Last Word: Professor Laurence Kirwan

By: Laurence Kirwan
Created on 13th October 2009

With practices in both the UK and USA, top cosmetic surgeon Laurence Kirwan gives us the lowdown on cosmetic surgery on both sides of the AtlanticThe main difference between the USA and the UK is that in America patients are looking at who hasn't had it done and in the UK they are hoping no-one will look at them and guess they did it.

The British are quite aggressive in terms of early facelifts and, if anything, are more adventurous than their American counterparts. Sometimes, and in a rather scary way, the British will travel abroad for surgery or choose doctors on the day of the procedure, with nigh a second thought. Americans are for the most part better informed and better researched, although the British are catching up.

Patients on both sides of the Atlantic tend to follow the same referral route to their plastic surgeon; through the internet, existing patients and friends, sometimes doctors and even more rarely GPs (almost unheard of). Non-plastic surgery doctors are, in general, poorly informed about the options and benefits of plastic surgery.

The differences are that the UK is a chatty, gossipy country that reads its tabloids and equivalent magazines so that print media seems to be more effective in attracting patients to my office in the UK - as opposed to the USA, where the internet and patient referrals are bigger factors. TV is a terrifically powerful medium but I am hardly on it or in it. TV make-over programmes are generally based on the idea of taking someone who is well past their sell-by date and converting them into something with an indeterminate shelf-life. I think this is often a leviathan enterprise with unnecessary medical risks.

The British are, of course, famous for their bad teeth and the almost complete absence of orthodontia (Jamie Oliver is but one example), whereas the Americans are renowned for their perfect teeth and orthodontia. Orthodontia is still a largely undiscovered art in the UK.

Plastic surgery is often performed in private surgical centres in the USA and most surgery is performed under sedation (versus general anaesthesia) and the patient goes home to their own bed, rather than remain in the hospital - as they need to in the UK.

Nurses in an American operating theatre are trained assistants whereas in the UK, they are usually only trained to the level of surgical scrubs nurses who pass instruments and are unused to assisting surgeons. In the USA we also have "physician assistants" who assist in surgery and can help "close" the wound. 

British anaesthetists (known as anaesthesiologists in the USA) have more facility with a breathing tube known as the laryngeal mask, which can reduce soreness of the throat after a general anaesthetic. However, American doctors are better at doing cosmetic surgery under sedation - thus avoiding the necessity for a tube in the throat in the first place. 

Lastly, US hospitals recognise that plastic surgery is a profit centre and generally attract it by keeping their fees low. UK hospitals seem to view it as a necessary evil and take any opportunity to charge large fees. Maybe this is a reflection of the English view of cosmetic surgery.