We all read about it in the magazines - the breast 'augmentation', the 'nose job'. But what counts as cosmetic surgery, and what's available on the NHS?
What is cosmetic surgery?
Cosmetic surgery is surgery which is done purely to change (presumably improve) your appearance. An operation on your nose, which gives you the pert 'button' appearance you've always dreamed of, doesn't count as cosmetic if, for instance, it was done first and foremost to correct a kink in your nose which has meant you've had terrible problems with breathing when you're asleep at night. Surgery done for cosmetic reasons only is not available on the NHS.
Could I ever qualify for NHS surgery that just changes my appearance?
The short answer is 'yes', but you need to fulfil specific criteria which are set out by your local health authority.
Surgery for conditions that are affecting your physical health
We tend to think of surgery to change the size of your breasts, for example, as purely cosmetic. However, some women have very large, heavy breasts that change the way they sit and stand, putting pressure on their spine and causing back pain. They are not 'abnormal', but they are causing physical knock-on effects. If you have a letter of recommendation from a hospital specialist confirming that your back pain is due, or likely to be due, to your posture because of the size of your breasts, you should be able to get treatment on the NHS. Another example might be unsightly varicose veins which are causing constant pain and aching.
Surgery to correct abnormalities you're born with
Some people are born with so-called 'congenital abnormalities'. An obvious example is a simple cleft lip. This won't affect your health, but it will make your appearance different from most other people's. Surgery for this sort of abnormality can be done on the NHS.
Surgery to correct injuries
If, say, you're in an accident, you may be left with scars that disfigure your appearance. If these are obvious (say, major scars on your face) you will be able to get them corrected, or at least improved, on the NHS. It all gets a bit more complicated if they are less dramatic, though. Here you may have to go through psychological tests to see how much of an impact they are having on your mental wellbeing (see below).
Surgery for abnormalities that affect your mental wellbeing
This one is a bit more tricky. Some people's physical appearance can cause problems with their confidence, make them depressed or stop them from being able to function normally. That can be hard to prove, and you would need to have recommendations from a specialist in mental health to support your application (see below).
Examples I have seen in my surgery include having one breast which is naturally significantly bigger than the other; having crooked teeth; or tattoos done in your youth which you now regret deeply.
I think I might qualify for cosmetic surgery on the NHS - what do I do?
The first thing to do is to talk to your GP. Each health authority sets its own rules about what does and doesn't count as 'cosmetic surgery'. However, they also have panels which will consider individual cases.
If your GP agrees that you might qualify, he or she will either refer you straight to a plastic surgeon or to a psychiatrist or psychologist if it's because your appearance is causing you mental distress. He or she will in turn assess you and write a report confirming if they think there is enough social, psychological, or physical benefit to be gained to justify surgery.
Not all of my patients qualify, and it can be hard to accept a refusal. But the NHS doesn't have a bottomless pit of money, and the rules are there to make sure that the NHS's resources are used most wisely.
With thanks to 'My Weekly' magazine where this article was originally published.