In this article Greg Swarbrick, our Partnerships Director, look at things you should consider before opting for cosmetic surgery and the evidence available to show how it might make you feel. 

PHIN collects feedback from hospitals which ask their patients – before and after treatment – to complete questionnaires on their satisfaction with the procedure carried out. We use this information to provide reassurance about the quality, effectiveness and safety of procedures conducted in private healthcare. It is also useful to help patients better understand what their experience might be like, so they can manage their expectations.

These satisfaction questionnaires have a response scale of 1 to 4, with 1 representing ‘Very dissatisfied’ and at the opposite end, 4 representing ‘Very satisfied’.

The tables below show how the pre-operation scores compared with the scores after cosmetic surgery. You’ll see there is generally a very positive improvement for all questions asked for each type of surgery.

Most, though not all, patients report improvements. It is worth remembering though that that improvements following cosmetic surgery are seen through a very subjective lens. The results of this type of surgery are not as clear cut as something like a knee operation where you can assess a person’s ability to kneel before and after surgery or a cataract operation where the assessment is whether the cataract has been removed and the patient can see clearly once more.

In cosmetic surgery, there may not be anything wrong with the patient’s appearance following surgery, but it might not match their expectations in terms of how they look or feel. This is why we have used a questionnaire that focuses on the patient’s satisfaction with their procedure.

Augmentation mammoplasty (also known as breast enlargement)

Responses from over 700 patients

Liposuction

Responses from 40 patients

Rhinoplasty (also known as a ‘nose job’)

Responses from over 80 patients

Practical guidance on choosing a reputable provider and avoiding an unsafe one

Before booking a consultation or procedure, we recommend you read our guide on Cosmetic clinics – what to watch out for.

What to expect from cosmetic surgery

As has been shown above, the results of cosmetic surgery are seen as very positive by the patients who have them, at least for the treatments reported by PHIN. It’s important that your clinician fully explains to you what will happen before, during and after your surgery and that you are given sufficient time to ask any questions.

You should not feel any pressure to have treatment, and in fact clinicians usually encourage their patients to take some time away to think about the treatment once they have a full understanding of what it involves.

It’s also important not to have any unrealistic expectations – there is no such thing as the ‘perfect nose’, or any other body part, so having a realistic discussion with your clinician about the outcome and your feelings about that will be time well-spent.

There is always a risk of a complication (an estimated 10%, according to BAAPS, the British Association of Aesthetic Plastic Surgeons) or that patients do not like the results, particularly because this cosmetic surgery is often such a subjective procedure.

You should always ask your surgeon before the procedure what the process is if there is any complication or if you feel you need to have corrective treatment to the original surgery. This will depend on the situation:

• If there’s bleeding or a wound, that’s medical and should be included in the package of treatment as ‘continuation of care’.
• If it’s purely aesthetic, then this will come down to a discussion between you and your surgeon. It may be technically perfect surgery, but aesthetically not quite what you were expecting. Even if the result has been modelled or visualised for you, in real life it can seem different. There are always limitations to any operation, and you should bear this in mind before treatment
• In terms of individual procedures, rhinoplasty should last a lifetime, while a facelift may last a decade. Any breast augmentation will always be subject to gravity and exercise – things stretch. Remember that for this and some other surgeries, you are putting something new on top of something that’s older.

Why are you considering cosmetic surgery?

Do think through your reasons for wanting to change the way you look, and remember that some changes can’t be undone. People have different reasons – for example, some women have breast reduction surgery to mitigate the back pain they suffer, and it is a procedure with very high patient satisfaction particularly for that reason. For others, it is a particular part of their body that they feel is causing them distress. You should never be pressured into having surgery either by friends, family, social media nor by a potential provider of cosmetic surgery. It should be done as what’s right for you, as you are the person who will be receiving the treatment.

There is often a mental health angle to having cosmetic surgery. People often hope that they will feel better mentally because of the way they will look. It’s worth considering why you might feel that way. Are advertising and marketing making you feel bad about yourself and as a result more likely to want surgery?

You should also be aware of the risk that cosmetic surgery can become an addiction in its own right, known as body dysmorphic disorder, with people always focused on the next surgery, unable to fully accept their appearance, whatever changes they make. This was described in a recent BBC News article.

Understanding the costs of cosmetic surgery

It’s important to consider whether you can afford cosmetic surgery and whether you have a full understanding of the costs. The PHIN website can help you understand the consultant costs (see: Understanding private consultant costs); you should also consider any other costs, such as hospital and anaesthetist fees, which your consultant can advise on and may vary depending on the type of treatment you have.

It’s very likely that you will have to self-pay for your cosmetic treatment as private medical insurers only tend to fund this type of procedure if it is medically required. See our guide which includes information on self-funding your private treatment.

How to choose your cosmetic surgery provider

When choosing a consultant, do look at how many of the procedures they have carried out for the surgery you’re interested in, plus what qualifications and training they have, and whether they are a member of an accredited body such as BAAPS, BAPRAS, ENT-UK or relevant organisations.

Worth noting is the risk that people whose doctors say that it’s unwise to have a certain treatment then go and seek out less-qualified doctors who’ll agree to perform the operation – but at much greater risk their own health.

It can be entirely appropriate to ask for a second medical opinion, but if several doctors agree you should not have a treatment it is worth following their advice. Surgeons or people who aren’t professionally regulated and who don’t collect and reflect on the quality and effectiveness of their treatments (and can demonstrate that) may pose a greater risk to you as a patient.

Whilst the proposed lower costs of cosmetic treatment abroad may be attractive, do remember that standards and protections for patients may be lower in other countries.

Want to make a complaint about your cosmetic surgery?

If you are considering making a complaint, see our guide What should you consider before getting cosmetic surgery?

You should also consider whether this is better made to the individual consultant or to the hospital or clinic which employs them.

Definitions of cosmetic surgery

Some cosmetic surgery because of its complexity or time to recover requires it to be done in a hospital setting and may even require an overnight stay, for example breast augmentation or reduction. 

Other less invasive surgical procedures, such as rhinoplasty (nose job) or non-surgical interventions like Botox or fillers, can be done in a hospital or clinic with you returning home the same day. 

In some cases, a different clinical setting may be required to the regular one if more complex surgery is needed or if the patient’s situation requires it. 

Exploring PROMs

If you would like to know more about how people who have had a procedure feel about it before and afterwards, check out our PROMs Explorer.

Further reading

There are many resources now available online for patients. Recommended ones include:

• British Association of Aesthetic Plastic Surgeons (BAAPS): Answers to patients’ frequently-asked questions: FAQs | The British Association of Aesthetic Plastic Surgeons
• British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS): Guidance for patients: Patient Information | BAPRAS
• Guidance for patients from the Royal College of Surgeons (RCS), which has checklists and videos: Cosmetic surgery — Royal College of Surgeons