Cosmetic surgery - is it worth the risk?

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Cosmetic surgery - is it worth the risk?

21st April 2010

Once only accessible to the rich and famous, cosmetic (plastic or reconstructive) surgery is now more affordable than ever. Some UK clinics offer liposuction at a monthly cost of £79 or breast enlargement for £99.

However, with cosmetic surgery on the rise, an increase in the number of patients suffering from complications is an unwelcome inevitability and Nigel Mercer, president of the British Association of Aesthetic Plastic Surgeons, called the cosmetic surgery industry an "unregulated mess".

While the dangers of cosmetic surgery are not as great as they once were there are still many risks inherent to any kind of invasive surgical procedure. Below is a list of just a few documented complications encountered during plastic surgery.

Allergy to anaesthetic - The incidence of anaphylactic reactions and the associated morbidity in the UK is still unclear and there is concern that it may be on the rise. The Association of Anaesthetists of Great Britain and Ireland (AAGBI) reported that between January 1995 and June 2001 there were 36 deaths as a result of anaphylactic reactions to anaesthetic in the UK with an estimated 500 reactions each year. Allergy to other drugs used during surgery, such as pain medication, is also a noteworthy risk.

Infection - The chances of contracting an infection following cosmetic surgery are low, typically less than 1% for breast augmentation, however the risk can last up to 2 months following surgery. Infections after breast enlargement surgery often require the removal of the implant. A report published in The Lancet Infectious Diseases journal suggested that infections are caused by contaminated implants, the patient's skin or poor sterilisation and cleanliness in surgical theatres.

Haemorrhage - A haemorrhage is an excessive, often life-threatening blood loss from damaged blood vessels and tissue. A haemorrhage occurs when there is excessive trauma to the site of cosmetic surgery. Although the risk is minimal, the danger increases if a blood clot (hematoma) has also formed during surgery as the haemorrhage may cause the clot to travel to other areas of the body. In 2008 the average rate for haematoma for British Association of Aesthetic Plastic Surgeons (BAAPS) members was 1.2% and there was a 2.06% chance of needing a re-operation.

Nerve damage - Nerve damage can occur simply from injecting anaesthetic or from the actual surgery itself. A patient may notice numbness, tingling, or changes in sensation but usually any nerve damage is temporary and sensation will return to normal within 6 months to a year. Sometimes it can take 2 to 3 years for complete regeneration, however if the nerve is cut completely, it may never return to normal and the patient may suffer permanent numbness or muscle paralysis. Nerve damage may be one of the long-term effects of liposuction, due to stripping of the outer sheath of nerve cells containing a fatty layer called myelin.

Scarring - Most cosmetic surgery will leave patients with some scarring, the rate of healing will depend on the individual and the type of surgery involved. Capsular contracture is the most common complication associated with breast augmentation and can happen at any time.

During surgery, a pocket is made for the implant, however throughout the healing process a capsule made of fibrous tissue may form in the pocket. This capsule will tighten, and squeeze the implant which makes it feel hard, this distorts the appearance of the breast causing pain and discomfort.

Emotional Distress - Health risks associated with cosmetic surgery are not always physical; many patients who have had complications during or after an operation are often left with psychological damage. Unsatisfactory aesthetic results (including contour irregularities, asymmetry and excessive or unfavourable scarring) can be disheartening or even devastating for patients. Couples have been known to separate after 'botched' surgery has left a patient with such low self esteem that intimacy in a relationship becomes almost impossible. For patients who are struggling to come to terms with poor cosmetic surgery Changing Faces is a leading UK charity that can support and represent people who have disfigurements to the face, hand or body from any cause. They have expertise in psychology, education, employment, health and social care, media and campaigning. They estimate that every year, over 530,000 people in the UK acquire a disfiguring condition from birth, accident, cancer surgery, skin and eye conditions, from facial paralysis and from medical accidents such as mistakes in cosmetic procedures.

Finding the right surgeon
There are ways a patient can help reduce the risk of cosmetic surgery going wrong - one way is to ensure that, after thorough research, they choose the right surgeon. The Department of Health believes that patients should receive advice about surgery only from doctors and nurses, as they have the qualifications and expertise to give high-quality advice. The General Medical Council (GMC) Specialist Register lists all Surgeons in the UK, and those that specialise in Plastic Surgery. In addition to being on the specialist register, surgeons should hold the qualification Fellow of The Royal College of Surgeons, (FRCS) or equivalent from another European or Commonwealth country. It is generally considered more desirable to choose a surgeon who does cosmetic work full time (all surgeons keep a log book of their operating history, patients are advised to ask to see this). All cosmetic surgery clinics in the UK also require annual registration with the Healthcare Commission.

Questions to ask before undergoing any cosmetic treatment:

- Who will carry out the treatment?
- What qualifications do they have?
- How long since their training in this treatment?
- How frequently do they carry it out?
- How many procedures/treatments have they performed?
- Do they have professional indemnity insurance?
- What are the risks?
- What is the chance that something may go wrong?

It is advisable to make a note of the clinic's aftercare policy and patients should make sure they receive any pre- and post-operating instructions in writing before undergoing any procedure. The clinic should also provide patients with a 24-hour number for use after surgery. As there is always a risk of complication or error during surgery patients are advised to check the complaints and 're-do' policies in the clinic, to ensure that they are covered should additional operations be necessary to rectify mistakes.

It is estimated that up to 100,000 people a year are being tempted by cheap "plastic surgery holidays". However regulations on surgeons and clinics differ widely between countries and the BAAPS would not recommend such drastic action. In 2007 a survey undertaken by the BAAPS revealed that 14% of surgeons had seen 9 or more patients in the year with problems resulting from cheap cosmetic surgery abroad with 92% saying they were most concerned with the lack of aftercare provided. Over half (53%) of surgeons saw dissatisfied patients from Poland, followed by 44% seeing patients from South Africa and 36% of surgeons seeing problem cases from Belgium. Other countries mentioned in the survey were Hungary, Turkey, Croatia, Cyprus, Egypt, Thailand and Malaysia.

The risks associated with plastic surgery are real. In most cases complications that arise are unavoidable while in others patients' lives are put at risk through negligence and inexperience. Many of those who experience poor cosmetic surgery will require further corrective operations, whilst others may suffer irreparable physical and psychological damage.

Some cosmetic surgery statistics
In 2006, the Medical Defence Union released an article estimating that £8.5 million had been paid out for claims over poor cosmetic surgery in the previous 10 years. Breast and facial surgery accounted for the most claims. The size of settlements ranged from £200 to £305,000.

In 2009, nearly 40% of surgeons in the UK said they had seen patients who had suffered complications from permanent filler operations and over 25% had to perform corrective surgery.

Breast augmentation is still the most common type of cosmetic surgery for women in the UK, with 8537 opting for it in 2009. Blepharoplasty (eyelid surgery) was second with 4827. Men were most likely to choose rhinoplasty (nose reconstruction) in 2009, although breast reduction (gynecomastic) surgery increased by 80%.

In 2009 statistics released by the American Society for Aesthetic Plastic Surgery revealed that of all age groups, men and women between the ages of 35 and 40 were the most likely to consider plastic surgery for themselves now or in the future (35%).

How can Fentons Solicitors help?
Fentons has a specialist department experienced in handling claims relating to clinical and medical negligence.

If you think that you have a case or require further information, contact Fentons on 0800 019 1297 or fill in the online claims questionnaire.

Sources:
- Association of Anaesthetists of Great Britain and Ireland (AAGBI)
- British Association of Aesthetic Plastic Surgeons (BAAPS)
- The Department of Health
- Pittet. B, Montandon. D, & Pittet. D, (2005) "Infection in Breast Implants", The Lancet Infectious Diseases, Vol. 5. 2 pp 94 - 106
- Jeevan. R, & Armstrong. A, (2007) "Cosmetic Tourism and the burden on the NHS" Journal of Plastic, Reconstructive & Aesthetic Surgery, Vol. 61:12 pp 1423 - 1424
- "Suspected Anaphylactic Reactions Associated with Anaesthesia", The Association of Anaesthetists of Great Britain and Ireland and British Society for Allergy and Clinical Immunology (2003) Vol. 3 p 5. Published online at www.aagbi.org/