Re-dos and the conveyor belt

As a specialist in cosmetic surgery around the eyes and the upper part of the face, I am asked to do a worryingly high number of ‘redo’ and corrective procedures following surgery that has not been successful elsewhere. In fact, around 30 per cent of my aesthetic practice consists of patients coming to see me for re-dos.

Why is this happening? Demand for cosmetic surgery, like blepharoplasty, brow lifts and fat transfers, is growing up to 20 per cent a year and corners are being cut, particularly by large multiples that run a conveyor belt service. Remarkably, due to a lack of regulation, people who are not fully qualified surgeons are able to carry out procedures which can easily go wrong.

For example, I recently had to deal with a lacerated eyeball and facial nerve damage. I have seen patients who have undergone blepharoplasty, which involves removing skin from below or above the eye to minimise eye bags, which has left them unable to close their eyes. The practitioner has removed too much skin – a problem which is very difficult to resolve without the use of skin grafts.

This is actually quite a technically challenging procedure and should not be undertaken by someone who is not a trained surgeon. I know that many of the cosmetic doctors who work in the UK have qualifications from abroad but these may be of a quite different standard to those in the UK. The definition of trained surgeons is those who have completed the training required to reach consultant status. Your cosmetic doctor may not even be registered with the GMC in any specialist capacity.

I am relieved that there are now proposals to regulate the area of cosmetic surgery more tightly. The Royal College of Surgeons has convened an intercollegiate committee to work out how to ensure that only suitably qualified individuals can undertake these procedures. In future, it is likely that people who carry out cosmetic surgery in the UK will have to show that they have a Certificate of Completion of Surgical Training.

In the meantime, patients who want to have a blepharoplasty or any other type of cosmetic procedure, should be proactive about protecting themselves. I advise them to ask questions beforehand about the complication rate and how many re-do procedures have had to be done by their surgeon in a 12 month period. Of course, there is always the possibility that things can go wrong but you would expect a reasonable complication rate to be no more than one per cent. Any competent practitioner will be happy to give you this kind of information – in fact, they should be auditing their performance and patient outcomes as a matter of course – but I would steer clear of doctors who don’t want to divulge these simple facts.

You may have to pay more to get the job done by a specialist, but your caution will pay dividends.

Daniel Ezra

Consultant ophthalmic and oculoplastic surgeon at Moorfield’s Eye Hospital in London
Daniel Ezra

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