Mirror Mirror On The Wall, Should I Be Having Surgery At All?

12503410_xxlIn the last issue of THSJ, we revealed statistics showing most women have their first cosmetic procedure by 21 years of age. With cases of BDD on the rise, Marie Shoulder from Bevan Brittan explains why it’s important to ensure that patients have realistic expectations on the outcome of their cosmetic surgery.

Around 2% of the population suffer from Body Dysmorphic Disorder (BDD). The disorder can range in severity but it is generally characterised by the sufferer being overly obsessive about their appearance, and in particular one aspect of their appearance which to others may seem trivial or non-existent.

A recent study by the Institute of Education at the University of London commissioned by the Department of Health revealed that those who have underlying psychological issues such as depression and BDD are more likely to have cosmetic surgery. The caution lies however in the fact that a psychological condition can actually worsen rather than improve following cosmetic surgery. In a case with a patient who has BDD for example they can undergo several cosmetic surgery procedures whilst becoming increasingly unhappy with their appearance, which can often result in depression, agoraphobia and social isolation.

This impact could add thousands to the potential value of any damages claim, certainly if a loss of earnings claim were to be advanced along with a claim for treatment such as Cognitive Behavioural Therapy. The current JC Guidelines value general damages for psychiatric and psychological damage up to £82,750 at the top end of the bracket where the impact of the disorder can affect the injured person’s ability to cope with life and work and on the injured person’s relationships with family, friends and those with whom he or she comes into contact and the prospects for recovery are poor.

So, how well do practitioners know their patients? In most cases, patients undergoing cosmetic surgery do so without referral from their GP. It is therefore extremely important that a thorough discussion takes place to identify the reasons why a patient is seeking to undergo surgery. If there is any suspicion that a practitioner is dealing with an at-risk patient, they must question whether the treatment is appropriate at all. A patient with BDD is unlikely to accept they have a mental disorder at all because to them their cosmetic flaws are very real so obtaining informed consent is fraught with difficulty.

The IHAS “Good Medical Practice in Cosmetic Surgery” Guidelines state that the patient must be asked to give consent to inform their GP of any planned surgery. A GP may be able to provide important information about the patient and so if the patient refuses to give consent to contact their GP this should instantly raise suspicion. So, if a practitioner decides to proceed, the patient must be made aware of the implications of not informing his/her GP and should be asked to sign a disclaimer to that effect.

It is an unnecessary risk to provide invasive cosmetic surgery without information about the patient’s medical history and every effort should be made to obtain confirmation from their GP that there is no known medical reason not to operate.

Although not mandatory, there are psychological screening processes available which are designed to provide a more thorough investigation into the patients reasoning for wanting cosmetic surgery. These screening processes can offer a strong indication of whether or not surgery is the appropriate choice for a patient before they go ahead.

The consultation that a patient has with his/her surgeon is a very important part of the cosmetic surgery process and should never be underestimated. Body Dysmorphic Disorder is a significant mental disorder which causes great distress to sufferers.

However, it also creates particular problems for cosmetic surgery practitioners with a higher risk of claims and potentially large awards of damages if an existing condition is exacerbated by the very surgery that was undertaken to make the patient feel better about themselves.