A poor prognosis for autonomy: self-regulated cosmetic surgery in the United Kingdom

Abstract

In recent years, cosmetic surgery in the United Kingdom, which is provided almost entirely by the private sector, has gained in popularity despite evidence of its potential risks to patients. Over 32,000 procedures were reported by one association of cosmetic surgeons alone in 2007, three times more than in 2003. This article examines the regulation of cosmetic surgery in the UK, in light of the need for informed consent and the importance of patient autonomy. Since 2000, the government has attempted through legislation covering all health care provision to regulate cosmetic surgeons' qualifications, patient rights to information, and the inspection and registration of premises. However, the risk to patients from unregistered and poorly qualified surgeons, and from private clinics with a poor quality of care, has still not been adequately addressed. Moreover, ensuring informed consent and the maintenance of standards has been left to professional self-regulation. An independent, government-funded umbrella organisation with lay representation and sufficient powers of registration and inspection of all relevant cosmetic surgery practitioners is needed to fully protect patients, and should have its roots in specific legislation governing cosmetic surgery.

Part of the problem or part of the solution? Plastic surgeons and body image dissatisfaction

“…Indeed, the imperative of improving methods of patient selection has been highlighted in a number of reports. 37,41,45,46 Reviews by Honigman et al 47 and Brunton et al, 36 together with prospective research by von Soest et al, 48 offers on procedures that a patient has not hitherto considered, 41,52 undue pressure to make quick decisions to undergo treatment through the use of incentives or discounts, 53 a cursory approach to patient assessment and selection (for example, by receptionists lacking the necessary expertise) 44 and aggressive marketing techniques, including the use of idealised and frequently digitally enhanced photographic images of 'clients', that promote false expectations of outcomes. 41,54 Evidence for the negative impacts on consumers of these types of business practices is mounting in the psychological literature.…”

Sensationalising the Female Pudenda: An Examination of Public Communication of Aesthetic Genital Surgery

“…Delving into, “Self-regulated cosmetic surgery in the United Kingdom: a poor prognosis for autonomy,” Latham (2010) observes that cosmetic surgery is increasingly popular in the UK – moving up from 10,738 surgeries in 2003 to 34, 453 in 2007. These operations are done in private clinics in response to patients’ request for aesthetic enhancement of their bodies and not for medical reasons.…”

“…Private sector advertising and marketing, Latham (2010) writes, may also increase false expectations amongst patients. Also, patients are unlikely to have been referred by their general practitioners, self referred people may not disclose important contraindications, are not on waiting lists, and this leave no time to reflect on the treatment or even reconsider it.…”

“…She may also have psychological needs that are not investigated by the surgeons and thus place her mental health at risk if she becomes dissatisfied or requires more corrective treatment. For these reasons, it is necessary for patients electing to go for genital cosmetic surgery to note that their care could be less than adequate, there could be lack of written guidance on clinic procedure, misleading advertisements about the potential success of treatment, lack of information about practitioners’ qualification and inadequate medical record and clinical governance ( Latham, 2010 ).…”

Labia reduction for non-therapeutic reasons vs. female genital mutilation: contradictions in law and practice in Britain

“…In spite of a series of laws since 2000 regulating many aspects of health care provision in the UK, Melanie Latham argues that cosmetic surgery is not well regulated and much has been left to self-regulation. 15 In contrast, when human embryology research and assisted conception procedures began to appear, a government commission (Warnock) was set up, a complex set of regulations was developed, laws were subsequently passed and have been amended and updated, and the Human Fertilisation and Embryology Authority was set up to monitor and regulate research and service delivery, and ensure quality of care (see <www.hfea.gov.uk/>).…”