Janet Street-Porter: Nips, tucks and a thin-skinned profession

The British Association of Plastic Surgeons (BAPS) is concerned that their profession is constantly portrayed as a bunch of face-lifters and boob enhancers. Yesterday, they argued that the bulk of their work, which deals with trauma injuries and burns, reconstruction following cancer, congenital deformities and degenerative tissue, is consistently ignored by a press choosing to focus on cosmetic surgery and all the attendant horror stories. Whilst I applaud the wonderful results I've seen carried out on friends who've suffered from cancer, and how women's self-esteem can be restored through breast reconstruction, it is worth pondering why this particular group of highly paid surgeons feels so hard done by.

The British Association of Plastic Surgeons (BAPS) is concerned that their profession is constantly portrayed as a bunch of face-lifters and boob enhancers. Yesterday, they argued that the bulk of their work, which deals with trauma injuries and burns, reconstruction following cancer, congenital deformities and degenerative tissue, is consistently ignored by a press choosing to focus on cosmetic surgery and all the attendant horror stories. Whilst I applaud the wonderful results I've seen carried out on friends who've suffered from cancer, and how women's self-esteem can be restored through breast reconstruction, it is worth pondering why this particular group of highly paid surgeons feels so hard done by.

Plastic surgeons are thin-skinned chaps - coincidentally for a profession where most of the clientele are women, the person wielding the scalpel is almost 100 per cent guaranteed to be a man. And like all middle-class professionals from architects to lawyers, they are concerned that the full range of their skills are relayed to an appreciative audience.

Yesterday's recommendations from the BAPS to the National Health Service focused on doubling the number of consultants, with proposals for improving access to plastic surgery at regional and local levels. All very worthwhile, but don't forget that in January, following the publication of two reports into cosmetic surgery and non-surgical procedures such as botox injections commissioned by Sir Liam Donaldson, the Chief Medical Officer, the Department of Health proposed measures to tighten up the way that the cosmetic surgery industry operates in Britain.

For all the whingeing by the surgeons, one is tempted to ask why they have been so slow in demanding stricter controls on those who practise their profession in this country. The boom in demand has meant that now there are about 20,000 high street clinics offering every sort of procedure from "filler" injections designed to smooth out your wrinkles, to breast reduction and augmentation, and liposuction.

No one really knows how many operations take place every year, although the figure of 100,000 is said to be roughly accurate. The British Association of Aesthetic Plastic Surgeons recorded more than 16,000 cosmetic procedures in 2004, up from 10,700 the year before, an astonishing increase of 50 per cent. And that's just the operations that their members told them about.

The Government accepted the recommendation from a group of experts that cosmetic surgeons should provide patients with details of their qualifications, registration and membership of professional organisations. All surgeons have to be registered with the General Medical Council (GMC). But there is still nothing to stop cosmetic surgeons attempting to carry out procedures they have little experience or expertise in.

More importantly, cosmetic surgery like many forms of medicine, is continually changing with fresh innovations and new techniques developing all the time, made available via the internet and professional associations.

How an uninformed member of the public is supposed to decipher what various qualifications mean and how they relate to your special requirements, God only knows. And although your plastic surgeon may be registered with the GMC and the British Association of Plastic Surgeons, how are the public meant to check that he is up to speed on the latest tests and trials of all the chemicals and potions women seem increasingly to have injected into their faces?

One national newspaper recently listed a dozen new substances which can be injected into the face to either fill in wrinkles, tighten muscles or smooth out crows feet, and for most of them there was no data available on long-term effects. For all we know they could turn into unpleasant hard pellets in 10 year's time.

Even a new face cream, costing hundreds of pounds, and whose fans claim it "rejuvenates" the complexion, has no real scientific evidence gathered over time to back up the wishful thinking. Because the cult of youth is so strong, there will still be a waiting list when it arrives in the shops.

The Government stopped short of insisting that every single plastic surgeon in Britain could only perform plastic surgery if they passed one industry examination with regular top-ups. Architects, accountants, lawyers and dentists have to do this, but not cosmetic surgeons.

And who is going to stop women continuing to have work done on their bodies by non-registered practitioners? The signs are not good. Only this week The Daily Telegraph carried pages of bilge about the benefits of cosmetic surgery serialised from a book by the actress and singer Toyah Wilcox entitled Diary of a Facelift. This was journalism at it's most irresponsible, with just one editorial column on the final day with the headline "what you should know before you go under the knife". Not "what you might like to think about before you consider the pros and cons of letting a complete stranger slice into your face". The benefits of cosmetic surgery were perceived as a given.

While Toyah gushes on about how her professional and private life have benefited from taking this radical step, (not to mention the financial rewards of writing a book about it) we note that the operation took place in Paris. So not a great advertisement for following Sir Liam's recommendation that we should use only registered establishments in the UK. Presumably Toyah isn't anticipating any need to sue her surgeon, should there be any unfortunate mishaps a year from now.

The press has focused on cosmetic surgery because it has been so unregulated, and many people have had bad experiences. For further evidence log on to awfulplasticsurgery.com and peruse worrying pictures of the famous. Who would rush for a nose job after studying recent photos of Janet, Michael and LaToya Jackson? Instead of nostrils, that thing in the middle of their faces is starting to resemble a beak. And we thought that money bought you the best medical practitioners going. Check out Steven Tyler of Aerosmith - is that a nose or a wonky bit of plastic above the famous pouting lips? There are also the cheek implants which render their recipients more like chipmunks than singers or actors. In spite of all this, demand continues to grow at an exponential rate and nine out of 10 customers for cosmetic surgery in this country are women, with one third having work done on their breasts.

The Government and the profession have been remarkably slow in protecting these consumers, and many would feel that the new regulations don't go far enough.

Cosmetic surgery is the biggest drug that's freely available in Britain no matter what your income. From princesses to secretaries, publicans to pop stars, there is a feeling that a nip or tuck here or jab there can revitalise our social circle, pep up our sex lives and even enable us to land a better job. And for every horror story or grisly episode of Nip/Tuck on television not a day passes without more happy customers extolling the upside of surgery from Sharon Osbourne with her £100,000 physical re-fit to her husband Ozzy's £20,000 face-lift and nose job.

And if you need a good surgeon, then I'm sure that a large number of the very men who were complaining yesterday about all the unsung work they perform on cancer sufferers and burns victims also carry out lucrative private work at least one day a week. After all, the biggest crime of the 21st century is to sag.