Cosmetic surgery: what the specialty covers, how to choose a surgeon and what to expect

Cosmetic surgery is surgery done to change how a person looks. It overlaps with plastic surgery but the aim differs. The NHS draws the line this way: reconstructive or plastic surgery repairs or rebuilds missing or damaged tissue and skin after illness, accident or birth defect, for example rebuilding a breast after mastectomy or repairing a cleft lip and palate, and it is often available on the NHS. Cosmetic surgery, by contrast, is not routinely funded.

In practice many surgeons do both, and the same operation, such as breast reduction or rhinoplasty, can be reconstructive for one person and cosmetic for another. If you think your operation has a functional reason, such as breathing difficulty, back pain from breast size or a long-standing condition, ask your GP whether an NHS referral is possible before assuming you must pay.

The NHS cosmetic surgery guide lists liposuction, tummy tuck (abdominoplasty), female and male breast reduction, hair transplant, breast enlargement with implants, labiaplasty, eyelid surgery, nose reshaping, ear correction, surgical fat transfer and facelift. Within each area, techniques vary and new names appear regularly, so ask the surgeon to describe exactly what will be done rather than relying on a brand term.

The NHS says only registered doctors can carry out cosmetic surgery in England and advises checking a surgeon on the General Medical Council online register. Some surgeons hold a cosmetic surgery certificate from the Royal College of Surgeons, which the NHS describes as showing they have been assessed against an agreed national standard. Professional associations such as the British Association of Aesthetic Plastic Surgeons and the British Association of Plastic, Reconstructive and Aesthetic Surgeons check qualifications, experience and insurance for their members.

Membership of a body is not a guarantee of results, and the NHS suggests asking directly how many of the procedure the surgeon has done, what training they have and what the most common complications are. Hospitals matter too: the NHS says independent hospitals and clinics providing cosmetic surgery in England must be registered with the Care Quality Commission, which publishes quality ratings.

Non-surgical treatments such as botulinum toxin and dermal fillers fall outside this department. The NHS notes that botulinum toxin products are prescription-only medicines, and that complications from fillers can be serious, including infection, nerve damage and blindness.

The NHS encourages people to ask themselves why they want a procedure, how long they have thought about it, what triggered the decision now, whether they are expecting it to change a relationship or job prospects, whether the change is for themselves or to please someone else, and whether they can afford the costs of any future maintenance. It warns against assuming a procedure will make everything better, because how you feel about your appearance is only one part of wellbeing.

It also advises telling both the practitioner and the person treating you about any mental health condition, past or present. Body dysmorphic disorder, in which a person is preoccupied with perceived flaws, is a recognised condition and can be a reason to seek psychological assessment before surgery.

The NHS says to book a consultation with the person who will actually do the procedure before deciding, and not to pay before you have had one. It lists questions to ask: how many of these procedures they have done, their qualifications and training, which professional association they belong to, the most common complications, what aftercare you can expect and who will provide it, what happens if something goes wrong or you are unhappy with the result, and what the cost is, including whether further treatment would be extra.

The practitioner should explain how the procedure is done, how long it takes, whether anaesthetic is needed, what pain to expect, how long recovery should take, the risks, how long the results will last and what you can expect to look like afterwards. Take away written information, and ask about the products or implants used.

• Avoid group treatments, events involving alcohol and online discount vouchers.

• Avoid mobile services run from private homes or hotels.

• Be cautious with practitioners who advertise only on social media; the NHS notes influencers are usually paid to promote services.

• Do not feel pressured into extra procedures you had not considered before arriving.

The NHS tells people to consider all the costs, including aftercare, correction if something goes wrong and future procedures needed to maintain the result. What drives the price is mostly the type of anaesthetic, the length of the operation and hospital stay, the surgeon's fee, implants or devices, and whether follow-up appointments and revision are included. Ask for an itemised written quote and for it to say what is and is not covered if a complication needs further treatment.

Cooling-off matters. The NHS says you should be given time after a consultation to decide, and for surgery abroad it states that you should have two consultations with the treating surgeon, giving a cooling-off period normally two weeks in the UK. Treat time-limited deals as a warning sign.

The NHS acknowledges that surgery overseas can cost less, but says safety standards may not be as high and that overseas clinics may not provide follow-up to the same standard. If complications arise after an operation in the UK, follow-up is the surgeon's responsibility; abroad you may not have anyone in the UK to turn to. It advises meeting the surgeon rather than only salespeople, not paying for a hospital you have never seen, and checking what insurance applies. It also says travel insurance does not normally cover complications from surgery, and that flying home soon after an operation increases the risk of problems.