THE INSURANCE ISSUE WITH ‘FIFO’ SURGEONS
It is estimated that two-thirds of all cosmetic procedures are carried out by foreign surgeons within Britain. This figure is based on a 2005 report by the Healthcare Commission, which stated that of the 800 surgeons operating in the UK, 600 were from abroad. They travel into the country, perform the procedure and then fly home, earning them the nickname ‘FIFO’ or ‘Fly In, Fly Out’ surgeons. Whilst all legally have to be registered with the General Medical council (GMC), many are believed to operate without UK insurance. This can pose enormous problems when something goes wrong, as patients have difficulty claiming compensation and in some cases may no longer be able to trace their surgeon at all.
Safer Cosmetic Surgery wholeheartedly supports the British Association of Aesthetic Plastic Surgeons (BAAPS) in its request that it should become a legal requirement for all surgeons working within the country to possess UK indemnity insurance. Safer Cosmetic Surgery member, Charles Nduka, a leading and highly experienced surgeon, has previously been requested to carry out corrective surgery on patients following disastrous operations by foreign surgeons who had then disappeared overseas. He says:
“Surgeons working for some of these clinics — well-known brands — are only able to work here because they are not paying UK indemnity insurance.”
“There are numerous examples of patients who have had operations and the surgeon was out of the country when they had a problem. Patients are being put in a very difficult position, unable to contact anyone to help them.”
One clinic where this has arisen is the Harley Medical Group, where there was a case in which Surrey lady Bernadette Cini contacted Nduka for help with reconstructive surgery. Cini had been operated on in the UK by Hicham Mouallem who also works in Italy and the Middle East. An infection developed after the £5,700 breast reduction yet when Cini sought redress, she found that Mouallem had left the country. His Italian insurers ignored the correspondence and eventually the ‘FIFO’ surgeon was found in another UK clinic; Mouallem now has UK insurance.
This is just one example of many instances where the use of FIFO surgeons without UK insurance has led to a failure in the continuity of care for patients. Charles Nduka and all Safer Cosmetic Surgery surgeons agree with the BAAPS proposal that legislative steps should be taken to ensure every patient is covered by UK indemnity insurance, providing proper safeguards for all.
PIP ONE YEAR ON – SPOTLIGHT ON WALES
It is just over one year since the Poly Implant Prostheses (PIP) scandal broke in the UK, leading to medical bodies to support the preventative removal of the implants. Use of the breast implants for breast enhancement, discovered to be made from industrial grade silicone, has led to a full review of the cosmetic surgery industry in recent months. Figures are also emerging about the scale of the problem and how women in some areas of the UK are faring with having breast implant replacement surgery.
The figures for Wales can be shown to highlight some of the key issues in the wider PIP situation. Originally, the French government suggested that 30,000 women should now contact a clinic to remove their PIP implants. In Wales, 157 women have had the defective implants removed and replaced on the NHS. With approximately 250 women in the region still waiting for treatment, the number still represents fewer than the 1,000 women in Wales who are estimated to have been fitted with the PIP implants, over 95% of whom were fitted with them during surgery in private clinics.
Originally 547 women were referred to the Swansea Morriston hospital for PIP removal treatment. The reason that there are fewer women having replacements than predicted indicates factors that remain true elsewhere in the UK. However, in England the Government only agreed to pay for the removal of PIP implant on the NHS and not the replacement.
The implants would have been used in surgery in Wales between 1990 and 2010 and may already have been replaced, either within the UK or overseas, in places like Belgium. In some cases, the PIP implants may already have ruptured and have been replaced long ago as a matter of urgency. Furthermore, some women may have left Wales already.
The decision by the Welsh Health Minister to permit women to have their implants replaced on the NHS proved controversial in Westminster at the time, during what has been a turbulent twelve months for the cosmetic surgery industry and for views on the attendant regulation. However, the lasting political effect of the PIP scandal is still the establishment of the Keogh Review who have looked into the regulation surrounding the industry and whose proposals may, we hope, finally lead to the banning of unsavoury practices such as two-for-one surgery ‘bargains’ as well as tighter control of all implants and devices used in surgery, which Safer Cosmetic Surgery and our surgeons wholeheartedly supports.
What the PIP scandal continues to throw into stark relief is the fact that the standard one or two year cosmetic surgery warranties are not always the best available option, even when they are honoured. A lifetime of aftercare, such as that offered by the members of Safer Cosmetic Surgery, is quite literally guaranteed to leave you in the safest possible hands, forever. All our surgeons are highly experienced and qualified and registered with BAAPS and/or BAPRAS.
CELEBRITY OBSESSION IS “TRIVIALISING COSMETIC SURGERY”
The heads of the UK’s two most prestigious associations for cosmetic surgeons have spoken out against the way in which the 21st Century fixation with celebrities’ lives, looks and bodies is impacting upon our view of cosmetic surgery.
Graeme Perks, the new President of BAPRAS, the British Association of Plastic, Reconstructive and Aesthetic Surgeons, recently highlighted the issue to The Times. He states that TV stars such as those in The Only Way Is Essex can be seen to be promoting plastic surgery. With celebrities of this ilk becoming hugely popular figures, many fans are regarding cosmetic surgery like a simple, small beauty treatment. It is also Perks’ view that the integrity, morality and professionalism of certain surgeons have been compromised by them behaving like “used car salesmen”.
The BAPRAS head is backed by Rajiv Grover, the President of the British Association of Aesthetic Plastic Surgeons, or BAAPS. Grover agrees that people jump into the decision to have cosmetic surgery without sufficient forethought, adding that rather than carefully considering which surgeon to select, some people “spend longer choosing their bathroom tiles.”
Indeed, it would seem that the flash, often brash, celebrity culture risks trivialising what are essentially medical procedures due to what Perks calls the “credit card philosophy”, where people simply buy surgery without having to save, just like their famous idols. Whilst he expresses a wish that this may change in these difficult economic times, it remains clear that people do turn to surgery to emulate the rich and famous. That includes trying to look like public figures who have not had surgery, such as the Duchess of Cambridge, whose nose was the most requested feature of 2012.
Whilst the adoration of those who do frequently have cosmetic procedures continues, it seems likely that some misguided individuals will turn to surgeons for the worst possible reasons. Whilst they must surely know that asking for a chin like ‘her off TOWIE’ does not guarantee fame or happiness, the desire somehow remains. Like the Presidents of BAPRAS and BAAPS, we advise that only those who have given a medical procedure genuine consideration and consulted a truly professional surgeon should undergo cosmetic surgery, regardless of the latest soap trends.
DISAPPEARING ACT FOR PIP SCANDAL
The company that carried out the majority of procedures where PIP implants were used has gone into administration and restructured itself, meaning that the women who were fitted with the dangerous implants can no longer hold the company liable.
Harley Medical Group was prominent among companies who permitted non-medical grade silicone to be used in breast surgery. The implants were unfit for purpose and potentially hazardous to health and the realisation that they had been used in thousands of procedures led to the ‘PIP scandal’ breaking in 2011.
The government set up the Keogh Review to look into the wider cosmetic surgery industry and many individual women had begun to pursue companies such as Harley Medical Group through the courts in an attempt to gain redress. However, now this company has been acquired by another holding group, diminishing their legal responsibility. Women in Yorkshire who used the clinic have therefore had to pay £2,000 to £5,500 or in some cases more to have the faulty implants removed at other hospitals.
We believe that this situation further highlights the importance of those who are considering cosmetic surgery only ever using a trustworthy surgeon. Safer Cosmetic Surgery’s members are highly qualified and experienced, being members of BAAPS (British Association of Aesthetic Plastic Surgeons) and/or BAPRAS (British Association of Plastic, Reconstructive and Aesthetic Surgeons), and regard the safety of their clients as paramount. Crucially, they each offer a lifetime of aftercare: which most clinics do not - such is their dedication of providing an outstanding healthcare service.
What the PIP scandal continues to throw into stark relief is the fact that the standard one or two year cosmetic surgery warranties are not always the best available option, even when they are honoured. A lifetime of aftercare, such as that offered by the members of Safer Cosmetic Surgery, is quite literally guaranteed to leave you in the safest possible hands, forever.
THE END OF THE TWO-FOR-ONE DEAL?
The Government is looking at banning two-for-one and similar deals within the cosmetic surgery industry, amongst other measures. It would be a move that has been called for from contributors of evidence for the Keogh review, including the British Association of Aesthetic Plastic Surgeons (BAAPS) and the British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS).
The two-for-one deal is one of the practices carried out by certain quarters of the cosmetic surgery industry that has threatened to bring the wider profession into disrepute. In the UK, as well as the US and elsewhere, there have been cases where people seeking to undergo a cosmetic procedure, such as breast enlargement, have been encouraged, or even pressurized into having a second one as part of a ‘deal’ or ‘bargain’. Sometimes the patient will be told that the supposed special offer is shortly due to expire and be subjected to heavy-handed sales calls and other techniques.
The practitioners who tout their two-for-one deals and special offers are well known for getting creative to sell more surgery. In certain cases, prospective patients are urged to bring along a friend or relative to take advantage of a deal such as two-for-the-price-of-one breast surgery – clearly a case where safety certainly does not lie in numbers. Keogh review committee member Vivienne Parry likened such aggressive sales techniques to those used “for selling double glazing.”
The potential ban must therefore be supported as such unscrupulous behaviour has led to disastrous physical and psychological damage for some of those patients who trusted the wrong advice. The Government may bring into effect a rule whereby photos of scarring and bruising, plus honest details of any other effects will have to be presented to prospective patients.
Safer Cosmetic Surgery wholeheartedly agrees with the move towards banning these cut-price deals and has long argued against these sorts of practices. We will continue to watch the steps the Government takes with interest as we hopefully approach an era of more ethical regulation. All of the surgeons at Safer Cosmetic Surgery are registered with BAAPS and/or BAPRAS and we believe in promoting 'safer' cosmetic surgery.
MEET YOUR SURGEON… OR NOT!
Over the past few years there have been an increasing number of cosmetic surgery procedures, which would once have been carried out by surgeons. People working within the healthcare profession are now undertaking surgical procedures that they may not be qualified to carry out. This marks the rise of the SCP, or Surgical Care Practitioner, a role which is growing more common within the NHS.
An SCP will carry our minor surgery such as carpal tunnel surgery, mole removal or closing wounds, which would normally be carried out by a highly experienced and qualified surgeon. There has been a twofold response to the increased popularity of such a role. Some believe that as specialists in certain minor procedures, they can become experts in that narrow area, lighten the load of the busy surgeon and provide a cost-effective resource for the NHS.
Others, who look at the many years of study and practice it takes to become a doctor and then a surgeon, feel that is just a cheap alternative to staffing a clinic with an actual, qualified surgeon. Those who practice surgery fully appreciate the benefits of even the most minor procedure being carried out by a doctor with a comprehensive understanding of the workings of the human body in its entirety.
However, despite such reservations, the role of the SCP seems set to grow. Anyone who is interested in cosmetic surgery remaining as safe as possible will take note of the changing parameters of those who are entitled to practice surgery. As ever, Safer Cosmetic Surgery will continue to monitor the regulatory approach to SCPs, as all those who carry out procedures must be entirely accountable.
For the part of those considering surgery, it is always vital to ensure that you know your surgeon is fully qualified to carry out your specific procedure. It is very important to check if your surgeon is registered with BAAPS (British Association of Aesthetic Plastic Surgeons) or BAPRAS (British Association of Plastic, Reconstructive and Aesthetic Surgeons). If in doubt, do not proceed – simply choose a Safer Cosmetic Surgeon who will be qualified in every respect, accredited and experienced. Whilst we welcome medical specialism and cost-effective management of healthcare, it remains vital that each and every procedure is carried out by the best qualified and most experienced surgeon available.
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