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What is the cosmetic surgery pathway?
Cosmetic surgery is surgery performed to alter your appearance for non-medical reasons. As these types of surgical procedures are optional, they are not routinely provided or funded by the Royal Free London or across the NHS. Such requests are reviewed by our internal exceptional treatment panel, which is called the Cosmetic Surgery Tribunal. The panel reviews any request from a GP or consultant recommending that a patient should receive a specific cosmetic treatment despite these restrictions.
What will happen if I am referred for a cosmetic procedure?
The first step is for you to be referred to our plastic surgery department by your GP or other health professional. Once referred, you will meet with a plastic surgeon for an assessment. The surgeon will establish to what extent your condition meets specific criteria and whether there are grounds to seek exceptional funding for cosmetic surgery. Should this be the case, you will proceed along the cosmetic surgery pathway.
As part of this pathway, you will also be asked to attend the medical photography department at the Royal Free Hospital. The area of concern on your body will be photographed so that the Cosmetic Surgery Tribunal can assess your request. The tribunal cannot accept your own personal photographs, those taken by your GP, or at another hospital. Any psychological distress may also be assessed through questionnaires or an appointment with one of the psychologists of the plastic surgery department.
The cosmetic surgery tribunal will then decide whether an exception should be made to fund the cosmetic procedure.
What happens during my surgical assessment?
You will have a consultation with a plastic surgeon to consider what cosmetic surgery procedures (if any) are appropriate for the part of your body that you wish to change. The surgeon will also be able to identify whether your case can be viewed as exceptional, when compared to other patients asking for the same (or similar) procedures, and to what extent your request meets stringent NHS criteria.
The surgeon will also decide whether you should proceed on the Cosmetic Surgery Tribunal pathway or whether you should be discharged. The surgeon will then write a letter giving details of your case to the Cosmetic Surgery Tribunal, a copy of which you should receive.
What happens during my psychological assessment?
If you proceed along the pathway, you will then meet with a member of the psychology team to discuss:
- the history of your concerns
- the impact your concerns have on other aspects of your life
- your knowledge of the surgical procedure and its risks
- your expectations of the surgery.
As part of the assessment, you will also be asked to complete some questionnaires. These will take about 10 minutes to complete and will include questions about your body image concerns as well as your general psychological wellbeing. Funding decisions are never approved solely based on your psychological distress. However, you may have additional support needs because of your distress.
Who is involved in the cosmetic surgery tribunal?
The cosmetic surgery tribunal consists of a surgeon, a clinical psychologist, and a member of staff representing the hospital management. In this meeting, your case is discussed, and the Tribunal will consider information provided by your GP, health care team, referring surgeon, psychologist (if applicable) and any other documents or information relevant to your case, including completed questionnaires and photographs.
The cosmetic surgery tribunal meets every four to six weeks.
How do I find out about the cosmetic surgery tribunal decision?
Your GP will receive a letter letting them know about the decision of the Cosmetic Surgery Tribunal. You will need to contact your GP to discuss this outcome as you will not receive a copy of this letter.
If your GP has not received this letter within two weeks of the meeting, they should contact the department directly.
What are the possible tribunal outcomes?
There are three possible tribunal outcomes:
Rejected
Your request for surgery has been rejected. The cosmetic surgery tribunal is the last tier of the Trust’s appeal process, and its decision is final.
Accepted
Your request for a cosmetic surgical procedure has been accepted and you will then be placed on to an NHS waiting list for surgery. However, at that point, there are no guarantees as to when exactly the surgery will be done.
Accepted – conditional
Your request may be accepted if specific conditions are met. These will be outlined in the letter sent to your GP. Examples of the conditions could be:
- to stop smoking
- learn more about the procedure and associated risks
- review and modify your expectations of surgery
- improve your emotional wellbeing
All conditions will be specific to you and the surgery you are requesting.
What can I do if my case is rejected?
If your request for surgical intervention is rejected, you cannot appeal this decision. There may be rare circumstances where incomplete information was submitted and a case can be re-discussed if new (and relevant) information becomes available.
Research suggests that cosmetic surgery is not always the most effective solution for body image concerns. By comparison, reducing how much you think about your appearance can be a more effective form of treatment. You might be eligible to access this sort of treatment through your local NHS Psychological Therapies service or through the plastic surgery department. You can contact the team rf-tr.
You are also free to explore other ways of having the surgery you want, such as paying for the cosmetic procedure privately.