There was more than a little bit of déja vu about the government’s response to the Keogh review of cosmetic surgery when it finally saw the light of day, early last Thursday.[1]
A bunch of us were led into a Department of Health underground room and given the embargoed report … I can recall receiving just such an embargo in the spring of 2005 before the Cayton report emerging on precisely the same issues (now buried deep in the government archives).[2]

Sadly, as I sat and read the report, I reflected that the same problems still remain intractable and very little had really improved since 2005. I was unimpressed: the government’s response to Keogh lacked a strong commitment to enhance patient information, ensure psychological assessment, and reduce advertising excesses, and failed to grip safety concerns firmly enough.

Changing Faces had submitted evidence to the Keogh inquiry set up in the wake of the PIP scandal back in 2012, which eventually reported in April 2013. So we are pleased that the government has agreed with “the overwhelming majority of the Keogh recommendations.” But we are unconvinced that the actions it proposes to take are purposeful or speedy enough to tackle the major problems revealed by Keogh’s review and exposed by the PIP debacle.

I think it is fundamentally important to consumers—patients—of cosmetic interventions of all kinds that these are deemed safe and are offered only by properly trained and regulated practitioners. It would appear that government action to ensure this is going to be disappointingly slow and will lack the firmness that Keogh was recommending. I fear that far too many people will continue to be exposed to unsafe cosmetic practice, many having their faces and bodies damaged long term.

There have been many reactions around the tricky questions of assuring patient safety and the training qualifications of providers but we at Changing Faces will continue to press the government on three particular weaknesses:

Impartial information to aid consenting
We think the government has given inadequate attention and resources to the urgent need for impartial, evidence based information for patients about the risks and benefits of cosmetic interventions. I wrote to Jeremy Hunt, health secretary, in July 2013 after the Keogh review was published, stressing how vital such information can be in helping potential consumers to make good decisions about their choice of cosmetic treatment.

In the aftermath of the Cayton review in 2005, Changing Faces worked closely with surgeons, dermatologists, psychologists, and others to create a Department of Health website that provided independent information on surgical and non-surgical cosmetic procedures. Within the first year, the website received more than 600,000 page views. Unfortunately the pages were not maintained, became out of date, and are now archived or maybe lost. We argue that this impartial advice should be resuscitated as soon as possible, updated and with new evidence added as it becomes available.

Psychological assessment
There is far too little attention given in the government’s response to the well recognised need for presurgery assessments of psychological wellbeing and to the importance of advice and support to address any psychological issues that arise from a course of treatment or its aftercare. Instead, the government has asked the Royal College of Surgeons to set up a committee, which, among many things, will be expected to produce a new code of ethical practice for cosmetic surgery.
This is far too slow and cumbersome a response and fails to touch all non-surgical treatments. A much firmer line is required to mandate psychological assessment into all patient pathways.

Advertising
Although agreeing with Keogh that advertising and marketing should not trivialise the seriousness of cosmetic procedures, the government has decided to rely on the implementation of voluntary codes of good practice to stamp this practice out.

This falls well short of the Keogh’s call for “tougher controls” of advertisements that encourage unrealistic expectations or foster the belief that cosmetic surgery is a quick fix for happiness.

Overall, the government’s response to the Keogh looks like a missed opportunity but it may yet be possible to influence these issues. Changing Faces will continue to actively press for improvements that will ensure that patients are not left disappointed or disfigured as a result of uniformed consenting, poor practice and lack of control over hyperbolic advertising.

Competing interests: I declare that that I have read and understood the BMJ Group policy on declaration of interests and I have no relevant interests to declare.

James Partridge OBE is founder and chief eExecutive of Changing Faces, the leading UK charity supporting and representing people with disfigurements (www.changingfaces.org.uk). He is also founding director of Dining with a Difference, a disability consultancy company.