Attitudes to cosmetic surgery: US versus UK

By: Katharine Griffiths
Created on 25th March 2010

We often look to America to take the lead in cosmetic surgery and now two leading experts in the cosmetic surgery field with experience on both sides of the Atlantic talk to Cosmetic Surgery & Aesthetics Guide about the difference in attitudes to cosmetic surgery

What would you say are the differences between patients in the US and UK?

Laurence Kirwan: I'm often surprised at how little research patients do in the UK. The general awareness of plastic surgery is greater in the States because it is not seen as something to be kept secret whereas in the UK, no one wants anyone to know they have had it.

The media don't necessarily give a balanced view of it - they obviously want to give the story an angle and are less concerned about giving unbiased information. Although that is true of the media in both the UK and US.

In the US there more websites so information, particularly about the complications or downside of procedures, is readily accessible.

Wendy Lewis: In the US patients get most of their information from the internet. There are two big official websites - www.plasticsurgery. org and www.surgery.org. From talking to patients in the UK, they often seem to go to the back of glossy magazines and pick someone whose name seems familiar.

British patients are more media driven; they see someone mentioned in the media and they will go to them on that basis alone. But this is not like buying a lip gloss. What's the worst that can happen if you don't like the lip gloss, you've lost £10, maybe £20; but this is surgery - your face, your body.

How would you compare training in the US and UK?
LK: Once you qualify as a doctor and are registered with the medical licensing authority, both in US and UK, you're allowed to practise medicine and surgery - it is like certifying to fly a two seater, twin-engine plane, then flying a great big jet, with 400 passengers. It isn't legal in the air but it is possible in the cosmetic market place.

Obviously, to some degree, hospitals are able to monitor the activities of surgeons but even so, poorly trained surgeons perform surgery for which they have little or no training.

In the non-surgical arena, on both sides of the Atlantic, the cosmetic field has become inundated by cosmetic doctors. In all fairness, some of them are highly skilled and provide a high level of care. But, if you see breast implants offered at £8,000 compared to £1,500 then you know that what you're paying for is the experience and training that the specialist surgeon brings to it.

It is not like buying a car where you decide what to buy and then look around for the best deal. You can buy a facelift for £1,000, £10,000 or £20,000. Now, the £10,000 facelift might be as good as the £20,000 facelift but the chances of the £1,000 facelift being as good are remote.

WL: Understandably, patients are often confused about the difference between cosmetic doctors and dentists that are performing aesthetic procedures and fully qualified dermatologists and plastic surgeons who are specialists and have had many more years of training to get where they are.

What should patients be aware of when choosing a surgeon?
LK: A good sound training and qualifications such as the American Board of Plastic Surgery or Specialist Qualification in Plastic Surgery in the EU are examples.

Before and after photographs, publications, patient referral, testimonials, positive press coverage as well as evidence that the surgeon has conducted training courses to his own peers, are very useful indicators of his expertise.

WL: It is not unheard of for a doctor from another country in Europe or the Middle East, who was not trained in the UK, to take a Harley Street address for consultations to give them some respectability.

What about consultations; what advice would you give?
WL: My advice is always to find cosmetic surgeons - or doctors - with the appropriate training and then have consultations with a few of them. Americans are much better consumers than the British and are programmed to go for a number of consultations and shop around before deciding.

Most surgeons in US charge for consultations but the US consumer factors that into how much the whole process will cost them.

LK: I charge for consultations because I see the consultations as having a standalone value - the client is paying for my advice and if I charge for the consultation that advice is not based on me trying to hustle the patient into choosing surgery. The cost of the consultation is not deducted from the cost of surgery.

WL: I always charge for my consultation because that is the way I run my consultancy business. And I tell my clients to expect a consultation fee from doctors they will visit. If it gets waived if you go ahead with surgery, that is a nice bonus. British consumers are very cost conscious and that sometimes affects how many consultations they will have.

For a non-surgical procedure it may be fine to see only one practitioner, particularly if they have had the procedure done before, but a surgical procedure is a very different thing: there is a process that should be followed and the consultation is part of that. I make my clients promise to have at least two consultations.

Americans will see more surgeons, rather than less. It is getting better in the UK but I used to have patients who wouldn't have a second consultation because they felt they were in some way betraying the first surgeon they saw.

In fact, it is very common that clients who are looking for corrective surgery say to me that the mistake they made was not seeing another surgeon for advice.

What else is important when choosing a surgeon?
WL: Before and after photos are very important but it is amazing how many surgeons in both UK and US don't realise this. Patients can't be expected to choose you without being able to see some of your results to compare.

LK: Before and after photographs are an essential part of my consultation. You can make any number of promises to patients about how you can make them look fabulous, but they are going to want to see what you can achieve. A surgeon will only show his best pictures although it is supposed to be a range. Either way, if you don't like what you see, start walking.

WL: For many American patients all they care about is the before and afters. If they don't like the photos they see, they will go see another doctor.

What major differences can you see between the cosmetic surgery industries in the two countries?
LK: The concept of clinic chains is starting to happen more in the States. This is a UK-based phenomenon - but many people think that it originated in the US.

WL: The business model of clinic chains has not worked in the US because so many factors come into play with surgery that it cannot be standardised - for example, you can't say that the facelift that costs you so much in Scotland and costs you the same amount in London will be of the same quality.

LK: I think the reason it hasn't worked in the States is that consumers do their research on individual surgeons so they don't want to go to a clinic where they are not necessarily sure of the
surgeon and they see an advisor initially. One of my patients in the US was told to sit down in a room at the clinic and look at an educational video and then say if she had any questions. This did not go down very well and she moved on to see another doctor.

WL: The reason the clinic chains began in the UK is that the British medical system did not allow advertising to the public so plastic surgeons weren't known to the mass of people. They were only allowed to place a discreet sign on the door saying Mr Smith - but clinics were able to advertise, so they have grown in market share.

LK: Clinic chains also have a wide array of young surgeons they can take advantage of. The training system in the UK makes it difficult to move onto consultancy level - so to make ends meet - some surgeons are getting their cosmetic surgery experience on the job, so to speak.

Are there any other different trends you perceive in the UK?
WL: In the UK there has been a rise in non-surgical procedures: SmartLipo instead of liposuction, fillers instead of facelifts. This taps into the cost factor, but also taps into the fear of hospitals and the associations we have with hospitals. Patients would rather not go into a traditional hospital and would like to avoid a general anaesthetic.

In the UK most surgeries are carried out at ‘traditional' hospitals, which people don't always like; whereas in US, there are far more private hospitals and surgery centres.

LK: Hospital fees are also much more expensive in the UK and that is one of the factors that makes surgery more expensive in the UK.

Patients often fail to realise that the price they are quoted is not just the surgeon's fees - the hospital and anaesthetist's fees have to be added.