When Rachel Kidd came into money after her grandfather died there was one thing she wanted: cosmetic surgery. 'I was very depressed and wanted a booster. I'd lost a lot of weight and my breasts had become very saggy,' says the 34-year-old sales executive.
She was happy to pay £5,500 for a breast uplift and a breast augmentation and chose a private clinic near her home in Leeds recommended by a work colleague. At the consultation the surgeon seemed professional and understanding. In the days before the operation she was 'very, very excited about it. I had no qualms. I didn't think anything could go wrong.'
But it did go wrong; terribly wrong. 'A week later my left breast felt different to the other one. It was hard to the touch, and bigger than the right one.' She initially thought it was just part of the healing process. But as the weeks went by with no change 'my left breast began to look as if it was hanging off the end of the implant'.
'I wanted nice boobs, but got hideous ones,' Rachel said. The surgeon insisted that her breasts looked fine and that he had done a good job. In fact he had not left a deep enough pocket on the left side of Rachel's chest when he was operating for the implant to sit in. She felt humiliated by how she looked. 'I didn't feel comfortable with men for probably 16 months after the operation. I wouldn't let myself get too close to a man or let people see them.'
Earlier this year Rachel received damages of more than £20,000 in an out-of-court settlement from the clinic. That was to cover her pain, trauma and suffering, both physical and psychological, and the cost of corrective surgery. She plans to have that soon, but will be much more rigorous in checking the experience of her surgeon.
Cosmetic surgery is a booming market which offers everything from invasive procedures requiring a general anaesthetic, such as breast enhancement, tummy tucks and liposuction, through to non-surgical treatments, which include Botox injections, laser removal of hair and 'fillers' to tackle signs of ageing.
Around 700,000 cosmetic surgery procedures were performed in the UK in 2005 at a cost of £360 million, more than three times the 202,000 treatments undertaken in 2001. The vast majority of procedures in 2005, around 595,000, involved non-surgical treatments such as chemical peels. They cost on average £200, compared with about £3,700 for those in which a surgeon wields a scalpel.
Research by Which?, formerly the Consumers' Association, shows that almost five million adult Britons would consider having cosmetic surgery to improve their appearance. Four per cent, or 1.4 million people, want their partner to consider some form of cosmetic enhancement.
The influence of celebrities who have had surgery, such as Anne Robinson, Sharon Osbourne and Debbie Harry, has probably played a part.
But failed operations like Rachel's are only one reason why the industry arouses concern. Which? has produced a dossier of evidence which exposes an array of 'hard sell' tactics being used by clinics. Which? claims that such practices are being used worryingly often in an attempt to persuade people to sign up for treatment, even though such tactics breach the letter and spirit of codes of conduct of the various regulatory bodies which are meant to govern the industry's behaviour and ensure high standards. The Good Medical Practice in Cosmetic Surgery code of conduct, drawn up by the industry's Independent Healthcare Advisory Services (IHAS), appears to have been breached time and time again in an increasingly competitive market.
In a letter to IHAS, Which? recounts how its staff who attended the recent Body Beautiful show, a huge trade fair at the Business Design Centre in north London attended by many members of the public, found 20 examples of rule-breaking and bad practice by cosmetic surgery clinics in the promotional materials they gave out to visitors. Which? found some of the country's best known operators such as Forma, Linia, Harley Medical Group and Make Yourself Amazing among the offenders. The organisation's catalogue of complaints includes claims, backed up by evidence sent to the IHAS, that clinics at the show were:
· offering patients money off the usual price of a procedure if they booked by a certain date, even though industry codes of conduct specifically ban such deals. Four clinics, including Linia and the Harley Medical Group, have been accused.
· advertising Botox, even though doing so is illegal because it is a controlled toxin and against the regulations of the Medicines and Healthcare Products Regulatory Agency, which approves medicines for use in the UK. Which? accuses both Harley Medical Group and the Forma group of doing this.
· Using terminology the Advertising Standards Authority has declared unacceptable, such as 'rejuvenation'. A leaflet given out by the Hurlingham clinic said, 'Rejuvenation is our business'.
· Engaging in questionable use of 'before and after' photographs in leaflets and brochures, even though IHAS guidelines say that advertisements 'should not include photographs that suggest the outcome of surgery will be reflected in the photograph'. Five clinics were accused of doing that, including Forma and Advanced Beauty Clinic
Which? also took issue with, and has sought the IHAS's view on, a number of other tactics that it regards as dubious but which are not covered by the IHAS's three cosmetic surgery codes of practice.
Which? questioned the use of:
· Testimonials and endorsements from celebrities, as Make Yourself Amazing did with Naomi Millbank-Smith from the Channel 4 Shipwrecked show and ex-Big Brother contestant Orlaith McAllister.
· Buy one, get one free offers. For example, Sk:n clinics were offering a free micro-dermabrasion or skin peel worth £60 to anyone buying a filler or treatment for lines and wrinkles costing £169.
· Cosmetic treatments as competition prizes, such as a free cosmetic surgery operation or one at half-price.
· Financial incentives of £100 to refer a friend to have a surgical procedure or £50 for a non-invasive treatment.
· What Which? calls 'misleading' statements used to promote the alleged benefits of products designed to help banish wrinkles.
Which? has also expressed concern that some people who have spoken to the representative of a clinic and made known their interest in having a procedure have then found themselves being bombarded with calls by sales staff.
Vikki Meagher, who had surgery last year to reduce the size of her breasts, told Which? of her experience. 'After an initial chat I felt I was put under a lot of pressure to take up surgery,' she said. 'At one point the clinic was phoning me three or four times a day pushing me to make a commitment. I felt quite overwhelmed.'
Jenny Driscoll, a senior health campaigner with Which?, said: 'The examples we found at Body Beautiful are clear evidence that the industry isn't following its own guidelines and that self-regulation isn't working. This was stuff that was being handed out to the public. It's not as if we really had to go in and look for this very hard. Telling someone that "if you have this surgery or treatment by the end of the year you will get some money knocked off" is part of classic pressure selling. We found four examples of that at the Body Beautiful show, even though the IHAS's Good Medical Practice guidelines bans such incentives. It's persuading people to have surgery before they have thought it through.
'More needs to be done to protect people and ensure that the industry follows the existing guidelines, especially on marketing, so they aren't pressurising people into having surgery. We have many examples of marketing material that we think is cavalier, given that the end product is often going under a general anaesthetic and having surgery.'
Critics claim that the tactics uncovered at the Body Beautiful show are little different to the glossy, alluring advertisements and promotional material which clinics put in newspapers and magazines and on their websites. Last Friday, for example, the website for one of the cosmetic surgery industry's biggest players, the Hospital Group, was offering potential clients an 'exclusive offer' in which they could 'Start 2008 with a New You and save £400. Get £400 off your booking. Your procedure must be carried out before 31 December 2007 to claim this discount.' Which? and leading cosmetic surgeons such as Rajiv Grover, who has a clinic on London's Harley Clinic, regard such inducements as unethical.
Hospital Group has challenged the allegations, saying that guidelines on offering discounts are in the process of being relaxed, although as yet the public guidelines have not been changed.
Mike Saul is a medical negligence solicitor who in 2004 was handling so many cases involving blunders in cosmetic surgery that he began working full-time on only those cases. He is 'inundated' with inquiries, has about 100 ongoing claims against clinics or surgeons and was Rachel's lawyer in her successful fight for compensation. 'The high pressure selling one often sees in the private sector of cosmetic surgery is something one might expect if one were purchasing double-glazing,' he said. 'Patients are offered discounts if they commit to a procedure instantly and asked to pay substantial deposits before they see their surgeons. This is totally inappropriate in the arena of private healthcare and surgery.
'Certain providers also trivialise and commoditise cosmetic surgery by offering loyalty cards and money-off vouchers for repeat surgery. This is again totally inappropriate and fosters the perception amongst some patients that cosmetic surgery is just an extension of going to the beauticians. They think it must be safe, when actually many procedures amount to major invasive surgery and carry all of the attendant risks.'
Sally Taber is the director of IHAS, which both represents and polices the cosmetic surgery industry - a dual role critics claim is inherently unstable and not conducive to good governance.
'The use of financial incentives, such as "buy one, get one free", isn't really acceptable,' she said. She is taking action to ensure that no company ever again advertises Botox. 'The companies that Which? mentioned have to realise that this sort of thing can't go on; it's not acceptable. They can't use Botox in an advertisement. But some are,' she says.
Taber admits that 'bad practice has been going on unchecked for quite a considerable time'. Referring to the IHAS's stipulation to clinics that 'You should not normally admit any patient for a procedure to be carried out sooner than two weeks after the initial consultation in order to allow the patients adequate time for reflection', she adds: 'We have a 14-day cooling-off period. That isn't being followed in some of the bad practice.'
However, she is pledging action. Taber talks with conviction about a new, much-improved system of self-regulation which she and the industry are currently working on. She also wants tougher and more regular action to clamp down on poor clinics by the array of healthcare regulatory bodies which have some role in scrutinising the industry, and especially the doctors, nurses and dentists who make up much of the personnel that patients see when they have a treatment at a clinic, a beauty parlour or a private hospital.
But critics say that, whatever improvements Taber puts in place, the existing system of self-regulation will always be woefully inadequate. Which? and the British Association of Aesthetic Plastic Surgeons (BAAPS) are among those who believe that an industry which combines a vested financial self-interest and the capacity to accidentally cause great harm if an operation goes wrong needs to have a truly independent, external watchdog.
Douglas McGeorge, the president of BAAPS, is blunt. 'The problem with lack of regulation is that patients' needs are being ignored because unscrupulous individuals can make a fast buck. If a patient comes to see me and says "I want Botox because of wrinkles on my face" I'll ask them why, because I'm a scrupulous clinician. If I was unscrupulous I could easily put some Botox into someone, even though I knew it was unlikely to do them any good, and charge them £300-£400. I don't do that, but some others do. Some people out there abuse the lack of regulation.'
McGeorge is amazed that the government decided earlier this year not to set up an independent body to police the lucrative and booming market in injectable treatments: Botox and fillers, which are meant to smooth over the lines produced by the ageing process. 'They missed an opportunity to clean up the industry because they felt self-regulation was all that was required. But while some people putting in injectables have the patient's interests at heart, others are more interested in their own businesses,' he says.
He is similarly disappointed that ministers are now considering proposals which would mean that most premises which carry out laser treatments to remove unwanted hair or blemishes no longer have to have a Healthcare Commission licence. The watchdog should be given the job of overseeing the entire cosmetic surgery industry so that unscrupulous operators at last have something to fear, says McGeorge.
In a sense, Rachel Kidd is lucky; at least she obtained some redress. Nobody knows how many of the hundreds of thousands of people a year who seek to improve their appearance through cosmetic surgery have a bad experience like her. But few disappointed customers complain, much less take legal action. Many are too embarrassed, others accept that there was always a risk involved, and some are put off by the sheer difficulty encountered in trying to exercise what are regarded elsewhere as basic consumer rights.
While Taber plans to improve regulation, she will not go too far: 'You don't want to wipe this industry out. It's important that people want to look better and feel better, and with correctly trained practitioners, this is effective treatment to help you look younger.'
As Rachel knows only too well, though, trying to stop or change Mother Nature's effect on our bodies often brings sadness rather than joy.
Facts and Figures
£528.9 million The total value of the UK cosmetic surgery industry in 2006
700,000 The number of cosmetic procedures in the UK last year, compared to 202,000 in 2001
84 per cent The proportion of cosmetic procedures last year that were non-surgical (eg Botox)
£5 million The estimated amount of money borrowed each year for cosmetic surgery
2,500 The number of men who had cosmetic surgery in 2006
£3,400-£5,000 The average cost of a breast enlargement
50,000 The number of Britons who went abroad for surgery last year
100,000 The estimated number of Botox treatments in the UK each year, making Britain the largest user in Europe
Guide to safer surgery
Ten steps to take if you are considering having cosmetic surgery, based on advice from Rajiv Grover, a leading plastic surgeon who works both in the NHS and in private practice in Harley Street
· Beware of glossy advertising and free consultations. Reputable surgeons do not need to advertise and always charge a consultation fee.
· Go to a surgeon that a friend or your GP recommends .
· Beware of travelling abroad for surgery.
· Understand the procedure, likely outcome, cost and risks - and remember that no procedure is 100 per cent risk-free.
· Check that your own expectation of the likely outcome of the procedure matches what your surgeon says .
· After a consultation, do not be rushed into making a decision or paying a deposit.
· Ask how many procedures of the sort you want the surgeon has carried out - it should be at least 50 per year.
· Do not have surgery if you have recently experienced a major life event, such as moving house, a relationship break-up, losing a loved one, changing jobs or having children.
· Check your surgeon's qualifications thoroughly. He should belong to the British Association of Aesthetic Plastic Surgeons, be on the General Medical Council specialist register for plastic surgery and hold the FRCS (Plast) qualification.
For latest information on the Which? campaign
For advice from the Department of Health
For advice from the British Association of Aesthetic Plastic Surgeons
www.baaps.org.uk or its advice line: 020-7405 3324