Vital signs: Sorry, girls, your boob and nose jobs will cost you more

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Harley Street has been in uproar for the past few weeks. Instead of ageing actresses scurrying out of those black Harley Street clinic doors, large Jackie O shades covering any evidence of work done, they have been replaced by legions of accountants rushing in to calm aggrieved surgeons.

The reason is the new guidance issued by HM Revenue and Customs which demands that doctors performing purely cosmetic operations, such as liposuction or some breast augmentations, must now register for VAT and pass the charge onto their patients. Last year around 10,000 boob jobs, 5,000 face lifts and 4,000 nose jobs were carried out - if 20 per cent VAT had been charged for each of those, an extra £500 million would have been created for the Treasury. Currently only non-surgical interventions, such as Botox, fillers and chemical peels, are subject to VAT.

From a financial point of view it is easy to see that this is a shrewd move but from a medical perspective the plans are worrying for two reasons. The first is that it is likely to drive even more patients to seek cheaper surgery, often performed abroad where standards and guidelines for plastic surgery are not necessarily as strictly controlled as in the UK.

The significant savings boasted by many overseas clinics are most likely achieved through a lack of appropriate aftercare and post-surgery check-ups.

While filming a TV series about the cosmetic surgery industry I saw many cases of procedures done on the cheap that had, unsurprisingly, gone horribly wrong, leaving patients physically and mentally scarred, often for life. It has always baffled me that folks will splash out on a flashy car or a designer handbag but will try to save as much money as possible when it comes to purchasing healthcare.

My second worry concerns the need to suddenly define surgeries as either functional, with a medical need, or purely cosmetic, ie with no medical indication. It is true that many face lifts and breast enhancements are done purely out of a need to keep up with the Joneses but many are done in order to help with serious psychological insecurities and are fulfilling the role of medical procedure rather than that of cosmetic procedure. The teen with sticking-out ears, or the young lady with no breast development, will have to fight tooth and claw to remain "functional" rather than "cosmetic". Will they still have to pay VAT? Unless surgeons decide they want to draft in teams of medico-legal experts to argue their case, then I suspect VAT will be inevitable.

Interestingly, the Obama administration came up with a similar idea to help dig its way out of its financial problems. Wittily nicknamed the "Bo-tax", it plans to slap a five per cent tax on cosmetic procedures and has already prompted an outcry from a surgery-hungry American public.

Given the power of people in certain echelons of American society known for their love of the nip and tuck, I would be surprised if this ever becomes law.