The Keogh review has postulated a number of ideas and one which is being discussed at present is that anyone who is to inject a patient, e.g. with a dermal filler, should have a special qualification. The idea would be that this would apply to beauticians as much as doctors. Whilst broadly this would be a step in the right direction, we agree with the standpoint of BAAPS who have only ‘cautiously received’ this suggestion. Rajiv Grover, President of BAAPS says:

“We welcome the recommendation…however, we would go one step further and insist that the people performing these procedures should be medical professionals.”

Along with BAAPS, we at Safer Cosmetic Surgery agree that only fully qualified and trained medical professionals and cosmetic surgeons should be permitted to inject substances such as dermal fillers. The legions of dermal filler disaster stories, there for anyone to see online, should be enough to warn prospective patients from entrusting the carrying out of an intrusive procedure to a beauty therapist with no medical training.

The stricter BAAPS (The British Association of Aesthetic Plastic Surgeons) standpoint on this issue would ensure that the highest standards are more closely adhered to, which must surely be a desirable outcome. As Rajiv Grover points out, it is not enough to be able to perform an injection – although to do this properly requires both knowledge and skill – but it is vital that the person who administers the injections also knows how to avoid and deal with any complications which may arise from the treatment.

BAAPS is quite clear that “non-surgical does not mean non-medical” and that dermal fillers and similar injectables should be regarded as a medicine. We agree entirely with this point of view and should it be embraced by the government, then it would be a great step forward within the industry.

One of Safer Cosmetic Surgery’s surgeons, Mr Graham Offer, featured in an eye-opening episode of Embarrassing Bodies recently. In Episode 6, Series 6, which originally aired on 25^th March he performed cosmetic surgery on a young woman called Anna.  Anna, 25 had large amounts of excess, saggy skin around her stomach and abdomen area as a result of losing a remarkable 10 stone in weight.

Unhappy with the resulting sagging skin, which she found both uncomfortable and unsightly, she had turned to the programme for help.  Dr Pixie examined her and she was referred for surgery.

Consultant Mr Graham Offer, based at the Spire Hospital in Leicester, talks Anna and the viewers through the planned surgery, a lower body lift which would involve removing a 360-degree section of the skin and fat from the patient’s stomach to the back, flattening the stomach and improving the waistline and buttocks.

Two months after her last consultation, which outlined the risk of heavy bleeding and infection, Anna returned to go ahead with the surgery, saying:

“It would mean the world to me to have this skin removed.”

During the major operation, Mr Offer, working with a colleague, had to perform liposuction to remove pockets of fat and then shrink the blood vessels with adrenalin. He went on to remove almost 4kg of excess tissue – which is in Mr Offer’s words “the size of a small baby” - during the massive operation which lasted over 7 ½ hours.

The surgery was deemed to have been an enormous success, with Mr Offer stating:

“Surgery went really well.”

Viewers are soon rewarded with the sight of Anna at her examination by Dr Pixie, 3 months after her surgery.  Dr Pixie asks:

“Wow – where’s your tummy gone?  It’s just…gone!  That’s amazing…It’s lovely – it’s like you’ve got a brand new tummy, it’s a phenomenal result!”

The results are truly remarkable and Anna, now displaying a far smoother and more slender stomach, is clearly delighted with the results.

Dr Pixie asks about the impact of the surgery on her life. “What’s changed for you?”

Anna’s reply is heartfelt:

“Ah, everything, I’ve been on holiday, I wore a bikini for the first time – I’d never have done that…”

She ends “I’m really happy.”

We are delighted that Mr Graham Offer, a member of Safer Cosmetic Surgery, BAAPS (British Association of Aesthetic Plastic Surgeons) and BAPRAS (British Association of Plastic Reconstructive and Aesthetic Surgeons), provided such a great outcome for his patient. This case once more demonstrates the excellent results which are possible when patients are referred to the most experienced and reputable surgeons.

The conduct of foreign Harley Medical surgeon Hicham Mouallem has been widely questioned in the media as the case of Bernadette Cini has come to light. 

Ms. Cini, 62, opted to have breast reduction surgery on her large and uncomfortable G-cup breasts and believed that Harley Medical was a reputable name within cosmetic surgery. Mouallem reassured Ms. Cini that he was adept in techniques that would minimise pain and ensure that the greatest sensitivity was retained, which swayed her to move forward.

Shortly after surgery, Ms. Cini contracted a raging infection which threatened to effectively consume her breasts – it was necrosis, which is a flesh-eating disease that is caused by pseudomonas, bacteria typically occurring in soil.

The £5,700 procedure left Ms. Cini requiring five further operations to save her breasts.  She was in prolonged and acute pain and she eventually found herself in such poor condition that she was unable to work and had to quit her job as a nanny.

Understandably, Ms Cini sought redress and enquired about compensation that she might be entitled to from Mouallem at Harley Medical.  However, she was thoroughly shocked to discover that he was not properly insured for practice within the UK. He was a foreign surgeon working as a FIFO ‘Fly In, Fly Out’ – resulting in little accountability in cases such as this.

Ms. Cini was determined to follow this through.  She tried to track Mouallem down for 2 years and eventually caught up with him, at which point he admitted that he had not warned her about the possibility of infection due to her excess weight.  He settled out of court for £20,000.

Harley Medical is not new to controversy.  It has also been named as the clinic which carried out the most PIP breast implant operations during the scandal that has rocked the industry in the past eighteen months.  Meanwhile, the risks associated with FIFO surgeons continue.

We advise that anyone considering surgery should be mindful of such risks and be sure to choose a trusted and reputable surgeon who is fully insured within the UK, such as any surgeon belonging to BAAPS (British Association of Aesthetic Plastic Surgeons), BAPRAS (British Association of Plastic, Reconstructive and Aesthetic Surgeons) or SaferCosmeticSurgery.

The procedures that come under the umbrella term ‘Female Genital Cosmetic Surgery’, or FGCS, form one of the fastest growing areas of surgery within the UK. Reports from BAAPS (British Association of Aesthetic Plastic Surgeons) indicate that this surgery may have increased by 300% in the past five years. Here’s a brief overview:

Also Known As…

Labiaplasty is the surgical term. It is also called genital or vulval reshaping, the Mommy Makeover, vaginal rejuvenation amongst many other terms and euphemisms.

Why the Sudden Popularity?

The fact that waxing, including the ‘Hollywood’ where all pubic hair is removed, is so commonplace means that women are noticing the detail of their genitalia as never before.  With greater awareness can come more widespread anxiety about appearance.

Paul Banwell, member of SaferCosmeticSurgery and BAAPS (British Association of Aesthetic Plastic Surgeons) commented to the media:

"With labiaplasty people realise that they can change something they may have been worried about for a long time. It's empowering women with the ability to have choice. Choice is important."

Is this a Good Trend?

That remains to be seen, but it is also important to note that the ‘pornographic norm’ of hairless, very tidy genitalia seems to have become unnaturally popularised amongst ordinary women.

There is also the shocking reports that some children as young as 14 have undergone this surgery, which SaferCosmeticSurgery would contend is far too young for any female to consider such a procedure apart from in exceptional cases where it is medically required.  BAAPS also asserts that under 18s should not undergo cosmetic surgery.

Michael Tyler, SCS surgeon and member of BAAPS comments, “Labioplasty is an operation very rarely indicated but its popularity in some circles signifies a demand beyond the traditional indications. All surgery carries risks and it is vital patients fully understand these prior to contemplating such surgery. I don't often see female surgeons offering this procedure.”

Is it a Complicated Process?

Beyond the surgical requirements, any potential patient will be required to attend two consultations at least.  If a company or surgeon is suggesting operating without due consultation, do not proceed.

There is also the chance of complications from bleeding to thrush and in rare instances, clitoral damage.

The Benefits

Some women who have had labiaplasty claim that they feel greater self-esteem and enhanced sexual relations.  However, as a relatively new procedure, there is no official data yet regarding the benefits of this surgery.

More patients are suing cosmetic surgeons than ever before claims the Medical Defence Union, which represents more than 50% of the doctors and surgeons in Britain at times when they stand accused of malpractice or negligence.

Within this rising tide of legal actions, more than 80% of them have been brought about in response to the perceived failure of breast surgery, face lifts, eyelid procedures, rhinoplasty and weight-loss operations.  Around 50% of those claims are for breast surgery alone – a statistic closely connected to the PIP implant scandal, but claims also cite wrongly placed scarring, nerve damage or asymmetry.

The fact of the matter is that a larger proportion of such claims for compensation are being upheld in cosmetic surgery cases than in general medial cases.  45% of cosmetic surgery claims succeed compared to approximately 30% of general medical compensation claims.  The MDU also acknowledged that there had been a “significant” rise in claims in the past 5 years, but refused to disclose more specific figures.

The MDU attributed this increase to:

"A huge rise in both the number of procedures and patient expectations of a perfect outcome."

They believe that these were major factors as well as some surgeons failing to give proper prior consultations, failing to ensure that the patient holds realistic expectations, or simply carrying out substandard work.

Such information is a clear reminder of the importance of seeking out UK specialist accredited plastic and cosmetic surgeons when looking to undergo a procedure.  Reputable surgeons, such as the cosmetic surgeons of SaferCosmeticSurgery, not only perform work to the highest possible standards, they also strictly make sure a patient is given proper consultations and are of course fully trained, registered and insured in the UK.  A surgeon that patients can trust is the most vital preventative factor when it comes to avoiding situations where compensation is required, so those looking into cosmetic surgery should research well and always choose a qualified and experienced surgeon. 

Surgeons belonging to the SaferCosmeticSurgery group all belong to BAAPS (British Association of Aesthetic Plastic Surgeons) and/or BAPRAS (British Association of Plastic, Reconstructive and Aesthetic Surgeons), and have at least 15 years of surgical training after the completion of medical school, and have been awarded a Fellowship of the Royal College of Surgeons in Plastic Surgery (FRCS Plast).

The notorious hidden fortune of discredited mogul Robert Maxwell has led investigators up many interesting paths.  Now the saga has taken a new twist as the investigators have been brought in to examine the affairs of Harley Medical Centre Ltd.

The investigative team, headed up by Paul Stanley of Begbies Traynor, will go through the financial transactions of the Harley Medical Centre in great detail, including the circumstances surrounding the payment of a dividend of more than £1 million in 2010.  The company went into administration in November following thousands of claims from women given the defective French PIP (Poly Implant Protheses) implants during breast enlargement procedures.

Mr. Stanley has previously spent long periods in Israel, trying to track down shares held by Robert Maxwell.  He is now joint liquidator of Harley Medical Group.

He has said of his new appointment:

“The company accounts show large dividends were removed in 2010 and the creditors are concerned whether the directors at this time should have known that they were facing problems.

“I have been appointed to trace all these transactions to make sure that the business was being run in a proper manner by the directors prior to the administration and to investigate possible claims against the UK distributor of PIP implants.”

There was a virtual tsunami of complaints against the Harley Medical Group from women who desperately wanted their PIP implants, which should never have been used, removed. The silicone within these implants was low grade industrial silicone originally destined for use in mattresses.  Harley Medical Group is believed to have fitted in the region of a staggering 14,000 faulty implants during breast enlargement procedures, which is a third of the UK total and more than any other cosmetic surgery firm.

The weight of £15m worth of complaints caused the firm, which had 30 branches nationwide, as well as the PIP company, to go into administration. Since then the creditors have asked Stanley’s team to look into the large dividends that were paid out.

All those who are concerned with standards in the cosmetic surgery industry will watch with interest as the experienced team proceed with their investigation of Harley Medical Group.  None of the surgeons of SaferCosmeticSurgery have ever used PIP implants, however, SCS surgeons have since removed and replaced many ruptured PIP implants.

We live in a world where novelty is often viewed as progress, or at least as an exciting new option. Whilst this may work in terms of fashion, or art, it should not automatically be assumed to be the case when it comes to cosmetic surgery.

There are a number of new types of procedures which should be approached with caution, simply because they are largely untested, may not work as well as they claim, may include the risk of complications or may even just cause too much pain.  

Alastair Platt, SCS & BAAPS member comments, “I don’t offer these procedures myself as they are not proven to yield great results.  It is safer to stay with tried and tested techniques rather than the latest fad that is often designed more with marketing in mind than sound evidence."

The “Vampire Facelift”

This procedure has been created based on the as yet unproven assumption that if a patient’s own yellow blood plasma is injected into target facial areas, such as around the eyes or the mouth, this will stimulate the production of collagen. However, whilst injecting plasma doctors often inject Juvederm too. The latter is hyaluronic acid-based and is designed to leave the face looking more plump and youthful. Juvederm has been tested and the results documented, but the plasma injections are very expensive, but have not yet delivered proven results.

Laser Lipo

In this procedure, laser wands are inserted under the skin and used to melt fat before it is removed from the patient’s body. This can help tighten skin, but some surgeons warn of the possibilities of burns, scars, hardened tissue and lasting pain.  Surgeons at SaferCosmeticSurgery typically tend to provide traditional liposuction, as this is a procedure with proven results.

Using Sculptra and Artefill for Lips

The use of Sculptra, which can stimulate collagen growth, should be restricted to certain areas of the face like the cheeks or around the temples. It can have disastrous effects when used in the lips, turning them lumpy or too puffy. As for Artefill, which contains tiny beads and collagen, this should only be used for filling in smile lines. When used in lips it can cause lumps which will not disperse but must be cut out.

Stem Cell Facelift

This is based on the idea that the stem cells contained within fat can be used to improve the quality of a patient’s skin. However, there is no proven scientific basis for these claims, so it remains a largely experimental area at present.

To avoid becoming a ‘guinea pig’ for a practitioner who may not have great experience with a procedure that is largely unproven, it is imperative that anyone considering treatments of this nature should only consult a registered and certified cosmetic surgeon, such as those listed at Safer Cosmetic Surgery.  All SCS surgeons not only have a minimum of 15 years of surgical experience, but they are also members of BAAPS (British Association of Aesthetic Plastic Surgeons) and/or BAPRAS (British Association of Plastic, Reconstructive and Aesthetic Surgeons).

At Safer Cosmetic Surgery we regularly look at figures for cosmetic surgery within the UK, but we also like to see how the rest of the world compares from time to time. Here are a few interesting facts and figures from the industry around the world:

• As ever the US leads the way in terms of the number of procedures. The International Society of Aesthetic Plastic Surgeons (ISAPS) collated information about surgery and non-surgical procedures like Botox that have been performed by surgeons and state that 21% of the world’s procedures are carried out in the US, or 3.1 million.

• Rhinoplasty, or the “nose job,” is currently most often carried out in China, Japan and Brazil.

• Blepharoplasty, or eyelid surgery, increased in the UK by 4.8% last year and became the second biggest procedure for women.

• The highest rates of cosmetic surgery amongst the population are actually in Korea, Italy and Greece, where over 10 procedures are performed per 1000 people.

• The US has the most plastic surgeons in the world, 5950, compared to just 450 in the UK.

• Although breast surgery has been the most popular procedure globally for the past ten years there is now a new trend. The ISAPS Global Survey states that liposuction comprises 18.8% of all surgical procedures. Breast augmentation comes in second at 17%.

• 14% of French women have had plastic surgery, although this figure includes minor procedures like mole removal and also reconstructive surgery.

• Brazil, the United States, China, Mexico, India and Japan are the countries where the majority of the top five procedures are carried out, these being breast augmentation, blepharoplasty or eyelid surgery, rhinoplasty or the “nose job” and abdominoplasty or the “tummy tuck".

• The UK is currently the fastest-growing market for cosmetic procedures in Europe.

The new figures from the British Association of Aesthetic Plastic Surgeons (BAAPS) make interesting reading this year. Whilst one may have predicted that the number of cosmetic operations would be dropping in a time of economic difficulty, the overall number of procedures have largely remained static.

However, the make-up of the 43,172 procedures carried out by members of BAAPS during 2012 has changed significantly. The growth area has been facial rejuvenation, with every main procedure rising by double-figure percentage points. Fat transfer to restore volume to the facial features went up 10%, eyelid surgery rose by 11%, facelifts by 14% and male brow lifts by a substantial 19%.

The most popular procedure of all remained breast augmentation, but this showed a slight decrease in the number of operations, falling from 10,015 by 161 to 9854, a fall of 1.6%. As to procedures to shape the body, specifically liposuction and tummy tucks, these fell by an average of 13%.

The public seem to be putting less focus on surgery for the body, which may be down to the effect of London 2012 and the impressive sight of hard-working, athletic bodies like that of Olympic poster girl Jessica Ennis. Indeed, according to government figures, local councils saw a 44% rise in the use of their gyms, swimming pools and other sports facilities during and immediately after the Olympics.

As BAAPS President Rajiv Grover puts it:

“The considerable drop in body-shaping procedures such as liposuction and tummy tucks may well be due to people choosing to head back to the gym (perhaps inspired by an unforgettable summer of Olympic golds!) or the fact that there are now many less-invasive options to target problem areas, such as for gynaecomastia or ‘man boobs’”.

Grover also believes that the figures show that the public realise the benefits of surgery for making significant improvements in the facial area, over and above the ever-popular Botox and fillers. He also notes that the public may be eschewing fads and sticking to safer, more effective treatments:

“Patients are looking for tried-and-tested procedures that deliver a reliable, long-lasting result and which have a proven safety record.

If the figures, as Grover suggests, indicate that the public are taking a more considered approach towards surgical procedures, rather than viewing them as knee-jerk solutions to obesity, for example, then this must be welcomed as a promising trend.

For many years, most of the trends of note within the cosmetic surgery industry have concerned procedures opted for by women, such as breast enlargement. However, there has been an increasing rise in demand for male surgical treatments, in the UK and the US in particular.

Part of the reason this is happening may be down to the media portrayal of ‘perfect’ male features which men are then going on to request from their surgeons in real life. For example, many men are citing a desire to have a jawline and chin just like Robert Pattinson or Brad Pitt; Zac Efron’s eyes are hugely popular too as are Ryan Gosling’s lips and Jude Law-style noses.

Not every male surgical patient is focusing on a Hollywood idol to help improve their looks, however. Most are just seeking some kind of personal enhancement, whether it be a rhinoplasty, chin implant or – more commonly than ever – liposuction. The latter is in keeping with modern trends as the population grows heavier, but there is also a greater focus on facial features to which men are now responding. This includes having surgery to remove eye bags, an operation made famous amongst men of a certain age in the UK by presenter Michael Aspel.

In 2012, of more than 43,000 cosmetic surgery procedures that were carried out by the British Association of Aesthetic and Plastic Surgeons, or BAAPS, members, approximately one in ten was performed on a male patient.

In the latest set of official figures currently available from BAAPS, the second most common procedure for men is now blepharoplasty or eyelid surgery, with 758 procedures performed on men last year, up 11.0%!  The most common procedure for men is rhinoplasty, with 952 procedures performed, though this is down 9% from last year.  Gynaecomastia, also known as the ‘man boob’ operation or male breast reduction, is down by 18%, with only 642 procedures carried out last year.   Though the figures for male cosmetic surgery have shown an overall slight decrease in 2012, there is no doubt that cosmetic surgery for men will continue to increase.

As the male population continue to show interest in cosmetic surgical procedures, it is vital to ensure that men are also given plenty of access to information about safer cosmetic surgery. Whereas many women will feel they have had some exposure to the debate around issues in the industry, be that through female-focused programmes or women’s magazines, male members of the general public have historically been less informed about the aspects that patients should consider. We believe in the continued promotion of the safety considerations regarding cosmetic surgery to all areas of the population, to ensure a greater number of positive outcomes for all patients.