Demographics and macroeconomic effects in aesthetic surgery in the UK

Psychosocial predictors, assessment, and outcomes of cosmetic procedures: a systematic rapid evidence assessment

BACKGROUND

Recent breast implant complications led to a UK government policy review of the evidence concerning cosmetic interventions. We synthesised cosmetic intervention research evidence covering psychosocial factors associated with requesting procedures and psychological outcomes, effects of procedures on psychological outcomes, preintervention assessments for identifying those at risk, alternative therapy effectiveness, and issues in achieving informed consent.

METHODS

Undertaking a systematic rapid evidence assessment, six databases and three journals were searched. Included studies were systematic reviews or primary studies of participants requesting cosmetic procedures; published 2002-2012; containing either psychological or psychosocial measures, a psychological outcome, or evaluation of informed consent. Reviewers independently assessed study eligibility, extracted data, and assessed quality, undertaking narrative synthesis.

RESULTS

Methodological quality of the included 13 systematic reviews and 179 primary studies was low, with wide variation in psychosocial measures. Findings suggest several psychosocial factors (e.g., intimate partner violence) may be associated with requesting cosmetic surgery. Multiple factors (e.g., unrealistic expectations) may predict poor psychological outcomes. Current psychological screening tools focus predominantly on body dysmorphic disorder (BDD) symptoms. Psychological and pharmacological interventions are effective alternative BDD treatments. Patients and doctors bring different needs to informed consent discussions, inconsistently matched to those required by professional ethics, litigation risk, and facilitating profit.

CONCLUSIONS

Systematically reviewing this literature for UK policy has highlighted that some groups may be at risk of poor post-cosmetic procedure outcomes. Practitioners and patients must explore reasons for seeking cosmetic procedures and discuss all potential results and alternative solutions. Future research should employ more robust methodologies to identify effects in those at risk, led by consensus on a core set of psychological outcomes.

Policy related to abdominoplasty in publicly funded elective surgery programs: a systematic review

Objectives  This systematic review set out to establish best practice in relation to policy for the inclusion/exclusion of abdominoplasty procedures within public health systems. Inclusion criteria  The review considered any studies relating to abdominoplasty that addressed issues of inclusion/exclusion from public funded health systems including criteria for clinical need, contraindications, fit/ready for surgery, policy compliance and issues in relation to surgical training. Search strategy  The search strategy sought to find published and unpublished studies and papers limited to English. An initial search of Medline and CINAHL was undertaken, followed by an analysis of keywords contained in the title, abstract and index terms. A second comprehensive search was then undertaken using Medline, CINAHL, EMBASE, AUSTROM, Health Business, and FullTEXT Elite and PsycINFO. The search was restricted to the period 1995-2005. Methodological quality  Each paper identified was assessed by two independent reviewers for methodological quality before inclusion in the review using an appropriate critical appraisal instrument from the Joanna Briggs Institute System for the Unified Management and Assessment Review Instrument package. Results  A total of 19 papers were included in the review. Owing to the diverse nature of the papers no meta-analysis or meta-synthesis was able to be used to pool studies. The results are therefore presented in a narrative form. The papers identified were mainly retrospective audits and discussion/opinion papers. The main issues addressed were criteria to establish clinical need, contraindications and policy compliance. Conclusion  There are clinical indicators, mainly in relation to physical symptoms/dysfunction, to support exemption of some cases of abdominoplasty. For abdominoplasty to be conducted clinical need must be assessed and formally documented. Where clinical need is primarily based on psychological distress/dysfunction a formal psychiatric assessment should be used to justify surgery.

Implantable hearing aids

The aim of this article is to give readers a general overview of the concepts involved in the latest generation of implantable hearing aids. A section on ear biomechanics has also been included to familiarize readers with the basic concepts involved. These devices have been developed over the last 20 years, driven by problems with conventional hearing aids and by advances in the understanding of middle-ear mechanics. The use of technology borrowed from cochlear implants has enabled the first generation of fully implantable aids to be trialled. The author examines the theoretical advantages and disadvantages of implantable hearing aids over conventional aids and then reviews the technology and clinical results of a range of devices that have been trialled.

A retrospective study examining the socioeconomic backgrounds of women undergoing bilateral breast augmentation at a private independent hospital in the United kingdom

Cosmetic breast augmentation is becoming increasingly popular and acceptable to women in the United Kingdom. This study examined the socioeconomic backgrounds of women undergoing breast augmentation who live in North Warwickshire in the Midlands. The case notes of 98 consecutive breast augmentations performed at a private independent hospital were retrospectively reviewed. The average age of the patient was 34 years (range, 17-53 years). They were requesting, on the average, an increase of 2 bra cup sizes (range, 1-3 cup sizes). The preoperative bra cup size was A/B (range, AA-C), and the postoperative bra cup size was C/D (range, B-E). The average size of the implant used was 270 ml (range, 160-410 ml). The average implant size used currently is considerably larger than that reported in studies 30 years ago. What women perceive as a "natural-appearing" breast has changed over time. The findings show that women from all across the socioeconomic spectrum are undergoing breast augmentation. In particular, the authors found that the largest proportion (34%) of their patients have come from social class IIIn. This is particularly interesting in that this social class is not overrepresented in North Warwickshire. The findings of this study may have implications for cosmetic surgery providers and may document the change in the attitudes of the authors' society toward cosmetic breast augmentation.

An analysis of 1361 aesthetic procedures from 2000 to 2005 in a large regional plastic surgery unit: implications for cosmetic surgery training

One of the challenges facing our profession is the adequate training of plastic surgeons in the subspeciality of aesthetic surgery, in addition to covering the rest of the large curriculum. The UK's Chief Medical Officer, Professor Sir Liam Donaldson, has recently called for better training for doctors, better information for patients, and a touger regulatory structure for private cosmetic surgery. In this study, we show that the training of cosmetic procedures in our unit has risen steadily over the 6 year period studied. As part of our committment to improving training, our unit has recently organised a 3 month block soely dedicated to aesthetic surgery, allowing increasing exposure to cosmetic clinics and theatre sessions. It is clear that as a group, we must continue to develop robust training schemes to produce plastic surgeons able to cope with the demands of 21st Century healthcare, and ensure that the public does not fall prey to practitioners in unregulated clinics.

Aesthetic surgical training in the U.K. independent sector – the clients' view: results of a survey on 155 private patients

As training opportunities in cosmetic surgery become less frequent in teaching hospitals, this survey set out to examine the attitudes of patients towards extending this training into the independent health sector. We questioned 155 private patients, 95% of who were happy for trainees to sit in during their consultations. Of these, 85% were comfortable with the presence of the trainee throughout their appointments and 92% said they saw advantages in having such trainees present. However, patients were less enthusiastic about trainees carrying out procedures, under consultant supervision and for a reduced fee. The survey found that while 49% felt it was a good idea, only 32% would consider it for themselves. Seventeen percent of patients thought this offer alone was inappropriate. This survey has shown that while the vast majority of private patients supported and were happy to participate in higher surgical training during private consultations, fewer would consider the possibility of cosmetic surgery performed by supervised trainees for reduced fees. The implications of these findings for higher surgical training in Plastic Surgery in the UK are discussed.

Maintaining standards of aesthetic practice in trainees subject to NHS restrictions

The Specialist Advisory Committee (SAC) in plastic surgery within the United Kingdom (UK) recommends a modular training programme to include aesthetic surgery. The intercollegiate board examinations test candidates on all aspects of aesthetic practice yet there is no formal, national aesthetic training in the UK. Closure of National Health Service (NHS) private patient facilities has reduced training opportunity [Nicolle FV. Sir Harold Gillies Memorial Lecture; Aesthetic plastic surgery and the future plastic surgeon. Br J Plast Surg 1998;51:419-24.] Calmanisation [Hospital doctors: training for the future. The Report of the Working Group on Specialist Medical Training (The Calman Report). London: HMSO; 1993.], the European Working Time Directive (EWTD) [; Phillips H, Fleet Z, Bowman K. The European Working time Directive-interim report and guidance from The Royal College of Surgeons of England working party chaired by Mr Hugh Phillips; 2003 []; Chesser S, Bowman K, Phillips H. The European Working Time Directive and the training of surgeons. BMJ Careers Focus 2002;s69-7.], and more importantly the implementation of "local" aesthetic guidelines have placed further pressures on training. Reductions of NHS case mix will ultimately lead to a reduction in trainee experience. With increasing regulatory pressure from the Commission for Healthcare Improvement, standards of aesthetic practice can only be maintained by increasing private/independent sector involvement. At present a disparity exists between the demand and provision of aesthetic surgery training in the UK. Aesthetic surgery forms part of the training curriculum for plastic surgery and as such remains a training issue. A review of aesthetic surgery training is needed in the UK through consultation with trainers and trainee representatives.