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'There are strict rules, surgery has to be clinically necessary'
Anna Davis, Education Correspondent19 Jun 2009
To be operated on purely for cosmetic reasons you have to be enormously affected.
There are strict guidelines in place and no operation is carried out without serious thought. If a patient is simply very fat, they will be referred for procedures such as stomach stapling.
Many HIV patients undergo liposuction because medication can cause lipodystrophy, giving them hollow faces and a collar of fat around their necks. Patients who have been in car crashes can develop lumps of fat caused by skin and fat getting separated from muscle.
If a patient comes to me and says she has had five children, has lost her breasts since feeding them and would like implants, I could send her to a psychologist who would tell me if it would be life-changing for her.
It can take six months to decide. Ultimately, it is down to the primary care trust.
People with cleft lips and palates often have rhinoplasty, as do people who have had facial trauma or problems breathing because their nose is bent too far to one side.
Sometimes women need a tummy tuck after childbirth as muscles have moved so far apart they have ended up with a central hernia.
I have also performed breast reductions on girls whose shoulders have permanent dips in them after years of being weighed down by their bra.
But most important is that every one of these has been clinically necessary.
Barbara Jemec is consultant plastic surgeon at Chelsea and Westminster hospital and a member of the British Association of Plastic, Reconstructive and Aesthetic Surgeons.
