The UK's Royal Society of Medicine has come down hard on the cosmetic surgery industry for endangering health of patients in its pursuit of profits.
Writing in the latest issue of the Society's Clinical Risk journal, Nigel Mercer, president of the British Association of Aesthetic Plastic Surgeons, lashed out, "
It seems as if the doctor's first duty to protect their patients
has been forgotten by many in the cosmetic surgery market."
'Quackery' was outlawed in medicine over a century
ago, but it is in danger of returning, perhaps in this time. One only has to look in women's magazines to read
unsubstantiated claims for procedures and treatments.
The General Medical Council (GMC) of the UK, enshrined that duty as the overriding principal of Medicine, and it has been set out in the Hippocratic Oath for millennia, but not many seemed to care.
"The authors of the invited articles in this issue of Clinical Risk
were given a broad remit to enable them to explore 'clinical
risk' as it applies to their practice, expertise and healthcare
system in relation to aesthetic surgery," Mercer said, and noted in a globalized world access to cosmetic surgery becomes easier and everyone vies for it.
But those in constant quest of better looks run several risks. A patient from the west of England died from DVT, following a facelift abroad.
The public are aware of the risk of deep vein thrombosis (DVT) after a flight and also after surgical procedures. This risk can be reduced by taking aspirin for antithrombotic prophylaxis,
but aspirin increases the risk of perioperative bleeding in
cosmetic surgical procedures, so patients in the UK are usually
asked to stop before major cosmetic surgery, because a haematoma
may need a return to theatre and lead to other complications.
If the patient is abroad, the care of those complications will
extend well beyond the end of the 'holiday'. Occasionally,
a blood transfusion might be required in these circumstances.
Would any one want a blood transfusion in a country with a published
HIV rate of 25% such as South Africa?
There are many questions as to whether the patients are told the whole truth of the risks, that is by the surgeon.
It may also be remembered that one in 25 of the population
will form a 'bad' scar, no matter how well the wound
is stitched, and it will take a minimum of four months to settle,
by which time the surgical tourist will be long gone home. Thus the surgeon is
practically working risk-free, because the patient will never
go back for follow-up or revision and will not be able to take
legal action. All this should change and there should be greater regulation of the profession.
A British journalist recently recounted her nightmarish experiences following semi-permanent filler injections to her face. She eventually ended up mutilated.
In the USA, there are only a handful of dermal fillers with FDA approval
(mostly for moderate to severe facial lines in HIV patients
with lipodystrophy), whereas in the UK there are over 100 on
the market. Why the difference? In the USA, the products undergo
testing as a 'drug', but in the UK they are tested
as a 'device' and so only have to pass 'CE'
mark requirements, which relate to standards of production,
not of efficacy. Drug testing is lengthy and expensive but CE
marking is not. This is a key area of concern.
Also the cosmetic surgery industry should not sell procedures
directly to patients, it was stressed. New products, such as barbed thread facelifts
and fibroblast culture for facial lines have come onto the market
with great publicity and media interest, only to disappear rapidly
when it became clear that they have a high complication rate
and/or low efficacy, leaving behind disgruntled patients and
Another paper in the journal notes that in France advertising is not allowed in any area of medicine,
and cosmetic procedures cannot be advertised by third-party
organizations, but adverts originating
outside France continue to be problematic. Perhaps, like tobacco,
there should be a Europe-wide ban on advertising all cosmetic
'surgical' procedures, including on search engines, it is felt.
Dr Harvey Marcovitch, editor of the Royal Society of Medicine's Clinical Risk journal called for tight control of advertising.
'We need proper regulation and we need both surgeons and GPs to manage patient expectation,' he said.
About 90,000 Britons had cosmetic surgery last year. The most popular procedures were breast implants, facelifts and fat loss. The industry, valued at £143million seven years ago, is predicted to be worth £1.2billion this year.
Complaints have also increased. Last year there were 173 complaints about botched breast operations to the Medicines and Healthcare Products Regulatory Agency, up from 135 in 2007, Daily Mail reported.