New Rules for UK Physicians Undertaking Cosmetic Surgery

Peter Russell

April 13, 2016

Doctors who carry out cosmetic procedures anywhere in the UK are being issued with new guidance to ensure patients are treated safely and effectively.

The guidance by the General Medical Council (GMC) sets out the obligations that doctors owe their patients, including ethical considerations, knowledge, skills and performance, safety and quality, and communications.

Meanwhile, the Royal College of Surgeons is setting out new professional standards for surgeons and is calling on the government to legislate to protect patients.

Industry Review

The new standards follow a 2013 review of the cosmetic industry in England conducted by Professor Sir Bruce Keogh, national medical director at NHS England. His report found that there was almost no regulation of non-surgical interventions, despite the fact that they can have major, permanent effects on people’s health and wellbeing.

The new GMC guidance comes into force from June, and covers surgical procedures, such as breast augmentation, as well as non-surgical procedures, such as Botox injections.

The guidance says that doctors must:

· Advertise and market services responsibly. Any advertising must be clear, factual, and not use promotional tactics, such as 'two-for-one' offers to encourage patients to make ill-considered decisions. It must not be aimed at young people or children, and it also includes a ban on offering procedures as prizes. Doctors must not allow others to misrepresent their services.

· Give patients time for reflection. They must make sure patients have time to absorb information about risks before going ahead with a procedure. Patients should not feel rushed or pressured.

· Seek a patient’s consent themselves. The doctor carrying out a cosmetic procedure is responsible for discussing it with the patient, providing them with the information and support they need, and for obtaining their consent. This responsibility must not be delegated.

· Consider the vulnerabilities and psychological needs of the patient and if necessary seek expert assessment.

· Provide continuity of care. The doctor must make sure patients know who to contact and how their care will be managed if they experience any complications, and that they have full details of any medicines or implants.

· Support patient safety. Doctors must make full and accurate records of consultations, using systems to identify and act on any patient safety concerns, and contribute to programmes to monitor quality and outcomes, including registers for devices such as breast implants.

Honest Advice

In a statement, Professor Terence Stephenson, chair of the GMC, says: "Cosmetic interventions should not be entered into lightly or without serious considerations. Above all, patients considering whether to have such a procedure need honest and straightforward advice which allows them to understand the risks as well as the possible benefits.

"It is a challenging area of medicine which deals with patients who can be extremely vulnerable. Most doctors who practise in this area do so to a high standard but we do sometimes come across poor practice, and it is important that patients are protected from this and that doctors understand what is expected from them.

"Our new guidance is designed to help drive up standards in the cosmetic industry and make sure all patients, and especially those who are most vulnerable, are given the care, treatment and support they need."


New professional standards being published at the same time by the Royal College of Surgeons (RCS) recommend similar practices. Mr Stephen Cannon, chair of the cosmetic surgery interspeciality committee and vice president of the RCS says in a statement: "Our message to surgeons and doctors working in the cosmetic surgery industry is simple: if you are not working to the surgical standards we have set out and published today, you should not be treating patients at all.

"We, and the regulators, will do everything within our powers to protect patients and stop unscrupulous individuals from practising."

However, the RCS wants to go even further towards stopping 'cowboys' from operating in the industry. It is calling on the government to introduce legislation in the next Queen's Speech next month to protect patients.

Mr Cannon says: "Cosmetic surgery is a booming industry, but the law currently allows any doctor - surgeon or otherwise - to perform cosmetic surgery in the private sector. This can make it difficult for patients to identify an experienced, highly trained surgeon from someone who should not be practising.

"To correct this, we will launch a new system of certification later this year which will help patients to find a certified surgeon, who has the appropriate training, experience and insurance to carry out a procedure - such as a tummy tuck or nose job.

"Giving the professional regulator, the GMC, the power to annotate its register of doctors, will give our certification system extra teeth and regulatory backing."

Non-Medically Trained Providers

There remain concerns that at present people such as beauticians with no medical training can administer non-surgical treatments such as Botox injections, even though it is a potent neurotoxin, and dermal fillers, which are completely unregulated. Surgeons say that only trained doctors, nurses and dentists should be able to provide non-surgical cosmetic treatments and urge the government to introduce tougher laws.


General Medical Council (GMC).

Royal College of Surgeons (RCS).