Plastic surgery is more popular than ever, buoyed by slick advertising. But it is still an alarmingly unregulated industry, writes Aoife Stokes
As secretary of the Irish Association of Plastic Surgeons, Sean T. O'Sullivan has heard of the nightmares that a botched procedure can cause. "There was a recent case," he says, "where a patient was having a rhinoplasty, a nose job, and the patient started bleeding - and the bleeding wouldn't stop. There was no back-up. That patient was put in a taxi and sent to casualty. In another case a patient had an abdominoplasty (tummy tuck), and the skin and fat in the abdomen rotted."
O'Sullivan, who is a plastic surgeon himself, practising at Cork University Hospital, recounts the cases to demonstrate the growing problems in Ireland's plastic-surgery industry - an industry, he believes, that is overstretched and lacking in the most basic aftercare services. Perhaps most critically, it seems to be seriously under-regulated.
"We would have serious concerns about the system," says Gerard Bury, professor of general practice at University College Dublin and president of the Medical Council. "There are a number of doctors practising in this country without registration, which would imply that he or she is practising without professional indemnity insurance. Doctors in Ireland are not accountable to the Medical Council. Patients have no protection." One problem, he points out, is that although the Medical Council compiles a voluntary register, doctors are not obliged to put their names forward.
The Medical Council wants doctors to be registered and insured before they can practise; it also wants any clinic or other institution offering procedures to be obliged to operate ethically, particularly in relation to informed consent and aftercare. In the past the plastic surgeons' association has called on the council to regulate the industry, but the council feels it is outside its remit and a matter for the Government.
At the moment Ireland has no licensing procedure for hospitals or clinics, and none is planned for the near future. As O'Sullivan points out - and the Department of Health and Children accepts - anyone can open their doors and call their establishment a hospital or a clinic. There are therefore no definitive figures for the number of private clinics or hospitals offering plastic surgery.
What is definite is that a growing number of British medical groups are operating clinics here, tapping into the burgeoning demand for plastic surgery. "There are British doctors who fly into Ireland in the morning, perform surgery and fly home that evening," says O'Sullivan. The problem, as he sees it, is that patients can be left without proper care. "There need to be appropriate services for managing problems. There can be complications, but there must be back-up. In some cases where surgeons fly in from the UK, the patient is then left in the care of a nurse, which is not sufficient."
The influx of clinics has greatly increased competition. The public is being assaulted with radio ads smoothly promising that you can change any part of your body you're unhappy with. Television adverts show us how beautiful we could be with just a simple procedure or two. And flick to the back of Vogue or any other glossy magazine and you'll find a host of convincing advertisements promising all kinds of miracles.
Anecdotal evidence suggests that more and more younger people are being influenced by sophisticated portrayals of the body beautiful, increasingly opting for medically unnecessary operations. One nurse at a private hospital says her 18-year-old daughter was determined to have a nose job. Although she wasn't entirely happy with her daughter's choice, she felt there was little she could do to stop her. Her daughter took out a loan for the operation, then approached a British clinic operating in Ireland, which agreed to carry out the procedure. The nurse was horrified by the choice of clinic, saying she would much rather her daughter saw a consultant plastic surgeon at a private hospital. Her daughter, however, refused to change her plans.
It's a scenario more and more parents may find themselves facing, as clinics agree to operate on younger patients. In England, with parental consent, some have performed surgery on patients in their early teens.
The behaviour of some in the Irish plastic-surgery industry has already been called into question. In April last year the Medical Council's fitness-to-practise committee found one surgeon guilty of professional misconduct for acting unethically in his involvement in advertising plastic-surgery procedures.
And it is not only an issue for private patients. Routine plastic surgery is available to public patients. Medical-card holders can approach their GPs for referral to specialists in public hospitals for procedures such as breast reductions and tummy tucks. The operations are not limited to medical necessity, although priority is given to the likes of cancer patients who need reconstructive surgery, which means patients who simply want to alter their appearance could have to wait up to a year.
Halina Ashdown-Sheils is managing director of Advanced Cosmetic Institute, which has four clinics in the Republic and one in Northern Ireland. She's had a nose job, eye lifts, laser skin treatments, liposculpture, breast implants and more, so when she talks about plastic surgery it's from first-hand experience. She believes the rules need to be stricter.
"The public need to be sure that they are being offered the very best medical advice, that the procedure is being carried out by an experienced surgeon in a medically controlled and safe environment and that protocols for aftercare are properly in place. And of course it needs to be offered at the correct price," she says.
"We have been calling for regulation for a number of years now, and we were hopeful that something would have been done at government level to put them in place, but regrettably we are still waiting. Back in 2001 the Government made it clear that they had no intention of moving forward on this issue."
But if regulation were to become a political priority, how would the Government start to tackle such an unwieldy and long-unregulated industry? It sounds a mammoth task, but Prof Bury suggests it could be done through the Irish Health Services Accreditation Board, an independent organisation set up to establish, monitor and operate an accreditation scheme for the Irish health system. "Though it doesn't have real teeth yet, it would be the first obvious route for any regulation," he says.
In the UK the industry is regulated through the National Care Standards Commission, an independent public body set up to regulate social care and private and voluntary healthcare services. Criticised for not going far enough in policing the industry, the commission spot-checks clinics offering plastic surgery and publishes its findings, something many industry members in Ireland would support here.
The Department of Health and Children has in the past insisted that regulation is unnecessary. The spiralling number of plastic surgeons, both Irish and British, operating here may have prompted a change of heart, however. The Department says the draft heads of a Bill to regulate unregistered doctors are in the formative stages.
Prof Bury is sceptical for now. "The council has repeatedly been promised the implementation of such regulatory legislation, but as yet we've seen nothing." Similarly, the plastic surgeons' association has heard nothing about any such legislation but would, says O'Sullivan, welcome this type of regulation in principle.
As he points out, Ireland has dozens of plastic-surgery incidents a year, from a lack of appropriate aftercare to a lack of information on possible side effects. More worryingly, some patients in the UK have died from plastic-surgery complications.
If the Irish industry is left unchecked, it's something that's bound to happen here too.
Prudent plastic surgery
There are some simple steps you can take if you're looking for a plastic surgeon.
The Medical Council can provide the name of a registered specialist or check whether a doctor you are considering is registered. Call 01-4983100 or visit www.medicalcouncil.ie.
The Irish Association of Plastic Surgeons (01-4022126, www.plastic surgery.ie) recommends consulting your GP before seeing a specialist. "GPs are clued in to this kind of thing," says Sean T. O'Sullivan, its secretary. "They can talk it over with the patient and recommend a surgeon. Whatever route people take, they should have time to mull it over. Sometimes the first time a patient meets the surgeon is in the operating theatre."
If you go directly to a clinic, ask whether the surgeon is registered and will be available in person in the event of complications.