting both ears.
A biopsy is a medical test involving the removal of cells or tissues for examination.
A new surgical technique often used in the treatment of hemifacial microsomia. Developed from limb lengthening operations first described in Russia, this technique is based on the principle of pushing small pins into bone, and moving these pins apart by a connecting bar which incorporates a screw thread. As the pins are gradually stretched apart, the bone and surrounding soft tissue is also stretched.
The group of nerves located behind the collar bone which control feeling and movements in the arm.
An artificial implant that is under the skin.
The smallest blood vessels in the deep layer of skin.
Another term for a haemangioma or strawberry mark.
A condition caused by mechanical interference with the median nerve in the wrist. This large nerve provides feeling to the thumb, index and middle fingers and half of the ring finger. It also provides power to the small muscles at the base of the thumb. The median nerve enters the hand from the forearm, passing beneath a tough ligament (known as the carpal ligament) that runs across the wrist. This nerve can become squeezed, either because the contents of the tunnel beneath the ligament swell, or because the size of the tunnel decreases. This squeezing of the nerve causes tingling in the fingers, often accompanied by numbness. These sensations are usually worse at night, and often wake a patient from sleep. Pain can occur later on in the condition and can be felt in the hand, forearm or even in the upper arm and shoulder.
An acquired shriveling of the outer ear common in boxers and rugby players.
Another term for a haemangioma or strawberry mark.
Abnormal cells in the cervix that only involve the surface layer of the cervix.
The neck of the uterus or womb.
Saromas arising from cartilage
Split or separation.
Where the lip components fail to fuse and are split or separated.
A specialist nurse that works as part of the cleft lip and palate team.
Where the palate is split or separated. This occurs when the main components of the palate – the two palatal shelves in the roof of the mouth – fail to fuse properly.
A clinical expert in the delivery of evidence-based nursing interventions usually in one specific area of clinical practice.
Medical practitioner who specialises in cancer and its treatment.
Nose reshaping operation carried out from inside the nostrils.
The central piece at the bottom of the nose that divides the nostrils.
A whole side-cleft running up to the nose from the lip.
A complete cleft of the palate extends to the hard palate, the bony part at the front of the mouth.
A graft consisting of skin and other underlying tissues such as fat and cartilage.
The cartilage bowl of the ear.
Conditions present at birth.
A congenital condition in which the ear takes on a cup shape due to shortening of the outer circumference of the ear.
A situation where tissues or scars shorten and cause deformity.
A bone distraction procedure whereby a cut is made in the bone which is to be stretched. Pins are passed through the skin and into the bone on either side of the cut. These pins are then connected together by a distractor. In most cases, the distractor is opened by approximately one to two millimetres each day through the turning of a small screw. An average distraction length is likely to be in the region of two to two and half centimetres, which will probably take about three weeks to achieve. At the end of the period of distraction, the distractor is left in position for six to eight weeks while new bone fills the gaps which have been created. A second small operation is then required to remove the distractor.
Is the term used to describe a number of conditions which, like craniosynostosis, involve the overgrowth and undergrowth of the structures of the head and face.
A condition caused by the premature closure of the gaps between the bones of the cranium.
Cryptotia means ‘buried ear’. This is a relatively rare deformation in which the groove behind the ear is not fully formed. This is aesthetically displeasing and can cause difficulties in wearing glasses. This condition can occasionally be corrected using splints but more commonly is corrected surgically around the age of 5.
A colloquial term for constricted ears.
Cysts associated with the skin are very common. They appear as rubbery or firm lumps just beneath the skin and attached to it. Often a tendency to get cysts is inherited. If they grow large they can become unsightly, they can become infected.
Concerning the act of defaecation.
Flat head syndrome in newborn babies. This is asymmetry in a baby’s head caused by the positioning of the head during extended time spent in a neonatal unit, the birth process, the position in the womb, and most often, the infant's preferred sleeping position.
Deep layer of skin.
A healthy part of the body where skin is removed as part of a skin graft or flap procedure.
Bridge of the nose.
This affects the layer of gristle which lies beneath the skin on the palm of the hand, fastening the skin to bone, enabling us to clutch and grip. The disease first makes its appearance as a small lump in the pit of the palm. Over time, this lump may form a cord of tissue that runs from the palm to the finger. After a while, this cord begins to shrink, drawing the finger into a clawed position.
A treatment for arteriovenous malformations (AVM) with onyx. Designed to stop the blood-flow to the lesions.
A cut made in the posterior wall of the vagina during childbirth.
Surgical removal.
An operation to remove a diseased part of the body.
A balloon-like device inserted under the skin near the area to be repaired, which is then gradually filled with salt water, causing the skin to stretch and grow.
A procedure whereby the face is deliberately split vertically along the line of the nasal bridge during monobloc advancement, in order to bring the eyes closer together, expand the upper jaw and rotate the two halves of the face into a more normal position.
This refers to a paralysis of part of the face caused by a dysfunction of the facial nerve. The facial nerve controls the facial muscles, especially those around the eyes and mouth – for example, the muscles that lift the eyebrows, close the eyelids and raise the corners of the mouth to shape a smile. It is in these areas that patients with facial palsy most commonly experience problems.
When developing tissues fail to join up properly.
Between the tissues of the body are layers of connective tissue that separate them. These layers are known as fascia.
A flap including the fascia along with its blood supply.
Transfer of a living piece of tissue from one part of the body to another, along with the blood vessels that keep it alive. Unlike a skin graft, flaps carry with them their own blood supply. Flap surgery can restore form and function to areas of the body that have lost skin, fat, muscle movement, and/or skeletal support.
Flap reconstruction involves the transfer of a living piece of tissue from one part of the body to another, along with the blood vessel that keeps it alive. Unlike a skin graft, flaps carry with them their own blood supply. Flap surgery can restore form and function to areas of the body that have lost skin, fat, muscle movement, and/or skeletal support. There are two main types of flap. These are local flap and regional flap.
Flap reconstruction involves the transfer of a living piece of tissue from one part of the body to another, along with the blood vessel that keeps it alive. Unlike a skin graft, flaps carry with them their own blood supply. Flap surgery can restore form and function to areas of the body that have lost skin, fat, muscle movement, and/or skeletal support. There are two main types of flap. These are local flap and regional flap.
Asymmetry in a baby’s caused by the positioning of the baby’s head during extended time spent in a neonatal unit, the birth process, the position in the womb, and most often, the infant's preferred sleeping position.
Free flap reconstruction involves the transfer of living tissue from one part of the body to another, along with the blood vessels that keep it alive. Unlike other flap transfers, free flaps are entirely disconnected from their original blood supply and are reconnected using microsurgery in the recipient site. This procedure involves hooking up the tiny blood vessels of the flap with those in the new site, and is carried out with use of an operating microscope.
A graft consisting of all layers of the skin.
Ganglions are the most common type of swelling in the hand. They contain a thick clear liquid called synovial fluid. Although ganglions can arise from any joint or tendon tunnel, there are four common locations in the hand and wrist - in the middle of the back of the wrist; on the front of the wrist at the base of the thumb; at the base of a finger, and on the back of a finger end-joint. Ganglions occur when synovial fluid leaks out of a joint or tendon tunnel and forms a swelling under the skin, although the cause of these leaks is not known. In some cases ganglions are painful, in others they are not.
A clinical geneticist arranges tests and advises patients and families who suffer from inherited conditions.
The term used to describe any surgery to the chin which does not involve the tooth-bearing part of the lower jaw. These procedures may be used to move the chin forwards, backwards, upwards or downwards, and are usually done via an incision made inside the mouth where the lower lip joins the lower gum. The bone of the chin is cut horizontally below the level of the tooth roots, and is then moved into its new position and fixed there with wires or titanium screws. These remain in place and do not need to be removed. The incision is then closed with dissolving stitches.
The lower urinary and reproductive tract.
A drug used to treat GIST sarcomas.
A skin graft involves taking a healthy patch of skin from one area of the body, known as the donor site, and using it to cover another area where skin is missing or damaged. The piece of skin that is moved is entirely disconnected, and requires blood vessels to grow into it when placed in the recipient site.
Concerning cancers arising from the female genital tract.
Medical practitioner who deals with the health of the female reproductive system.
A benign overgrowth of blood vessels on the skin that appears as a soft, raised swelling. They are typically crimson red in colour with a slightly dimpled surface. They appear just after birth, largely around the head and neck but can appear anywhere on the body. Colloquially known as strawberry marks or birthmarks and medically also referred to as strawberry naevi, strawberry haemangiomas, capillary haemangiomas and cavernous haemangiomas.
Major injuries that have been sustained to the hand. This could range from burns and skin loss to loss of digits.
Bony palate at the front of the month.
A congenital condition involving underdevelopment of the face.
The human papilloma virus.
Defect of the urethra in baby boys.
Slight notch in the lip.
This involves either realignment of bones or ligament reconstruction using a tendon; suitable only for a minority of patients who have an unstable joint but little damage to the surfaces of the joints.
The external lips of the vagina.
The outer lips of the vagina.
The inner lips of the vagina.
A surgical procedure to reshape the inner lips of the vagina.
Operations to move the facial bones forward.
Sarcomas that grow out of smooth muscle.
A lesion is a medical name for a skin blemish of some sort. Skin lesions include moles, warts, cysts and lipomas.
A muscle in the middle of the eyelid.
Lipomas are fatty lumps under the skin. They usually grow slowly as painless swellings.
Uses a piece of skin and underlying tissue that lie near to the wound. The flap remains attached at one end so that it continues to be nourished by its original blood supply and is repositioned over the wounded area.
Local removal of a lesion with a cuff of normal tissue.
A colloquial term for constricted ears.
A clear fluid carried through a network of channels in the body known as the lymphatic system.
These are organs consisting of many types of cells, and are part of the lymphatic system. Lymph nodes are found all through the body, and act as filters or traps for foreign particles. They contain white blood cells and are important in the proper functioning of the immune system.
A vascular malformation. These involve the lymph system and are present at birth or develop up until the age of two. The do not shrink or fade. They vary from small blister-like marks on the skin to large swellings in the neck, limbs or face.
A network of channels in the body that carry a clear fluid called lymph.
Melanoma is the type of cancer that arises in pigment cells within the skin. It is less common than the other sorts, but can be more serious. The majority of patients are still cured by simple removal, but melanoma can come back after removal and spread elsewhere in the body. Over the past few decades, the incidence of melanoma has risen steadily throughout the world.
Facial surgery to correct abnormalities of the jaw.
Medical practitioner who specialises in cancer and its treatment.