Thinking about cosmetic surgery?

Many of us would like to make some changes to ourselves physically – whether it be to turn back the clock or enhance what we’ve got. Cosmetic surgery can help with that, but how do you know whether it’s right for you?

Here are some key things to consider before you decide whether to go ahead with cosmetic surgery:

What do you want to achieve from cosmetic surgery?

Think about what it is you want to change about yourself. Do you want bigger breasts? Do you want to look younger? Consider whether the changes you want to make are realistic; if what you want is to look like Angelina Jolie, then it is highly likely that no amount of surgery is going to achieve that. If, however, you want to look the way you used to ten years ago, then a facelift might be a good option.

What are the alternatives to cosmetic surgery?

The decision to have cosmetic surgery should not be taken lightly – don’t be fooled by the word “cosmetic”, this is still major surgery and should be treated as such. Think about whether there are any alternatives to surgery that you could consider.

If you’re thinking about liposuction or a tummy tuck, for example, then a strict diet and exercise regime is a good place to start (most surgeons will insist on this before they operate, anyway). For facial rejuvenation, some things can be treated with non-surgical treatments like Botox and fillers.

If, however, you decide that surgery is the best option for you, then it is very important that you…

Do your homework

Research potential surgeons in your area, make sure you are happy with their qualifications and experience in the specific surgery you are looking for, then consult with at least two – ideally three – surgeons before picking one to perform your operation.

Cosmetic surgery can be an incredibly positive, life-changing experience, but it is not something to leap into. If you follow the advice above, you should be able to ensure that your own experience is a happy one.

What is the advantage of an overnight stay in hospital, versus day-case surgery?

This is an interesting question and to a large extent the answer depends on the individual. These days some people prefer to be able to go home on the day of their surgery in order to relax in the comfort of their own home. Many, however, prefer the security of an overnight stay in hospital, where they know a medical professional will be on hand if they have any problems.

There are cosmetic surgeons who offer quite complex surgical procedures as day cases. Personally, I prefer to be able to monitor my patients overnight after surgery, to ensure that they are recovering well and are physically fit to return home the next day.

When is an overnight stay appropriate?

Generally, if your surgery is performed under a general anaesthetic, you will be expected to spend a night in hospital. This is so that we can ensure that you have fully recovered from the effects of the anaesthetic before returning home, but it also allows the surgical team to keep an eye on how you are healing after the surgery.

In my cosmetic surgery practice, facelift and breast augmentation patients generally spend a night in hospital after surgery, as these procedures are performed under general anaesthetic.

When is day-case surgery appropriate?

As mentioned above, there are surgeons who will offer almost any cosmetic surgery procedure as a day case. In my practice, I prefer patients to spend a night in hospital for monitoring. If a patient has a non-surgical procedure, such as Botox or dermal fillers, then of course they can return home immediately after the treatment.

If your procedure is performed under local anaesthetic, then the effects of the anaesthesia will not last so long and you could, if your surgeon agrees, return home on the day of surgery.

Why do cosmetic surgery prices vary so much?

This is an interesting question. Many patients who come to see me at my London cosmetic surgery practice are surprised that I charge for consultations, and that my prices for surgery are high, compared to some of the larger cosmetic surgery chains.

Cosmetic surgery consultation fees

There are a few reasons why individual cosmetic surgeons like myself tend to charge more than the larger groups. Let’s start with consultations: if you have a consultation with one of the clinic chains, which is usually free of charge, it is likely to be with a salesperson, rather than a cosmetic surgeon.

When you have a consultation with a qualified cosmetic surgeon, they are charging you for their time and expertise. A surgeon like myself will perform a thorough medical examination before assessing your suitability for surgery and I charge a consultation fee on the basis that not all patients will go on to have the operation.

Indemnity insurance

UK surgeons have to pay very high indemnity fees before they are allowed to perform cosmetic surgery – around £40,000 a year. This is in order to safeguard patients in the unlikely case of any complications arising following surgery.

Individual surgeons have to account for this when charging their surgical fees. Clinic chains, on the other hand, because they have a large number of surgeons on their books and a large number of patients walking through the doors are able to spread the costs more and so charge lower fees.

Other cosmetic surgery costs

When you have an operation, the surgeon’s time is not the only cost incurred – there’s the anaesthetist, who is there not just to ease your pain but also to monitor your wellbeing during the operation, and the theatre time, as well as any nursing staff.

Again, when you visit a large clinic chain, they tend to bulk book theatre space in advance at a lower cost, whereas individual surgeons will book the theatre space as and when they have a suitable patient.

Why pay more?

The key here is that when you use an individual cosmetic surgeon, your consultation is with that surgeon, so there is no pressure to go ahead and book the surgery as there would be with a salesperson. You also get to know your surgeon and can speak to him/her ahead of time about any concerns you may have.

With the larger cosmetic surgery chains you often don’t meet your surgeon until the day of the operation, which means you don’t know what his/her work looks like, and don’t have the same chance to form a rapport with him/her.

What happens if my cosmetic surgery procedure goes wrong?

Generally, cosmetic surgery is very safe – particularly if you have chosen your surgeon wisely and ensured that s/he is fully qualified and experienced, with membership of the appropriate professional bodies.

However, like any surgery, it does carry some risks – these can be complications of the surgery itself, such as infection and bleeding, anaesthetic complications, or complications post surgery, such as implant rotation.

What can be done?

The first thing to remember is that cosmetic surgeons in the UK pay very high indemnity fees, to insure them in the unlikely event of something going wrong. This means that they should be able to rectify the problem without any additional cost to you.

If the problem is a surgical or anaesthetic complication, this should be dealt with at the time of the procedure, and you may not even be aware of it. If the problem happens post surgery, the process may be more complicated.

Talk to your cosmetic surgeon

If you are unhappy with the results of your cosmetic surgery, or feel that a problem has arisen after the surgery, then the first thing to do is to talk to your surgeon. Most cosmetic surgeons will be happy for you to book an appointment to speak to them post surgery, and to listen to any concerns you may have.

Remember that sometimes a “problem” may be subjective – i.e. what seems like a problem to you may not be something that the surgeon feels they have done wrong – and so if you feel that corrective surgery is needed, you may need to argue your case well or be prepared to pay for additional surgery. If you are asked to pay for the extra procedure then you may want to consider the following:

Find another cosmetic surgeon

If you are unhappy with the results of your cosmetic surgery, but the surgeon feels they have done the best job possible, then it may be that you have not chosen the surgeon most suited to your needs. If you are being asked to pay for revisionary surgery anyway, then you might be best placed to seek a second opinion and consider paying a different surgeon to do the job.

In my London cosmetic surgery practice, the vast majority of patients are very happy with the outcome of their surgery. It is important to have realistic expectations, which is something I encourage at the consultation stage.

What is more important in choosing a cosmetic surgeon: recommendations or before and after photographs?

Both personal recommendations and before and after photographs are very useful tools when it comes to choosing a cosmetic surgeon. Which is more important to you will ultimately be a personal decision, but you should consider a number of different factors, which I’ve outlined below.

Who is the recommendation from?

Do you trust the person who is recommending the surgeon? Is it someone you know well, a stranger whose number you have been given by the cosmetic surgery clinic, or even someone on an online forum?

If the recommendation comes from someone you know well, and you have seen and been impressed with the results of their surgery, then this is probably a good indicator that the surgeon is someone you can trust with your own cosmetic surgery.

Anonymous recommendations

Sometimes a cosmetic surgeon might give you the telephone number of a previous patient who has said they are happy to talk about their experience.

This can be very helpful, particularly if you are feeling nervous about the procedure, but it is important to think about whether the person at the end of the phone sounds genuine. You also might like to ask to see their before and after photographs, so you can see whether you are as impressed with their results as they are.

Recommendations on forums can be tricky, as it is difficult to know who the people are who are posting the comments. Generally, if there is an overwhelmingly positive array of comments online about a particular cosmetic surgeon, then s/he is likely to be good, but in this case before and after photographs will provide an additional aid to put your mind at rest.

In conclusion

Ideally, the surgeon you choose would both come recommended and have before and after photographs that show the kind of results you are looking for.

If a surgeon is unable to show any before and after photographs, however, be wary. Personal recommendations are a fantastic indicator of a surgeon’s bedside manner, but remember that everyone is looking for something slightly different from their cosmetic surgery, and photographs of previous patients are the best way to see whether a cosmetic surgeon can provide the results you want.

Is cosmetic surgery painful?

If you were to undergo any cosmetic surgery procedure without an anaesthetic, then it would of course be very painful! Thankfully, however, anaesthetic techniques are so advanced nowadays that you won’t feel a thing throughout the cosmetic surgery itself.

After the cosmetic surgery procedure

Although you will be numbed throughout the operation, there will be some pain once you have come round from the anaesthetic. How much pain and in what location will depend on the type of cosmetic surgery you have had.

You will be given pain medication to take that will help to make you more comfortable in the first few days after surgery. Generally any residual pain should disappear within the first couple of weeks after you operation.

Facelift pain

People often expect facelift surgery to be particularly painful – in fact, it is one of the least painful forms of cosmetic surgery. There will be a “tight” feeling after surgery, and there may be some bruising and swelling at the point of incision, but generally facelift surgery is surprisingly pain free.

Types of anaesthetic

There are a number of different anaesthetic techniques that can be used for cosmetic surgery. In my London cosmetic surgery practice I prefer for patients to undergo a general anaesthetic, whether it be for facelift or breast augmentation.

A general anaesthetic ensures that the patient is pain free and blissfully unaware of what is happening during the procedure itself. Some cosmetic surgeons perform breast augmentations under twilight sedation – where the patient is semi-conscious throughout – or even local anaesthetic, as this allows the patient to return home on the day of surgery.

In my practice, I believe that it is safer and more comfortable for the patient to be under a general anaesthetic and be closely monitored for 24 hours after cosmetic surgery.

What does ‘downtime’ really mean?

We often hear people talking about ‘downtime’ when it comes to cosmetic surgery and non-surgical cosmetic procedures, but what does the phrase really mean, and how does it relate to the recovery period and the time it takes to see results?


When it comes to cosmetic procedures, most people use the phrase ‘downtime’ to refer to the period of time during which you might want to refrain from your usual activities or stay away from the public eye. So for non-surgical procedures like Botox or fillers, this might just be a few hours, while you wait for the redness to go down, whilst for some surgical procedures it could be a matter of weeks.

Recovery period

The recovery period is a more technical term that is usually applied to cosmetic surgery, and refers to the time after the procedure when you may need to stay in bed or avoid certain physical activities.

Depending on the procedure that has been performed, there may be additional measures that need to be performed during this period, such as dressing changes, stitch removal or lymphatic massage, which will usually be performed during your routine follow-up appointments with the cosmetic surgeon.

Time taken to see results

This refers to the point at which all swelling and bruising has gone down and the final results of the procedure can be seen. These two things may not happen at the same time; with a procedure like Botox, for example, although any redness caused by the procedure disappears fairly quickly, the product takes a few days to take effect, so you might not see a reduction in wrinkles for a week or so.

With a surgical procedure like breast augmentation, however, although you will notice an immediate increase in bust size, it will take longer for the swelling and bruising to diminish. The final results can be seen once everything has settled down.

What do my cosmetic surgeon’s professional qualifications and memberships mean?

Looking for a cosmetic surgeon to perform your breast augmentation, facelift or other cosmetic procedure can be a very confusing and difficult process. Not least confusing is deciphering all the initials after a surgeon’s name and working out which of those are important.

Here is a breakdown of my qualifications and accreditations and what they mean:


This means Bachelor of Sciences and means that I have graduated from a science degree as well as my clinical studies.


MB BS stands for Bachelor of Medicine and means I have graduated from my five year medical degree. This is the minimum requirement necessary to practise as a doctor in the UK.


This stands for Doctor of Medicine, which is a research qualification, equivalent to a PhD in the non-medical world. This is a higher degree than an MB BS but is not necessary in order to practise medicine.

FRCS (Plast)

This means that I have passed all the exams necessary to become a fellow of the Royal Society of Surgeons, specialising in the field of plastic surgery.

If you are considering having cosmetic plastic surgery in this country, you should ensure that your surgeon is a fellow of the Royal Society of Surgeons at least, although a speciality in the field of plastic surgery is especially reassuring as it shows that s/he has trained specifically in plastic and reconstructive – if not cosmetic – surgery.

Professional association: BAAPS

BAAPS is the British Association of Aesthetic Plastic Surgeons, which is an independent self-regulatory body for the cosmetic surgery industry. There is very little official regulation of the industry, so associations like the BAAPS exist to try and promote good ethical practice and offer reassurance to patients.

If you are unsure about your surgeon’s qualifications, the best thing is to ask at the consultation stage, and don’t be afraid to walk away if s/he is unable to offer proof of their expertise.

Do I need to like my cosmetic surgeon?

In a word: yes! It is vitally important that you feel comfortable in your cosmetic surgeon’s company. You need to be able to ask your surgeon as many questions about the procedure as are necessary to ensure that you understand everything that the surgery entails, and you also need to be able to state your own requirements from the surgery clearly, which may be difficult if you do not feel at ease with the surgeon.

Won’t the results depend on my physical features, rather than what I want?

A good cosmetic surgeon will be able to hone his or her technique to the requirements of the individual patient.

There will of course be limitations related to the actual physiology of the patient – if a breast augmentation patient is very flat chested, for example, she may not be able to achieve a DD cup in one operation, as there will not be enough skin on the chest to allow for this.

If she feels comfortable enough with her cosmetic breast surgeon to state her desires honestly, however, they may be able to work together to come up with a treatment plan that will allow her to come close to her ideal cup size over time, although this may involve multiple operations.

What if my requirements are not achievable?

It is still important that your surgeon knows what you want to achieve, whether it is possible or not, because if it is not possible to get the result you want then you need to be aware of this before you decide whether or not to go ahead with the surgery.

If you can communicate clearly what you want from surgery, your cosmetic surgeon will be able to tell you how close you can get to this. If you don’t feel comfortable with your surgeon then this level of communication might be difficult.

What if I don’t feel at ease with my surgeon?

This is what the consultation stage is for. Most cosmetic surgeons charge for their time at consultation precisely because they don’t expect 100% of patients who attend a consultation to go ahead with surgery. Not feeling comfortable with the surgeon is just as valid a reason not to go ahead as any other.

Why stop smoking before having cosmetic surgery?

Patients often ask me why they need to stop smoking several weeks before an operation; the assumption is that I, like everyone else, am just concerned about the general ill effects of smoking on their health.

However, the truth is that smoking can have serious implications for anyone undergoing any type of surgery, and here’s why.

Smoking affects the body’s ability to heal itself

The nicotine in cigarettes and tobacco acts as a vasoconstrictor, which means it tightens the blood vessels in the body. This means that it can decrease the blood flow to certain areas of the body, which in turn can prolong healing time.

In some very severe cases, this longer healing time can result in infection, severe scarring and even the need for further surgery in future. Many surgeons will refuse to operate on smokers at all.

Smoking ages the skin

I’ve explained why you should stop smoking before any form of surgery, but with cosmetic surgery it is especially important, particularly if you are having the surgery to look younger. Smoking, as we have already heard, decreases blood flow to certain parts of the body, including the skin.

This can result in the formation of free radicals, which attack the healthy cells in the skin, causing accelerated ageing. For this reason, it is essential to stop smoking before having any anti-ageing procedure, otherwise you will undo all the good work.

How long before surgery should you stop?

The earlier you stop, the better, for all the reasons mentioned above. If you can’t manage to stop earlier though, I would recommend quitting a minimum of six weeks before surgery, and continuing to avoid nicotine for at least six weeks afterwards.

All surgeons will have slightly different requirements here, but I can guarantee that any reputable surgeon will insist that you stop smoking prior to surgery.