The Review of the Regulation of Cosmetic Interventions led by Sir Bruce Keogh and an expert panel was published by the Department of Health on the 24th April 2013. Cosmeticsurgerycounselling.com together with Cosmeticsupport.com support this Review and note the central position of the emotional and psychological welfare of the cosmetic surgery consumer/patient. Cosmeticsupport.com is a partner of the APPG on body confidence, offering a non- profit voluntary and independent professional emotional support, psychology and counselling service specializing in cosmetic surgery patients and body dysmorphic disorder patients since Jan 2000. https://www.gov.uk/government/news/recommendations- to-protect- people- who-choose-cosmetic-surgery

As a consumer/patient and psychotherapist with a specialist interest in body image issues and cosmetic surgery counselling, I have been very concerned about the trivialization of cosmetic surgery and how this affects patients’ expectations. Regulation will offer greater physical and mental protection by reducing some of the greater anxieties suffered by patients.

The review addresses two main areas: 

1. Physical protection 
2. Emotional welfare

Physical Protection

It is easy to see from a selection of the recommendations below how much more protection will be afforded to patients who have been vulnerable in an unregulated industry:

1. A register for all medical devices including breast implants
2. Surgeons must be on the GMC Specialist Register and practicing in that field
3. Fly-in/Fly-out surgeons subject to UK standards
   
4. Patients can review meaningful data
5. Legislation to classify fillers/botox as prescription only 
6. Ban on incentive/special offers
7. Patients must see the surgeon and not a sales person 
8. Fund to help patients when companies go bust
9. Ombudsman for private health (including cosmetic surgery) 
10. Compulsory insurance
    

Emotional Welfare

The Keogh Review acknowledges the vulnerability of patients. Every elective beauty enhancement surgery contains a vast emotional component. Psychological questionnaires may create better-informed surgeons but, with the best of intentions, do not create well-informed, integrated (mind/body) patients.

It is easy to think that counsellors should only be involved when cosmetic surgery goes wrong or if a surgeon believes a patient to be unsuitable for surgery. This dated concept of counselling creates a lost opportunity to increase patient safety and negate surgical risks. Specifically trained cosmetic surgery counsellors would make a valuable addition to the forthcoming patient safety regulations resulting from the Keogh Review.

The counselling conversation is a unique experience where patients can feel safe enough to explore their issues. This is not the same as talking to a friend, although the best counselling sessions will feel that way.

Counselling (as part of the consent process) pre-operatively creates a preventative measure against rogue traders in the industry. A cool-off period is more productive when patients are referred to counsellors who understand what constitutes a well-informed patient according to new regulation.

Mind and body in cosmetic surgery have become alienated from one another and must be re-united if safety is to remain centre stage. The person-centred relationship built up in pre- and post-operative counselling becomes the intermediary between beauty shopping and medical procedures. Patients benefit from the opportunity to safely reintegrate internal (mind) and external (body) aspects of their needs. This delivers a more relaxed, realistically-grounded patient to the surgeon.

Every fibre of my being believes that counselling should be an integral part of the consent process: even more so in the cases of patients who wish to keep their surgery secret. At the very least patient support sites and support groups would benefit from the professional skills a cosmetic surgery counsellor brings to the experience. 

The quest for beauty is equally a quest for health, happiness and well-being. As consumers/patients, the false belief has been that the path to beauty, health and well-being is always safe and pretty. Regulation from the Keogh Review will go a longer way toward making this a reality if the path to well-being is clearly integrated.

The disjunction between pressurizing commercial interests of the surgery industry and the self-critical anxieties of credulous patients is where insight through counselling creates well-informed patients.

Patients who once were insecure about their looks as well as ill-informed about their choices can take pride in joining a cultural shift towards better knowledge and better outcomes both practically and emotionally.

Consultations with a surgeon are a time to concentrate on what can and cannot be done through surgery. It is not the time or the place to discuss personal psychological issues.

Consultations can create confusion in patients. Many patients may need more than one consultation with a surgeon. We are not easily able to look objectively at our bodies the way a surgeon can. Often, we are unable to picture how the discussed changes will really look. Some surgeons offer 3-D imaging but even with that it is not always easy to imagine the predicted reality. Additionally, we may think we need one thing and a surgeon may suggest something else. Sometimes we may need more than one surgery to achieve our goals. Patients may feel anxious about asking for a second consultation.

Patients need time and freedom from pressure to consider everything after a consultation. Patients may say they do not need counselling but experience shows that they spend countless hours online searching for support groups to talk about their needs and experience. Whilst these online relationships are helpful for patients, they often compound mis-information and cannot replace the benefit of conversation with someone suitably qualified to understand the sensitive issues involved. This need to talk has been exploited by sharp operators online who take referral fees or have other exploitative agendas that they keep concealed. Genuine, non-exploitative counselling sessions online through specifically tailored support groups keep patients safe in many ways.

Physical patient safety will benefit from the Keogh review. A specifically trained independent cosmetic surgery counsellor will help a patient shield themselves against the twin arrows of hype and dismissal. A safe conversation has no exploitative agenda. A more frivolous conversation about beauty and fashion can be helpful to while away the hours before and after surgery but will not enhance patient safety.  Where advertising in medical procedures exists, so too remains the need for demystification. 

Name: Windy Dryden
Company: Goldsmiths, University of London
Telephone: 

Debbie Sadowitz has been doing a wonderful job for many years, helping those considering cosmetic surgery by single-handedly running this and her sister website. Long may she continue to do so and I support her efforts. Professor Windy Dryden, Goldsmiths, University of London

Res Extensa Versus Res Cogitans

Dr. Art -- 22/07/2001 00:08:57

Ya know.. For surgeons its very easy.. cut this.. implant that... place a little of this under a wrinkle, plump up a lip.... easy. Patient responds, scars reduce over time... As Surgeons are apt to say... 'a chance to cut is a chance to heal' but what about the soul? The Heart? The satisfaction of the patient? Are they really any happier after the procedure? Many are ... some are not.

I suppose Psychiatry and Psychology are the evil step children of medicine. Perhaps? We deal with the left overs of what 'Cut and Repair' cannot touch. We deal with the soul. Pssssst.... Thats what Psyche means... Soul and Mind.

Making people 'whole', 'complete' and happy is not an easy task. Its not only the surgeons knife that does all this. Good personal relationships help and sometimes these can only be achieved through a good alliance with a caring therapist. It will bring self acceptance...self confidence.. and finally -- knowing who you are and what you want -- will show you what to do.

Aside from abusive partners, nagging spouses, disappointed mothers and fathers and yes.... even disappointed children... its all up to you.. NOT YOUR SURGEON, that counts. And we and the surgeons can sit here writing all this until the cows come home and it still doesn't matter.

What matters is .. how you feel about yourself. If surgical procedures can achieve this .. then MORE POWER TO THEM.. but what if they don't. or you feel you need more. Seeking out a life coach or psychotherapist/psychiatrist is as life enhancing as any procedure you are likely to pay for. And lasts forever when done right.

For those among you who thumb your noses at 'Professional Psychological Help' I leave you with a 1500 year old buddhist proverb... "When you know who you are, you will know what to do. I wish you all the best in your quest".

After 20 years of practice.. I believe this says it all...

To disconnect the mind and soul from the body in the hope of finding happiness leaves one hollow and unsatistied. Always seeking the next procedure that will make you whole and individually 'beautiful'.... You may not have to look that far.

Art

THE NEED FOR COUNSELLING
submitted by Deborah Sandler

In response to your Call for Evidence re Cosmetic Surgery I propose the following recommendations:

1. Pre- and post-operative counselling should be strongly recommended as a necessary component of cosmetic surgery. 
   
2. Counsellors should be specially trained and approved. 
   

Why?
As noted by Sir Liam Donaldson in 2005 (1), there is a lack of balanced information about the risks and benefits of cosmetic surgery. Prospective patients can too often be the victims of unscrupulous clinics which offer pressurizing sales promotion. Sometimes this is even disguised as ‘counselling’ or ‘patient support’. Such practices provide a misleading sense of reassurance to vulnerable people subject to manipulative advertising.

Patients need opportunities to talk about their motivation, expectation and fears with unbiased and trained counsellors wholly independent of commercial pressures.

Who benefits?
The PIP scandal has prompted the formation of many new patient support groups with a focus on justice for patients adversely affected.

PIP patients will benefit from counselling which offers an opportunity to recover from the post-traumatic mental trauma caused. Many lives have been turned upside down and many are still struggling with the damaging consequences of their experience.

All patients benefit from counselling before and after life-changing and irreversible surgery.

‘Cooling-off’ periods that include counselling sessions are more productive 

‘Cooling-off’ periods allow patients to consider their choice of surgeon 

Surgeons benefit by having calmer, more relaxed, better-informed patients 

Patients will have access to counsellors as advocates where necessary

Counsellors can organize patient meetings with permission. This encourages realistic expectations. Promotional static photos shown during information-laden consultations are inadequate

Online patient support groups reveal high levels of confusion and anxiety through misleading adverting, causing poor decisions on the part of the patient. Specially trained cosmetic surgery counsellors kept up-to-date with current policies will help clarify the information patients need.

After-hours online counselling reduces post-operative stress, helping recovery. Patients feel safer knowing there is unbiased emotional support and information a few clicks away.

Current Obstacles
Creating well-informed patients requires collaboration from all parties involved in cosmetic surgery, especially surgeons and nurses The support of BAAPS and BAPRAS, both as organizations and as individual surgeons, would enhance emotional patient safety. Disappointingly, I have repeatedly been met with reluctance on their part when seeking support for this additional safety net, despite their claim to ‘tirelessly educate the public’2. I have asked BAAPS’ permission to allow me to reproduce their surgical information fact sheets on my website only to be met with ‘our surgeons are sensitive about who uses their information’ and ‘if you use our information sheets, everyone else will want to’ and ‘if you reprint this information, it is plagiarism’. This kind of information protection puts the safety and education of patients at risk.

My experience has shown that a patient who claims to have done some ‘research’ on their plastic surgery procedure will be able to talk about prices and distances and whether or not the plastic surgery clinic they are going to will drive them home. Crucially, most of their research will revolve around the photos they have of the clinic and the glossy pictures of the results that clinic is showing. Patients also generally know about a clinic’s ‘special offers’. In other words, the patients ‘research’ is often little more than reading an advertising brochure.

I understand that the current call for the ban on advertising cosmetic surgery may stop this type of ‘patient research’ but there will still be a need for patient education, information and support, even without the advertising.


Conclusions
Clear information and psychological support creates well-informed patients who are able to:


Understand their motivations physically and emotionally 

Manage their expectations

Make informed decisions

Know how to access psychological support pre- and post-surgically 

Know how to access emotional support after hours and at weekends 

Understand the difference between advertising and information

Not succumb to pressurized sales techniques.


Declaration of Interest
I have a training in psychotherapy and a specialist interest in body image, with personal experience of both good and bad cosmetic surgery, as well as body dysmorphic disorder. I am a member of the All Party Parliamentary Steering Group for Body Image. I have run a voluntary, independent and non-profit cosmetic surgery patient website for 13 years (Cosmeticsupport.com) offering information and psychological support, including moderated discussion forums and videos. The latter cover such questions as:

How Do I Become a Well-Informed Patient?
What Makes A Good Consultation?
What Are Realistic Expectations from Cosmetic Surgery? Will I Need Further Surgery?

The site covers all surgeries and other cosmetic procedures and receives no commercial funding. I would welcome the opportunity to work with BAAPS/ BAPRAS more closely in offering this type of information to all cosmetic surgery patients.

References:

1. www.guardian.co.uk/technology/2005/dec/22/news.medicineandhealth
2. www.baaps.org.uk/about-us/press-releases/1029-surgeons-put-forward-regulation proposal