In my job I am constantly having to battle against prejudices and preconceived ideas about cosmetic surgery.

Unfortunately, we have it woven into the fabric of our society that cosmetic surgery is all about vanity and creating unnatural caricatures of previously beautiful people. This has led to the perception that all cosmetic surgery is unnecessary and so is a choice for the patient as to whether they have it or not. It is on these grounds that I frequently hear that patients have to take holiday or unpaid leave from their jobs as their employers will not allow them to take sick leave.

I saw someone this morning who approached their HR Department and asked how long they would be allowed off after surgery and the HR Department immediately asked if it is cosmetic, in which case no time would be allowed. I think this is unfair and should not be allowed to happen.

I tell all my patients that I am very happy to provide a sick note and I simply write on the sick note: Surgery, as the employer does not need to know the details of the patient’s medical condition since this is confidential. I think it is wrong for an employer to make a judgement on whether they are allowing a patient to have sick leave based on the reason for the sick leave. I do not know if it is legal, but I certainly do not think it is ethical for an employer to have a blanket policy that any cosmetic surgery would not qualify a patient to take sick leave. What are the grounds for this decision? Are the grounds that the surgery is not necessary and is the patient’s choice? Well in that case would a hernia repair, hip replacement, cataract surgery, surgery for gastric reflux or haemorrhoids necessary? I could go on.

Many operations, in fact, most operations that are the patient’s choice and they do not need to be performed but the reason for performing them is to improve quality of life and yet all of the above I suspect would be deemed perfectly appropriate for the patient to have sick leave after them.

So what makes cosmetic surgery different?

It can have a significant effect on quality of life and indeed studies have shown that the impact of cosmetic surgery on quality of life is more significant than most, if not all of the procedures above. So why do we not think it is as worthy as having your haemorrhoids fixed or your hip replaced?

I think it is because cosmetic surgery addresses psychological wellbeing rather than physical wellbeing. This is not always the case as there are often functional and physical improvements following cosmetic surgery.

Operations such as breast reduction and tummy tuck spring to mind. It is true to say a large part of the improvements the patient experiences following cosmetic surgery is in their psychological wellbeing and self-esteem.

We as a society do not value this. We do not treat psychological wellbeing with the same importance as physical wellbeing. If a work colleague goes off with stress or depression we do not know how to handle this and they are often thought to be shirking or weak, whereas if a colleague goes off with a painful back or a kidney infection we only have sympathy for them.

In today’s society psychological and mental health problems are an epidemic.

They are achieving a lot of exposure with the Royals and the Government backing campaigns to increase awareness and encourage people to speak up, but we are still a long way away from treating mental problems on the same level as physical problems. The particularly distressing fact about mental health is that it is a major cause of morbidity and mortality to our young people and because of the stigma attached to it people suffer in silence. When asked: How are you? You would probably have no problem saying: I’m fine but I have got a bit of back ache, or I have got terrible indigestion but you probably would not be quite so comfortable saying: I’m okay but I am feeling a bit low today, or: I cannot seem to stop crying.

I completely understand the public perception of cosmetic surgery. I see it myself on television and in the media. When you are only fed images of pumped up lips and enormous buttocks you would be forgiven for thinking that these people have no right to go off sick following this sort of surgery. However, these are not the people who are having surgery on a daily basis. Hospitals throughout the land are performing cosmetic surgery and changing people’s lives, not by inflating their lips or putting implants in their buttocks but by making subtle adjustments to the bump in their nose, by giving fullness back into their empty breasts or by removing the spare tyre from their tummy that they have had since having three kids.

Most people do not want to look like a caricature of themselves. They just want to look like themselves. I know we have all seen the woman who spent thousands of pounds wanting to look like Barbie and the man who wants to look like Ken. I am sure the media love these stories but the people I see in clinic are happy being who they are but they are unhappy about something, whether it be their tummy, their breasts, their nose, their ears. They just want to feel better about some part of their body.

The fact is that when it comes to improving symptoms and looking at the quality of life of patients before and after surgery, you can rank cosmetic surgery right at the top and it does as well if not better than any other operation, particularly when you make adjustments for age because cosmetic surgery is often performed in young people who have many years to enjoy the improved quality of life.
I do not think we are going to change the public perception overnight and employers will continue to look down on patients who go off sick following cosmetic surgery. I guess that will lead patients to simply not tell the employer what they are having done because after all, it is none of their business anyway. They can just say: Women’s problems.

I wish I could change the way these things are perceived and bring them on an equal footing with functional surgery and I will continue to try.

One of my passions is to raise awareness about cosmetic surgery to try and change perceptions so that it is not portrayed as being a branch of medicine that is somehow less worthy than other branches of medicine.

There is an image that all plastic surgeons are unethical, money grabbing cowboys but the reality is very far from that (well I would say that wouldn’t I?).

One of the problems is that for many plastic surgical procedures, patients look for a surgeon by going on the internet or look at advertising and marketing in glossy magazines, rather than the traditional route of going to see a GP and being referred.

This has allowed a huge growth in practitioners who are not fully trained to set up and practice plastic surgery (practice being the operative word).

Whenever I talk to people about this, they are always shocked and alarmed to discover that there are so many untrained doctors performing surgery.

They think that surely there is a law against such a thing and that it should not be allowed, but I am afraid there is no law against this and it is allowed and it is going on all over the UK.

I feel so strongly about it that I have written a book called ‘Never Accept a Lift From Strangers: How to choose the best plastic surgeon for your cosmetic breast surgery’ and it is available from Amazon.

One might ask why I have had to write a book about this as you would have thought that it was obvious to see which surgeons have been trained and which haven’t.

Unfortunately, it is not obvious.

I talk about cases in my book of high profile people, both here and abroad, who have had complications following plastic surgery performed by non-trained plastic surgeons, people like Colin Hendry the Premier League football player and the pop stars, Kanye West and Usher, have all had family members who have been affected and I am sure they thought their plastic surgeons were fully trained.

The problem is that when someone asks me to tell them what to look out for, it is not so clear cut.

That is why many doctors and surgeons have very impressive sounding biographies and you may be fooled into thinking that they are properly trained, but only when you delve deeper do you realise that they have no formal training in plastic surgery or that they may have started it but not completed it.

To be honest I blame us, the professionals. I think that we make it too difficult for people to seek and understand what all the credentials mean.

You see, there are a lot of associations and qualifications that do not count for much, although there are others that mean a lot and stand for many years of specialist training in a very competitive environment and yet to the outside eye, they can all look good.

I do not think it is a problem unique to doctors either.

I talk in the book about a problem I had finding an accountant and only later realising that there are many advisors out there who sound credible but are not qualified chartered accountants.

The same is true in the legal profession as I was talking to a friend of mine who for many years I thought was a lawyer, but in fact I discovered he was neither a solicitor nor a barrister and actually had a paralegal qualification, and I have to be honest I still do not quite understand the difference which leads to the next question:

Does it matter?

Well in surgery, yes it does matter because surgical training is very long, very competitive and very hard.

It is an extended apprenticeship which takes many years, it took me thirteen years of training after becoming a fully qualified doctor (which in itself takes 6 years) to finally finish and receive my certificate for specialist training in plastic surgery, FRCS (Plast).

There are exams to take, culminating in a final exit exam which tests whether you are safe and skilled enough to be put in charge of patient care independently once the training is finished.

If you are accepted to become a full member of the BAAPS, The British Association of Aesthetic Plastic Surgeons, then there is an audit every year where we must submit our figures on the number of operations we have done and any complications or revisions we have had to perform.

We have a strict code of conduct to which we must adhere and we have a peer group that we are accountable to.

However, there are many doctors out there who are performing plastic surgery who are not a member of one of the plastic surgery associations (BAPRAS and BAAPS).

Not only does this mean that may not be fully trained in plastic surgery, it also means that they will not be held accountable to the same rules and ethical guidelines which they are bound to practice within.

I don’t think we are going to solve this problem overnight because I think there must be something inherent with people in a profession that they keep it shrouded in mystery to make it look impressive and worthy of their stature.

I would love to be able to say to you look for this one thing to be certain that your doctor is fully trained in plastic surgery and surely that would make sense.

It might help to stop the horror stories you hear about rogue practitioners working out of their front room.

The media love to pick up on these stories and report how terrible it is, but I think the real piece of news is that they are usually not doing anything wrong and it is perfectly within the law for people to perform treatment and practice out of their front room, even people with no qualifications, that is the real story.

I don’t think we will be seeing any legislation any time soon. We cannot rely on the Government to protect us from this, certainly not at the moment, so I see my job as a plastic surgeon to do what I can to inform and educate people as much as possible.

So, what should do if you are thinking of having plastic surgery?

Unfortunately, there is no easy soundbite but I would say do your research, look for reviews and ask for a personal recommendation for anyone who is a full member of BAPRAS or BAAPS, anyone who has FRCS (PLAST) after their name and anyone who is a consultant plastic surgeon in the NHS will be fully trained in plastic surgery.

I am always happy to answer questions and to help and advise. You can see me on Facebook live every Tuesday night at 7pm and you can get hold of a copy of my book here.

There are a lot of different surgeons who perform cosmetic surgery.

They range from plastic surgeons to general surgeons, ENT surgeons, maxillofacial surgeons and even people who are not surgeons at all such as GPs or dermatologists.

This is not a problem in itself as long as the doctor is working within their scope of practice. It may be that an ENT surgeon will be just as competent to perform a rhinoplasty as a plastic surgeon would. The problem comes when surgeons start working outside of their scope of practice and this is something that The Royal College of Surgeons is trying to address by credentialing surgeons which means they will assess them to make sure they are only working within areas that they have been trained to be competent in.

The problem with this is that first of all it has not been launched yet and secondly, it is a voluntary process so unless you know to ask or check whether your surgeon has the appropriate credentials then

untrained doctors will continue to be able to perform procedures on unsuspecting patients who may not know or feel comfortable to ask the necessary questions.

I am always surprised when I talk to people about some of the topics in my book.

They are shocked when they hear that there are surgeons out there performing breast surgery whose formal surgical training may have been in ENT surgery or accident and emergency surgery.  While it might sound unbelievable, it is happening and there is absolutely no law against it.
Unfortunately many surgeons do not make what their area of specialist training is, if it does not fit with the more lucrative cosmetic procedures that they mainly perform. You cannot assume that just because your surgeon is working in a plastic surgery clinic and is talking to you about having breast implants that they are a plastic surgeon or have any specialist training in cosmetic breast surgery.

We are very fortunate that the complication rate of most cosmetic surgery is very low but this allows untrained surgeons to get away with performing surgery on patients.

However, the problem comes when there is a complication or if the patient has a complex problem such as a breast asymmetry or a chest wall deformity.

It is in these situations where a surgeon who has experience of not only cosmetic breast surgery but also reconstructive breast surgery will have the necessary skills and experience to be able to foresee potential problems and tackle any issues that may arise.

Cosmetic breast surgery is not easy. All patients will have some degree of asymmetry to a greater or lesser degree.
It is about identifying this, managing the expectations and knowing when and what to do about it.

It may be putting different size implants in, sometimes to maintain the base width of the implant and different profiles of implants will need to be used in each breast and this requires skill and experience.

It may be the use of internal sutures to redefine the inframammary fold and to ensure that the placement of the implants are accurate.
It may require a combination of a breast lift or possibly surgery to address the chest wall.

This is why I feel it is important to see a specialist for your procedure and to Never Accept A Lift From Strangers.

Here at the Staiano Clinic we are all plastic surgeons who specialise in breast surgery. We love seeing people who have done their research and welcome questions.

If you do not feel that you are in a position where you can ask questions of your surgeon in your clinic then beware.
If you want to know more, then you can get a copy of the 5 Questions To Ask Your Plastic Surgeon here.

If you have any questions, then you can tune in watch Consultant Plastic Surgeon and  our Director, Jonathan Staiano on Facebook Live every Tuesday night at 7pm for a live Q&A session.  You can join in live or post your questions in advance to [email protected] using the hashtag #AskJJ.

If you want to know more about plastic surgery training and what it takes to become a cosmetic surgeon.  Check out Jonathan’s book ‘Never Accept A Lift From Strangers – how to choose the best plastic surgeon for your cosmetic breast surgery’.  It is available to buy through our website or on Amazon.

We are very proud to share another award with you, Staiano Plastic Surgery has been awarded:

Birmingham’s Leading Expert in Cosmetic Surgery

in the UK Medical Excellence Awards 2016.