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Fly-in, Fly-out Surgeons: The Real Cost of Value-For-Money Cosmetic Surgery

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What are the real costs of value-for-money cosmetic surgery? Clinics using so-called 'fly-in, fly-out' cosmetic surgeons - foreign surgeons who fly into the UK, carry out a list of operations, then fly out again - are becoming increasingly common. It is something that has helped the growth of affordable cosmetic surgery in the UK - patients who are happy to meet the surgeon on the day of the operation can undergo their chosen procedures when and where they want, at a price they are happy with. The surgeons concerned often perform operations like on a factory production line; it's efficient and cost-effective, but what if things go wrong? Where does the patient stand in relation to putting things right, or even claiming compensation for any suffering they might have endured?

The truth is that the use of fly-in, fly-out surgeons can complicate things, at least where medical negligence is concerned. The British Association of Aesthetic Plastic Surgeons (BAAPS) is so concerned that it has called for changes to the law that could make fly-in, fly-out surgeries increasingly rare, a move widely supported by medical negligence solicitors in the UK.

The BAAPS offers a three-point plan, designed to protect both the patient and the cosmetic surgery profession:

Firstly, they call for a rule that patients must only have consultations with the surgeon who will perform the operation. This measure seems sensible and could in itself reduce the number of negligence claims brought against cosmetic surgeons in itself. As in all medical litigation, the performance of a cosmetic surgeon is judged against what could be expected of a typical surgeon with similar experience. This can include the consultation with the patient before the operation as well as post-operative care, in addition to the actual performance of the operation. If any area is found to be substandard, the surgeon (or clinic) may be found to be negligent. With this in mind, it would seem to be important for the surgeon responsible to be present at the consultation in order to assess the patient's suitability and discuss the treatment in full. This is not always the case with fly-in, fly-out surgeons: whilst patients may see a surgeon in consultation, it may not necessarily be the one who will ultimately perform their surgery.

Secondly, the BAAPS raises the issue of indemnity insurance, stipulating that surgeons' insurance policies must cover costs should a legal case arise in the UK. Generally, patients undergoing cosmetic surgery will have an agreement with the clinic rather than the surgeon, so any initial action for medical negligence would be taken against the clinic. However, there have been exceptions to this, where a cosmetic surgeon is joined to legal proceedings as an additional defendant. Not all fly-in, fly-out surgeons carry UK medical indemnity insurance, so there can be practical difficulties in taking legal action against them, not least because of the distances involved. Even where the foreign insurer is tracked down, they cannot be expected to have good knowledge of the British legal system and, as a result, claims can become more costly and more complicated.

Thirdly and finally, the BAAPS proposes that all non-UK doctors are required to undergo revalidation when they register with the General Medical Council. Under current rules, a surgeon recognised as a specialist in their own country is automatically allowed onto the UK's specialist register. This is perhaps the most controversial proposal from the BAAPS, and no doubt will meet opposition from cosmetic surgery clinics, but it is perhaps the most crucial one for patients.

Standards of training in cosmetic surgery procedures differ between countries, and this can have a serious impact for the patient where there is a problem. Some of the most notable recent examples have involved faulty silicone gel breast implants. Whilst the faulty implants are no fault of the surgeons, foreign surgeons employed to remove the implants do not necessarily have the training and expertise necessary to remove any silicone leakage. This is a crucial part of the removal procedure, as the gel can migrate from the breasts to other parts of the body.

So, will these proposals be adopted? Medical negligence solicitors certainly hope so, and many of their future clients seeking compensation after cosmetic surgery problems will surely benefit. In the meantime, we can only hope that clinics act responsibly when appointing their fly-in, fly-out surgeons. If they don't, it's the patients that could pay the price.

Tom Rokins writes on behalf of Switalskis, which has seven offices in West Yorkshire. Switalskis deals with various medical negligence claim such as brain injury and birth injury.