Keep your NHS Out of Our Nose Jobs! Plastic Surgeons Make Unprecedented Stand on Training


  •        Study: training opportunities for ‘cosmetic’ procedures virtually non-existent on NHS
  •        New generation cosmetic surgeons unprepared for private practice
  •        Sector seen as controversial and dangerous by both public and medical community
  •        Study: Gov’t recommendations continue to be flouted - commercial chains most culpable
  •        Revolutionary new training pathway unveiled by top surgeons


London – 8th September, 2015 – New studies unveiled today at the Annual Scientific Meeting of the British Association of Aesthetic Plastic Surgeons (; the only organisation based at the Royal College of Surgeons solely dedicated to the advancement and education in aesthetic plastic surgery; highlight that alongside the current and rapid reduction in funding for cosmetic surgery procedures on the Health Service, there is also a disappearance of training opportunities for the upcoming generation of surgeons.


A study presented at the conference by BAAPS Trainee member Reza Nassab revealed that in the NHS, since the advent of CCGs (v PCTs):

  •        There has been a 14% reduction in provision for breast augmentation, with tighter restrictions, for example mainly for conditions such as amastia (essentially, missing a breast)
  •        Only 1/5 (22%) of CCGs offer breast lifts (Mastopexy) but again with tight restrictions, for example only for those suffering significant asymmetry
  •        Whilst a good percentage of CCGs still offer eyelid surgery, this is entirely for visual obstruction and not for aesthetic purposes
  •        4/5 (79%) CCGs still offer nose surgery, however these are only offered for airway obstruction, trauma or congenital defects.
  •        CCGs approve now funding for a third less facelift surgery than PCTs once did, and purely for significant conditions such as facial palsy or congenital deformities


According to consultant plastic surgeon and BAAPS President Michael Cadier;

“It’s a well-known adage that it takes 10,000 hours training to truly master a craft, and in bygone NHS days this was entirely possible for aesthetic plastic surgery – but with the advent of the European Working Time Directive; which limits the amount of time junior doctors can work; and a rise in medico-legal worries which means trainees don’t get as much of a chance to perform surgical procedures under supervision due to litigation fears; they’re lucky if they get 3,000 hours by the time they become consultants.


“Whilst they will have plenty of exposure to reconstructive treatment for burns, trauma and other medical conditions such as tumours, it does mean there’s a whole new generation of consultants going into private practice offering procedures such as facelifts and breast augmentation, having had virtually no contact with these types of ops during their time on the NHS.


“Whilst some may object that head and neck cancer or cleft palate training will have prepared them enough for ‘cosmetic’ surgery, this is simply not the case. It is also high time that we stop relying on the Health Service to prepare them for the private sector – why, indeed, should public funding go towards this arena?


“As the only Association solely dedicated to the advancement of aesthetic plastic surgery, we are ready to take up the mantle of responsibility for training with a groundbreaking new programme alongside our colleagues in other plastic surgery societies and the National Institute of Aesthetic Research – for the development of the profession but most importantly of all, for patient safety.”


The BAAPS is launching therefore a ground-breaking series of new Fellowships – fully funded, three-month programmes for trainees who wish to develop a well-rounded career in aesthetics achieving the perfect C’s, DD’s and even F’s under the aegis of some of the UK’s top exponents. Paid for by the BAAPS with support from the British Association of Plastic, Reconstructive and Aesthetic Surgeons (, the Fellowships offer hands-on practise, mentorship, access to specialist expertise and understanding of how to deal with complications – everything they need to know to become competent aesthetic plastic surgeons with a wide range of exposure.


According to the National Institute of Aesthetic Research ( CEO Brendan Eley, who is collaborating on the programme alongside BAAPS and BAPRAS;

“Not only will trainees be able to access the expertise and guidance of top surgeons in busy private units, but Fellows will be further rewarded for undertaking quality research and audits, which we will be under the auspices of the NIAR. The aesthetics arena has been famously called a ‘data-free’ zone with little scientific investigation in new treatments and advances, so this gives us a unique opportunity to put the sector under the microscope, evaluating the efficacy of techniques and analysing trends, as well as Patient Reported Outcomes (PROMS) – measures of patient satisfaction – which are routine in other health disciplines but severely lacking in cosmetic surgery.”


Further statistics show the sector is viewed with distaste by the public and even the medical community*, unsurprising when other studies unveiled at the conference also show that Government recommendations emerging from the recent Keogh review continue to be shamelessly flouted by the industry. Research by trainees Sohaib Rufa and Chris Davis presented at the conference reveal that whilst there have been some improvements in cosmetic surgery marketing in the last two years, the guidelines determined by the Keogh review continue to be pointedly ignored, mostly by the larger commercial chains.


Their study, which examined the top 50 providers of cosmetic surgery (as listed by Google), showed that:

  •        1/7 (14%) consultations still don’t take place with the operating surgeon but a salesperson or intermediary (this is worse than in 2013, where 90% did take place with the surgeon)
  •        2/5 (40%)
  •        1/6 (16%)
  •        Only 3/5 stipulated the recommended two-week cooling-off period


Their research found that non-compliant providers were typically chain companies rather than independent individuals or small group practices.


Consultant plastic surgeon and BAPRAS President Nigel Mercer adds;

“Whilst the private sector is wide in scope, it is clear that some of the more ‘conveyor-belt’-style commercial entities are simply not an appropriate environment for young surgeons to be exposed to a wide variety of complex procedures and to learn how to deal with complications. Starting out in private practice can be a lonely stage professionally, without having the added pressure of delivering high volumes of patients in a stack ‘em high manner. Moreover, as this research shows many of these companies continue to market in an unethical manner.


“Credentialing will soon be implemented, but this is simply the most basic level for a clinician to be able to legally practise. We want to develop experienced surgeons operating at the gold standard, and this is what these Fellowships are designed to provide. The public deserves no less.”


Experienced BAAPS/BAPRAS surgeons can apply to host trainees – the Fellow will be attached to a group of consultants (at least two) who have a high volume of work, otherwise three or more to ensure a wide range of exposure. Trainees will be expected to perform 40 half-day operating sessions, 20 half-day outpatient sessions and a half-day for audit and research and provide log books.


Participating units are expected to expose the Fellow to minimum numbers of breast (20), truncal (10), facial and peri-orbital (20), Botulinum Toxin (10) cases, among others such as nasal, ear and dermal filler injections.


Preference is given to BAAPS and BAPRAS trainee members and those who have a trainee log book showing interest in and dedication to aesthetic surgery.


Eventually the hope is for these Fellowships to cater to all trainees wishing to go into aesthetic plastic surgery (10-20 per annum).





The BAAPS (, based at the Royal College of Surgeons, is a not-for-profit organisation, established for the advancement of education and practice of Aesthetic Plastic Surgery for public benefit. Members undergo thorough background screening before they can join. Information about specific procedures and surgeons’ contact details can be found on the web site, or by contacting their advice line at 020 7405 2234. Further materials can be posted to members of the public seeking specialised information. BAAPS is also on Twitter: and Facebook:

For all media enquiries, please contact Nikki Milovanovic on 020 7549 2863 or email call Tingy Simoes on 07973 147 388)


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