Whether or not to embark on cosmetic treatment is a big decision, with far reaching implications.  Some bad cosmetic surgery results cannot be corrected. Divorce from a bad cosmetic surgeon and their handiwork will undoubtedly still leave you scars, so choosing your cosmetic surgeon in the first place is not a step to be taken lightly or unadvisedly!
According to BUPA, upwards of 75,000 cosmetic surgery operations took place in the UK in2003.  The demand for cosmetic treatment grows constantly, so at a conservative estimate, in a quest for lostyouth or enhanced physical beauty, patients part with over a £1 billion each year in the UK – and that’s just for surgery, add to that the price of non-surgical treatments and “miracle creams” for a more realistic amount.  Indeed, in 2005, a BAAPS–Mintel survey estimated that 690,000 cosmetic procedures were performed in the UK. 
Human nature being what it is, it is sadly not surprising to find that the “dishonestand untrained” try and mix in with the “professional” in an attempt to cream off some of that money.  Sadly, there is little protection for the British public from unscrupulous practitioners and clinics – the burden falls on you to research and protect yourself.  In the USA, people discuss their cosmetic surgery openly and GPs know a great deal about what is current and to whom they can refer patients – indeed many of them will have had cosmetic surgery themselves!  Here in the UK, we are still somewhat puritanical about our looks, and cosmetic surgery is less acceptable a topic for discussion with friends.  GPs are hard pressed and may have little experience of aesthetic surgery because few of their patients have undergone it.  So what can you do?
First establish that your prospective surgeon is on the General Medical Council’s Specialist Register – this really is an absolute minimum, if they are not on the register, you can be sure that they have not completed a recognisedtraining in Plastic Surgery. (GMC).
Second, see only the surgeon who will be doing the surgery.  Beware of UK cosmetic businesses that make you see a “cosmetic co-ordinator/ adviser/ consultant” before you see a surgeon.  These are not surgeons, they are sales people being paid on a bonus incentive arrangement.  They have no surgical qualification– although some may have qualified as nurses – and they are employed to convert you from an “enquiry” to a “sale”.  They optimise throughput for that business, rather than for patients, by only putting you in front of a surgeononce you have signed up for, or at least look likely to sign up for a procedure.  Likewise don’t be persuaded to see a surgeon they happen to have in the building that day, insiston seeing only the one who will be performing your operation, or none at all.  These are businesses that employ surgeons, and you have the choice to give them your custom or not, so be picky and advocate for yourself.
Third, ensure you see your surgeon at least 2 weeks before your scheduled surgery and as often afterwards as you require to be satisfied that you are making a reasoned, well-informed and correct choice.
Fourth, ask about the surgeon’s experience and training – the average UK-trained Consultant Plastic Surgeon, having qualified as a doctor, will have spent 4 postgraduate years in basic surgical training, a further year or two as a senior house officer in Plastic Surgery (back at the bottom rung of the ladder), a year or so in a research post and then 5-6 years in a recognised training scheme with a national training number.  At theend of that they must past a Specialist Exam, with a famously low first time pass rate, coordinated by the 4 British and Irish Colleges of Surgeons, and only after this will they receive a Certificate of Completion of Specialist Training.  To become a Consultant in NHS practice, they must then be appointed in open competition by a committee of their peers and will then be responsible for training the next generation ofUK surgeons and keeping abreast of developments in their field.  Why not use that training as your minimum bench mark and compare any surgeon you meet against it?  You won’t go far wrong if you do. 
Fifth, ask about follow up arrangements and the surgeon’s availability – beware of surgeons whose main practice is based abroad and who fly in from time to time to operate in the UK.  They may be technically proficient, but how will they make themselves available if you have a problem post-operatively? Be even warier of flying abroad for surgery, unless you can be sure of your surgeon’s abilities and that you will never have a complication – unless you can afford (and guarantee to be fit enough) to fly back, or stay there for months afterwards in case of problems.
Sixth, find out what would happen if you have a complication.  A surgeon who claims not to have complications is a liar.  Even the best cosmetic surgeon has occasional unsatisfactory results and that is when your choice of surgeon becomes vital because what makes a good technical surgeon, the right one for you, is the steps they take to minimise complications (training, appropriate planning and patient selection) and the steps they take to deal with them when they do occur. Reputable surgeons re-operate free of charge for a result they consider suboptimal.  Disreputable businesses ask you to sign a disclaimer and will charge again, like a wounded bull, if you need further surgery for a bad result.
Seventh, and on the same vein, ask whether extra charges will be incurred if extra additional hospitalisation or treatment is required in the peri-operative period?  Reputable hospitals are businesses too, and they can only afford to offer a fixed price package (no extras) if they calculate accurately that their surgeon rarely has complications – so if your surgeon offers a fixed price deal, that’s a vote of confidence from the hospital he or she uses (and the more reputable and famous that hospital, the bigger that vote of confidence).  Bear in mind that whilst further surgery for acute complications usually will not incur a fee from the hospital, re-operating for an unsatisfactory result after several months likely will, even though your surgeon should not charge (and in my practice, neither will any of the anaesthetists who work with me). Beware of businesses that include an insurance policy in their fee: they are just accepting that you and their other customers will often need further surgery and are hedging against it and passing the cost on to you.
Eighth, if you are shown photographs, ask whether they are unaltered photographs of the surgeon’s own patients.  Beware clinics that have a portfolio of glossy pictures used by all their sales people and the surgeons who work for them. Beware of different lighting, exposure, positioning and make-up in pre-and post-operative pictures.  Not all surgeons show photographs. That’s not necessarily a bad thing if they believe that some patients can be misled by them, or if the patients on whom they have operated previously have declined to let their photos be used so as to protect their privacy– many patients are delighted with their results, but want them kept private!
Ninth, expect to be given literature on the treatment being proposed.  UK Care Standards require that patients receive explicit literature about proposed treatments, written in plain English.  If a surgeon has taken time to write and produce reasoned, evidence-based literature that is tailored to his own patients and practice, I think that should imply something about the care he will give you, in comparison with a surgeon who dishes out mass produced leaflets from his professional organisation, or worse, none at all.  If your surgeon has a web site, look at the quality and breadth of information available there.

Finally, beware big advertising campaigns. The General Medical Council used to forbid advertising by doctors.  Within strict guidelines, they no longer do and many reputable surgeons have web sites and advertise indirectories and magazines.  They pass that on to their patients by calculating their fees to cover their overheads, which will also include paying a good secretary, nursing staff and renting consulting rooms.  If you purchase your cosmetic treatment from a business that advertises nationally, pays banks of call centre telephonists, sales coordinators and salaried surgeons, think how much more their overheads are and how much profit they will require on top.  Make sure you look at the fees you will pay and that you are comparing like with like - that £1billion is going somewhere each year.