There has been a significant increase in the amount of cosmetic surgery undertaken in the UK over the past decade and although the greatest increases been in nonsurgical procedures such as fillers and Botox, the number of operations under general anaesthesia has also increased. The media has concentrated with some justification on whether patients are given adequate information, time to consider and even whether some surgeons are too reluctant to say no.
Less attention has been paid to the concept that a healthy patient with no pathology is undergoing a general anaesthetic not uncommonly involving deliberate hypotension and lasting for many hours. Although general anaesthesia is extremely safe with a risk of death of about 1:83000 it is another risk to take into consideration. The matter is made more complicated by the tradition that in the UK we do not specifically explain each and every risk of anaesthesia before an operation.
The other side of the coin is that cosmetic surgery can make a massive difference to someone’s life. My cosmetic patients often tell me how happy they are after the operation.
It would be totally unjustified to unnecessarily alarm patients and so a fine balance needs to be kept between creating concern and providing proper consent. Elsewhere on my website you will find more information about anaesthetic consent including a form setting out the various risks. I originally put this on the website over five years ago and had no feedback from patients saying that they would like more explanation. Indeed, it is obvious that many patients want to know as little as possible.
For that reason, I believe it is important to take less risk with anaesthesia for cosmetic operations as opposed to operations for pathology not only because many pathological operations have to go ahead in the interests of the patient but also because it is imperative upon us as anaesthetists to take less risk with the cosmetic patient. To achieve this end Weymouth Street Hospital has a universal preassessment service and all patients receive an online questionnaire which is then surveyed by both the preassessment nurse and the consultant anaesthetist involved. Further tests and investigations can be organised to minimise risk and to ensure the patient is as fit as possible.
I would not proceed with a cosmetic anaesthetic where the level of risk is increased by other medical problems such as hypertension, heart disease, obesity and diabetes. In some cases this will mean investigating these illnesses and optimising them in advance. This is particularly pertinent to diabetics where we can often improve control and now have clear guidelines.
If you are having a cosmetic operation, please read my website. Please reply to the hospital’s email about preassessment in good time so we can work together to ensure a safe procedure with a good outcome