Cosmetic versus Plastic Surgery

There is often a degree of confusion about the differences between a plastic and a cosmetic surgeon.  Indeed, for most people, the terms plastic surgery and cosmetic surgery are synonymous.  However, plastic surgeons are surgery generalists, whereas cosmetic surgeons are specialists in aesthetics.  

Plastic surgeons complete an approved and accredited residency training program in plastic and reconstructive surgery under the authority of the NHS.  This program covers a wide range of surgical procedures, including treatment for burns victims, reconstruction of deformities (for example, cleft lip and palate), or breast reconstruction after cancer.  It does not include procedures for aesthetics, such as liposuction or facelifts, as the NHS does not support them.

Although the criteria to become a qualified plastic surgeon are stringent, the emphasis on training is not specifically oriented around aesthetic outcomes.  By contrast, cosmetic procedures are not about curing illness.  Rather the objective is to improve a patient's physical attractiveness.  Cosmetic surgeons are particularly interested, experienced, and skilled in delivering aesthetic results.

At present, in the UK, cosmetic surgery is not a unique specialty, and has no specialist register.  Any licensed physician can train for and offer cosmetic surgery.  This includes ENTs, dermatologists, GPs, ophthalmologists, and general surgeons. 

Thus, oversight of cosmetic surgery has become an increasingly important subject.  Patient demand for cosmetic surgery procedures has surged in the UK since 2011. As the NHS does not cover the costs for these, most are performed by private practitioners.  In 2014, there were approximately 43,069 cosmetic surgery procedures carried out by members of the British Association of Aesthetic Plastic Surgeons (BAAPS).  However, the number of cosmetic surgeons in the UK is at least three times that of the BAAPS membership.  

Our conclusion is that there is a clear need for certification and a specialist register for cosmetic surgeons in the UK.  This is accentuated by the fact that cosmetic surgery is being performed by a wide spectrum of medical backgrounds.  Moreover, it seems essential that cosmetic surgery should explicitly focus on aesthetic outcomes as an additional criterion in training and accreditation.  This would include issues of patient evaluation, education, and safety. 

For patients interested in having a cosmetic procedure, the key criteria for choosing a surgeon, should focus on the doctor’s experience with the specific treatment.  Initially this can be evaluated through recommendations, reviews, and testimonials.  Training, experience, certification, and compliance with standards should also be considered.  The practitioner’s consultation should illustrate expected outcomes using before and after photos of past patients of similar age, gender, and body type.  The surgeon should explain what to expect before, during, and after the procedure, explaining in detail the potential risks, and the elements of post-operative care.

Cosmetic surgery can be an empowering and life enhancing process if the surgeon and the patient make decisions together with absolutely realistic expectations.

The British Association of Body Sculpting (BABS) has members from various backgrounds.  We strongly believe in the need for GMC to recognize cosmetic surgery as a specific medical specialty with its own specialist register. Furthermore, we believe that medical professionals specifically dedicated to aesthetics are the most competent to establish and manage training programs, policies on best practices, continuing education, and patient safety.  The goals of the BABS are to document the best practices of its members, to disseminate these widely, and to provide guidance to patients, non-cosmetic doctors, insurers, and regulators.

The BABS members follow a code of practice that ensures high ethical standard, and strive for improvements in care of patients through better training and educ