Cosmetic surgery and general practice

7th February 2013

 

Cosmetic surgery has become a lifestyle choice in many western countries, and as the risks of surgery decline even further, it is perceived by many as without penalty and a service to be delivered at will. This view is encouraged by media representation of surgeons and surgery, both fictional and real, without much in the way of critical interpretation for the viewer. 

Many patients now access cosmetic surgery without consulting their general practitioner, possibly because they feel the surgery is not worthy of a GP consultation, or perhaps that the GP will be disdainful or judgemental, or possibly because they feel the GP has no greater information than the patient when deciding about selecting cosmetic surgery. The latter view is common in my experience, but also usually wrong and this article sets out some key areas of knowledge for GPs that are consulted.

Cosmetic (or aesthetic) surgery has changed in scope immensely in 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. Many procedures have been found to improve patient’s confidence, sense of well-being and psychosocial functioning, prime amongst them breast reduction surgery. No GP, with so many other responsibilities, can be expected to be informed about all the options available and so it is worth holding some principles to guide the patient through these complex choices.

The role of the GP in advising a prospective patient
•  Suitability for cosmetic surgery
•  Financial and health consequences
•  Choosing a surgeon
•  Supporting the outcome
•  Interceding in care 

A GP can help determine whether a patient is suitable for surgery, advise the patient on health and financial consequences, help the patient choose a surgeon, support them through the outcome of surgery and often intercede in care valuably.

When considering suitability for surgery the GP’s knowledge of the patient can be very valuable, not only by conveying information about health and medication, but also about recognising any psychological issues and asessing the patient’s ability to consider the decision sensibly and in the context of their other life events. The Practitioner will also be able to advocate caution and sensible evaluation of the options before offering the patient advice on how to choose a surgeon.

Choosing a surgeon can be difficult. Some basic principles will seem obvious: surgeons moving around the country or continent 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 assessed, and almost always more contactable. For similar reasons I consider it unwise to consider having surgery abroad with no easy access should there be complications, and with scant regard for the risks of thromboembolism associated with combining surgery and travel. Increasingly, the NHS is only likely to offer the minimum safe care for such complications of private cosmetic surgery abroad.

Accredited plastic surgeons on the Specialist Register of the GMC comprise one clear standard, and this is almost always met by consultant plastic surgeons with NHS appointments. This latter group will already be known locally to GPs and represents all the security of established surgical practice. Similarly, membership of the BAPRAS requires such qualifications. Members of BAPRAS may denote their status by displaying the logo of the Association. 

Other organisations for related specialties such as ENT and Maxillofacial surgery have appropriate or similar standards (see below). Patients and GPs should be careful to assess the worth of organisations not on this list as some have emerged to act as commercial referral agencies, and not to represent core surgical specialties. 

Specialist organisations
•  British Association of Plastic Aesthetic and Reconstructive Surgeons
•  British Association of Aesthetic Plastic Surgeons
•  British Association of Maxillo-Facial Surgeons
•  British Association of Oto Rhino Laryngology 

Some patients may bring the name of a surgeon to their GP seeking more information. The GMC website (http://www.gmc-uk.org/) gives details of specialist registration and the qualifications held. In this respect the FRCS in Plastic Surgery (FRCS (Plast.) is desirable. Some surgeons may have qualifications reflecting other specialist fields,  such as FRCS (OMFS) for Oral and Maxillofacial Surgeons, which are appropriate for some aspects of aesthetic practice.

In general, surgeons should be accountable, fixed in location, known to the local medical services, on the relevant specialist register, and prepared to divulge details of qualifications and accept questions on their qualification and experience from the GP or patient when in doubt. They should be practising in a safe, well staffed, well equipped and accessible hospital. 

Qualities to seek in an aesthetic surgeon
•  Of known 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

You may find a discussion with the GP after the first consultation is helpful, but after surgery the support of the GP can be especially invaluable.  Every surgeon should have a support facility to care promptly for patients with complications arising from surgery, and this is another reason that surgery at any significant distance (even within the UK) is less desirable. However, wound infections, wound care and medical complications, whilst thankfully unusual, may present to the GP first and need treatment.  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 wherever possible.  This professional liaison can be invaluable to the patient.

Finally, on some occasions GPs may help a patient to seek a second or even third opinion, something that many patients feel intimidated about doing 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 other options from other surgeons.  In most cases this will not be needed, but no surgeon should resent such intercession by the GP, and in fact should welcome it, recognising the enduring relationship and bond of trust between patients and their family practitioners.

Simon Kay
Full Member of BAPRAS
 

 

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