After the recent problems with certain French breast implants, cosmetic surgery experts advise how patients can be as sure as possible that the implant or other cosmetic procedure they're considering is top quality.

By Lisa Salmon.

Up until last year, and in spite of the tough economic times, going under the cosmetic surgeon's knife was becoming increasingly popular.

Breast augmentations (boob jobs) continue to be the most common cosmetic surgery by far. But while figures from 2011 showed the number of women having breast enlargements had risen by 6.2%, the increase was recorded before the recent French PIP (Poly Implant Prosthese) implants furore.

In December, it emerged that the PIP breast implants contained industrial silicone which may be more likely to rupture and leak. Last month the Department of Health said as many as 47,000 women in the UK may have the implants.

The scandal may make women think twice before going under the knife for breast augmentation, or indeed any kind of cosmetic surgery.

But if the potential aesthetic improvement overrides any safety concerns, how can cosmetic surgery patients be as sure as possible that their desired procedure is the best possible quality?

Stephen Hamilton, a consultant plastic surgeon and spokesman for the British Association of Aesthetic Plastic Surgeons (BAAPS), which represents 40% of UK plastic surgeons, doesn't think the PIP problem will have put many women off having breast implants.

"I think the PIP problem has scared people, but I don't think it's necessarily made them change their minds about having surgery," he says.

"I think it's made them ask more about their implants, and that's a good thing."

The plastic picture With 10,003 breast implant operations performed by BAAPS members in 2011, up from 9,418 the year before, they remain the most popular form of cosmetic surgery in the UK and were nearly twice as high as blepharoplasty (eyelid surgery), which went up 4.8% last year to 6,057 operations.

Overall, the number of surgical procedures carried out by BAAPS members in 2011 showed a rise of 5.8% from 2010, to a total of 43,069. The greatest rise was in male tummy tucks (abdominoplasty), which showed an increase of 15%, while female tummy tucks increased by 7%.

"I wonder if some of these treatments have moved over from being an absolute luxury to being a personal treat in tough times," ponders Hamilton.

However, he points out that such treats may be risky if patients don't do their research well, as much of the cosmetic surgery sector is currently unregulated, and materials like fillers aren't classed as medicines, so they can be bought cheaply on the internet.

"Hopefully the recent problems mean there'll be some more patient education, and some change in the regulatory framework," he says.

"It's certainly true that the current framework for regulation is pretty light-touch."

Good advice For those just beginning the cosmetic surgery journey, Hamilton advises acting on recommendations from people who've already been successfully treated, or perhaps talking to a GP who may have other patients who've had good or bad experiences with cosmetic surgery.

If recommendations aren't an option, he suggests locating a surgeon through the BAAPS website's Find a Surgeon search facility (, as it's a good way of ensuring a doctor is well qualified in a particular procedure.

He says that while there are perfectly good surgeons in the UK who aren't members of BAAPS, it may need plenty of research to find one.

"One of the problems is that it can be very difficult to sift through all the names and find somebody in an area that's become so commercialised.

"It can be tough to make sure you're getting the right advice from the right person, as there's a danger in aesthetic surgery that people are just trying to sell you things. If you feel like that, you're probably better to look for advice somewhere else."

But the reality is that many patients will look for the cheapest option, often on the internet, and if that's the case they should ask for clear evidence that the surgeon is fully trained in what they're doing, and is on the specialist register.

The cheapest option is often abroad, says Hamilton, but he warns of "massive safety issues" which can work out much more expensive if there are any complications after surgery, and the patient is hundreds of miles away from their surgeon.

"If patients do travel abroad, they should do their research very thoroughly. If your reason for choosing a surgeon is price, it's probably a false economy.

"If you're receiving very cheap treatment then you have to ask yourself where the savings are being made. Medical care is expensive, and the worry is that corners are being cut somewhere," he warns.

Patients should always have a full consultation with their surgeon - not a nurse or an advisor, Hamilton stresses.

"If patients are seeing their surgeon for 10 minutes before they embark on a major surgical procedure, I don't think that's right," he says, pointing out that when he sees patients, the first consultation for any procedure takes between 30-45 minutes, followed by a second, shorter, consultation after a cooling-off period of a few weeks.

"What you certainly don't want," he says, "is people acting on impulse - you need to know they've thought about it and are sure it's right for them."

Towards regulation The Department of Health has now launched two reviews, one examining how the PIP problem was handled in the UK, and the other looking at whether the cosmetic surgery industry needs to be more effectively regulated.

This includes considering whether those who carry out cosmetic interventions have the right skills, whether clinics look after the care and welfare of their patients, and the regulation of implants and fillers.

Plastic surgeon Professor Laurence Kirwan, who runs clinics in the UK and the USA and is a member of the American Society for Aesthetic Plastic Surgery, suggests that some clinics don't offer the personalised doctor-patient relationship which is integral to practising medicine.

He warns: "Their ownership is profit, not patient-driven. As seen from the PIP fiasco, there's an urgent need for strenuous, effective regulation of any device implanted into the human body.

"Cosmetic surgery is like any other surgery and should only be performed by properly trained surgeons. Health catastrophes, such as seen with PIP, must be avoided at all costs in the future."