Cosmetic surgery has seen dramatic growth in the UK over the last decade. I prefer to use the word aesthetic which means the patient’s perception or requirement because increasingly we are undertaking cosmetic surgery on demand as opposed to correcting what others would perceive to be a problem.
The majority of aesthetic surgery is extremely safe although there are ongoing concerns about the lack of regulation of the industry and the recent debacle over PIP breast implants is but one example. I am fortunate to only work with surgeons who have undergone comprehensive and formal training and I only work in fully equipped hospitals approved as such by CQC. As a result surgical risk to the patient is well managed.
My responsibility is to mange anaesthetic risk. Anaesthesia is very safe with a risk of death of perhaps 1:83000. Optimisation of concomitant disease or other medical problems allows us to safely undertake major surgery in patients with poor levels of health and at the extremes of age. However, aesthetic surgery is not being undertaken to correct a pathological problem such as a broken bone or a cancer. Refusing to undertake aesthetic surgery may upset the patient but will not cause physical harm. The level of risk that is acceptable for aesthetic surgery is therefore far less than for other operations.
Perhaps the most important element is patient education. I suspect many patients undergo complex aesthetic procedures under general anaesthetic without any concept of the risk they are taking. That is not to say that the risk is either significant or unacceptable but merely to point out that only the patient at the end of the day can decide whether their desire for the operation justifies the risk. As such I always explain to my patients if there are any increased risks.
There are many things we can do to minimise risk; anaesthetic preassessment is essential. I use an online interactive patient questionnaire on my website to obtain a comprehensive medical history. If patients have medical problems I always see them in my rooms at 9 Harley Street and undertake further investigations before agreeing to surgery. Although some of my surgical colleagues have nurses in their practices who take a history, I always preassess patients myself as only an anaesthetist can assess anaesthetic risk.
At the end of the day, I do not believe that we should undertake any aesthetic surgery without full assessment and optimisation. I will not anaesthetise a patient if there is any possibility that their other medical problems can be improved if we delay. I will not undertake an operation if I believe there is a significant risk for my patient. If you are reading this blog with a view to undergoing aesthetic surgery, I hope you will find this reassuring. I am always happy to meet prospective patients and discuss these issues to help to make up their minds but this needs to be done well in advance of the day of surgery.
Finally, given that the acceptable level of risk is less for aesthetic surgery than other operation, I believe only senior anaesthetists who hold or have held substantive posts as consultants in the NHS should anaesthetise patients in this field.

About the author

Dr Aubrey Bristow is a consultant anaesthetist in central London. These articles are his personal views and reflect individual issues of interest to patients. They are not a comprehensive review of the subject nor a substitute for a consultation with your anaesthetist.