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The Hidden Costs of Medical Tourism

I have just read another article about the dangers of medical tourism.

Medical Tourism is a thriving industry and many people from the UK travel abroad to have cosmetic procedures. I completely understand why they do this because it can be seen as having a holiday or having a trip overseas, not to mention the significant saving in costs with the surgery.
However, I cannot recommend it and this is why.
When I get referrals from patients who live overseas or even in other parts of this country, I always recommend that they seek a surgeon closer to home, because whilst there are not that many plastic surgeons in the country, we are represented in most towns and cities. If you know what qualifications to look out for, you should be able to find someone who is appropriately skilled and qualified to do your surgery. In fact, I dedicate a chapter of my book to the risks and benefits of medical tourism or having surgery far from home.
I have read a recent report about patients in overseas cosmetic surgery clinics suffering significant infections following surgery. One of the many problems with having surgery overseas is that the standard of training of the doctors and the standard of cleanliness cannot be guaranteed. The processes and checks that are performed in the clinic may not be to the same level that they are in this country.
Clearly there are many well trained surgeons and excellent clinics overseas but the issue is in knowing who and where they are. The surgery is often significantly cheaper and you should ask yourself why this is?
It may be that the level of indemnity insurance of the surgeon is much less than required in the UK which means that if you do have a problem, you will have less comeback on the surgeon.
It may be that the clinics and the hospitals do not need to invest in stringent and robust infection control procedures and safety checks that are required in UK facilities.
It may also be that the level of aftercare and support following a procedure could be affected as I always stress that it is best to see your surgeon, not only before but after your surgery to put your mind at rest and to make sure things are progressing satisfactorily.
At the end of the day, it is up you, to the patient to make the decision as to where to have surgery, whether it be at home or abroad and the onus is on us as practitioners to make sure you are fully informed about all the risks and the benefits of each.

I go back to my mantra I will always tell patients, which is:

“Do your research and do not be afraid to ask questions”

If you would like a copy of my book which is available now click the link here.

I talk about why Plastic Surgery is cheaper overseas in one of my LIVE Q&A sessions on Facebook every Tuesday night at 7pm, watch it here:
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Jack Of All Trades Or Master Of One?

People are often surprised at how diverse a plastic surgeon’s skills extend.
We are one of the only medical specialities that can operate on any part of the body.
We are trained in:

  • Cancer reconstruction in the head and neck, breast and skin
  • Treatment of burns
  • Hand injuries
  • We treat congenital birth defects including cleft lip and palate
  • We manage any soft-tissue defects such as lower limb trauma after a road traffic accident or management of pressure sores or ulcers

We can literally operate from the head to the toe.
All plastic surgeons will sub-specialise in a particular field and his or her practice will be limited to that area while working in the NHS.
However, in the private sector, where most plastic surgeons perform cosmetic surgery, there is no limitation to the area that they operate on.
Any fully trained plastic surgeon will be able to do a facelift, a nose job, put in breast implants, do a tummy tuck and do liposuction as well as the range of non-surgical injectable treatments available.
When I was in the NHS, my practice was limited to breast reconstruction following cancer and now that I work in the private sector, I limit my work to breast and body contouring.
This is very rare and most plastic surgeons will at least offer facelifts and botox, even if they specialise in the breast.

In fact, there are only a handful of plastic surgeons that specialise in the breast, and so pretty much every plastic surgeon will offer breast enlargement even if they are trained as a hand or a burn surgeon.

I certainly have a lot of patients who request botox or a blepharoplasty and I am capable of performing the procedure, but the ethos behind my clinic is to provide a world-class service delivered by the most highly trained professionals.

I have been very careful about who I choose to work with me at the clinic to help me expand and grow.

It is great to have Khurram Khan on the team.  He is a Consultant Plastic Surgeon at the Children’s Hospital and he is focusing on all of the local anaesthetic work. His main area of interest is in facial plastic surgery, so he is the perfect complement to the team to allow us to expand the range of treatments that we can offer.

We also have Azzam Farroha, who is a Consultant Plastic Surgeon at the QE Hospital in Birmingham and he specialises in skin surgery and treats benign and malignant skin lesions with a special interest in skin cancer.

I have been very careful how I expand the clinic because it can be tempting to just take on as much work as possible.

However, early on, I set out our Brand Values and I will stay true to these and will always aim to do the right thing.

Ethics and delivering the best results to our patients will always be the core focus of what we do.

As plastic surgeons, we are trained to be ‘Jack of all trades’ and this is one of the great appeals of the speciality, but I feel that we are moving in to an age where the specialist is becoming more important and certainly in the niche of cosmetic breast surgery, there is a need for surgeons who are experts in the field to help to bring the speciality away from some of the negative publicity that it receives.

The variety of surgeons who offer breast enlargement is vast.  In fact, I have written a book about it!

“Never Accept A Lift From Strangers – how to choose the best plastic surgeon for your cosmetic breast surgery”

As is the case with most things in life, it is not enough to be doing excellent work and the success or failure depends on getting the message out there and getting the world to listen.

Please help me to get the message out – share this on Facebook, email your friends and Tweet it on Twitter.

I am always happy to receive comments and feedback, so it would be great to hear from you and if you want to chat with me live, you can find me on Facebook Live at 7pm every Tuesday night, so like our page and I will see you there.

Just because they look like a plastic surgeon and they say they are a plastic surgeon, doesn’t mean they are a plastic surgeon!

One of my passions is to raise awareness about cosmetic surgery to try and change perceptions so that it is not portrayed as being a branch of medicine that is somehow less worthy than other branches of medicine.

There is an image that all plastic surgeons are unethical, money grabbing cowboys but the reality is very far from that (well I would say that wouldn’t I?).

One of the problems is that for many plastic surgical procedures, patients look for a surgeon by going on the internet or look at advertising and marketing in glossy magazines, rather than the traditional route of going to see a GP and being referred.

This has allowed a huge growth in practitioners who are not fully trained to set up and practice plastic surgery (practice being the operative word).

Whenever I talk to people about this, they are always shocked and alarmed to discover that there are so many untrained doctors performing surgery.

They think that surely there is a law against such a thing and that it should not be allowed, but I am afraid there is no law against this and it is allowed and it is going on all over the UK.

I feel so strongly about it that I have written a book called ‘Never Accept a Lift From Strangers: How to choose the best plastic surgeon for your cosmetic breast surgery’ and it is available from Amazon.

One might ask why I have had to write a book about this as you would have thought that it was obvious to see which surgeons have been trained and which haven’t.

Unfortunately, it is not obvious.

I talk about cases in my book of high profile people, both here and abroad, who have had complications following plastic surgery performed by non-trained plastic surgeons, people like Colin Hendry the Premier League football player and the pop stars, Kanye West and Usher, have all had family members who have been affected and I am sure they thought their plastic surgeons were fully trained.

The problem is that when someone asks me to tell them what to look out for, it is not so clear cut.

That is why many doctors and surgeons have very impressive sounding biographies and you may be fooled into thinking that they are properly trained, but only when you delve deeper do you realise that they have no formal training in plastic surgery or that they may have started it but not completed it.

To be honest I blame us, the professionals. I think that we make it too difficult for people to seek and understand what all the credentials mean.

You see, there are a lot of associations and qualifications that do not count for much, although there are others that mean a lot and stand for many years of specialist training in a very competitive environment and yet to the outside eye, they can all look good.

I do not think it is a problem unique to doctors either.

I talk in the book about a problem I had finding an accountant and only later realising that there are many advisors out there who sound credible but are not qualified chartered accountants.

The same is true in the legal profession as I was talking to a friend of mine who for many years I thought was a lawyer, but in fact I discovered he was neither a solicitor nor a barrister and actually had a paralegal qualification, and I have to be honest I still do not quite understand the difference which leads to the next question:

Does it matter?

Well in surgery, yes it does matter because surgical training is very long, very competitive and very hard.

It is an extended apprenticeship which takes many years, it took me thirteen years of training after becoming a fully qualified doctor (which in itself takes 6 years) to finally finish and receive my certificate for specialist training in plastic surgery, FRCS (Plast).

There are exams to take, culminating in a final exit exam which tests whether you are safe and skilled enough to be put in charge of patient care independently once the training is finished.

If you are accepted to become a full member of the BAAPS, The British Association of Aesthetic Plastic Surgeons, then there is an audit every year where we must submit our figures on the number of operations we have done and any complications or revisions we have had to perform.

We have a strict code of conduct to which we must adhere and we have a peer group that we are accountable to.

However, there are many doctors out there who are performing plastic surgery who are not a member of one of the plastic surgery associations (BAPRAS and BAAPS).

Not only does this mean that may not be fully trained in plastic surgery, it also means that they will not be held accountable to the same rules and ethical guidelines which they are bound to practice within.

I don’t think we are going to solve this problem overnight because I think there must be something inherent with people in a profession that they keep it shrouded in mystery to make it look impressive and worthy of their stature.

I would love to be able to say to you look for this one thing to be certain that your doctor is fully trained in plastic surgery and surely that would make sense.

It might help to stop the horror stories you hear about rogue practitioners working out of their front room.

The media love to pick up on these stories and report how terrible it is, but I think the real piece of news is that they are usually not doing anything wrong and it is perfectly within the law for people to perform treatment and practice out of their front room, even people with no qualifications, that is the real story.

I don’t think we will be seeing any legislation any time soon. We cannot rely on the Government to protect us from this, certainly not at the moment, so I see my job as a plastic surgeon to do what I can to inform and educate people as much as possible.

So, what should do if you are thinking of having plastic surgery?

Unfortunately, there is no easy soundbite but I would say do your research, look for reviews and ask for a personal recommendation for anyone who is a full member of BAPRAS or BAAPS, anyone who has FRCS (PLAST) after their name and anyone who is a consultant plastic surgeon in the NHS will be fully trained in plastic surgery.

I am always happy to answer questions and to help and advise. You can see me on Facebook live every Tuesday night at 7pm and you can get hold of a copy of my book here.

If all you have is a hammer everything looks like a nail

There are a lot of different surgeons who perform cosmetic surgery.

They range from plastic surgeons to general surgeons, ENT surgeons, maxillofacial surgeons and even people who are not surgeons at all such as GPs or dermatologists.
This is not a problem in itself as long as the doctor is working within their scope of practice.
It may be that an ENT surgeon will be just as competent to perform a rhinoplasty as a plastic surgeon would. The problem comes when surgeons start working outside of their scope of practice and this is something that The Royal College of Surgeons is trying to address by credentialing surgeons which means they will assess them to make sure they are only working within areas that they have been trained to be competent in.
The problem with this is that first of all it has not been launched yet and secondly, it is a voluntary process so unless you know to ask or check whether your surgeon has the appropriate credentials then

untrained doctors will continue to be able to perform procedures on unsuspecting patients who may not know or feel comfortable to ask the necessary questions.

I am always surprised when I talk to people about some of the topics in my book.

They are shocked when they hear that there are surgeons out there performing breast surgery whose formal surgical training may have been in ENT surgery or accident and emergency surgery.  While it might sound unbelievable, it is happening and there is absolutely no law against it.
Unfortunately many surgeons do not make what their area of specialist training is, if it does not fit with the more lucrative cosmetic procedures that they mainly perform. You cannot assume that just because your surgeon is working in a plastic surgery clinic and is talking to you about having breast implants that they are a plastic surgeon or have any specialist training in cosmetic breast surgery.
We are very fortunate that the complication rate of most cosmetic surgery is very low but this allows untrained surgeons to get away with performing surgery on patients.
However, the problem comes when there is a complication or if the patient has a complex problem such as a breast asymmetry or a chest wall deformity.
It is in these situations where a surgeon who has experience of not only cosmetic breast surgery but also reconstructive breast surgery will have the necessary skills and experience to be able to foresee potential problems and tackle any issues that may arise.

Cosmetic breast surgery is not easy.

All patients will have some degree of asymmetry to a greater or lesser degree.
It is about identifying this, managing the expectations and knowing when and what to do about it.
It may be putting different size implants in, sometimes to maintain the base width of the implant and different profiles of implants will need to be used in each breast and this requires skill and experience.
It may be the use of internal sutures to redefine the inframammary fold and to ensure that the placement of the implants are accurate.
It may require a combination of a breast lift or possibly surgery to address the chest wall.

This is why I feel it is important to see a specialist for your procedure and to Never Accept A Lift From Strangers.

Here at the Staiano Clinic we are all plastic surgeons who specialise in breast surgery.
We love seeing people who have done their research and welcome questions.
If you do not feel that you are in a position where you can ask questions of your surgeon in your clinic then beware.
If you want to know more, then you can get a copy of the 5 Questions To Ask Your Plastic Surgeon here.
If you have any questions, then you can tune in watch Consultant Plastic Surgeon and  our Director, Jonathan Staiano on Facebook Live every Tuesday night at 7pm for a live Q&A session.  You can join in live or post your questions in advance to laura@staianoplasticsurgery.estaging.co.uk using the hashtag #AskJJ.
If you want to know more about plastic surgery training and what it takes to become a cosmetic surgeon.  Check out Jonathan’s book ‘Never Accept A Lift From Strangers – how to choose the best plastic surgeon for your cosmetic breast surgery’.  It is available to buy through our website or on Amazon.

Second Hand Breast Implants on Ebay!

Did you hear about the lady who was selling her 2nd hand breast implants on Ebay?

She said that they didn’t quite fit her, so she got a new pair!

I think the story was a bit of a joke.

I don’t doubt that someone would actually try to sell their old implants,

I mean you can get anything on Ebay these days (how about a hand made suit of armour for a guinea pig?).

But I don’t think that anyone would have actually bought them and seriously thought about implanting them, would they?!

The press love to get hold of a story about dodgy cosmetic surgery and dubious practices, but I think that part of the problem is the lack of regulation in the industry.

The fact of the matter is that there is no law against anyone selling a used pair of implants and perhaps more worrying, there is no law against anyone buying these implants and implanting them in someone.

Of course, if that someone was a surgeon and a member of a professional association (like BAPRAS and BAAPS for plastic surgeons), the association and probably the GMC would take a dim view of this and I am sure there would be disciplinary action.

However, the problem is that that someone does not have to be a member of any professional body and doesn’t even have to be a surgeon.

In fact, that someone doesn’t have to be a doctor at all!

There is more regulation on who can operate on your goldfish than there is on who can operate on your daughter (perhaps goldfish is not a good example and your dog would be better, anyway, the point is that there is no regulation on who can operate on a human).

We are currently relying on patients being able to get enough information about their practitioner to make an informed decision and avoid being treated by non-trained individuals (aka cowboys).

The problem is that it is happening and it is happening to high profile people – Colin Hendry, the premiership footballer and Usher and Kanye West, the music stars have all had family members come to harm having plastic surgery performed by surgeons who were not fully trained and affiliated with the plastic surgery associations.

If it can happen to them, what hope have the rest of us got.

I see that Ebay has withdrawn the listing for the breast implants, but you can still buy dermal fillers from Ebay and you can invite people around to your house and inject them on your kitchen table.
Sounds frightening (and it is), but all perfectly legal.

Totally against good medical practice that all doctors are bound to work within and there is no way the CQC (Care Quality Commission) would approve the facilities in your kitchen table to be suitable to be performing non-surgical procedures.

But the fact is that, because you don’t need to be a doctor to perform these procedures and you do not legally need to work in a facility that has been approved by the Care Quality Commission, these sort of practices go on and we don’t really know the extent of it.

We only hear about it when it goes wrong.

It is good to raise awareness about the perils of this unregulated industry, but it would be nice if there were some positive stories now and again.

Plastic and cosmetic surgery can have a tremendous impact on people’s lives and is a powerful force for good.  It has been given a bad name, but there are still a huge number of appropriately qualified doctors and nurses providing high quality care in an ethical way in safe and clean medical facilities.

Please ask questions and be aware of the level of training and experience your surgeon or practitioner has (check out my book for an in depth guide about surgical training).

Caveat Emptor – Let The Buyer Beware

Oh yes, and don’t buy your breast implants from Ebay!






Reflection on 2016

It is always time for reflection at the end of the year, as well as planning for 2017

When I look back at 2016, there are several milestones that stick out for me:

Buddy Scheme

This is an initiative that we started which involves putting prospective patients in touch with current or past patients to share experiences and provide advice.

We try to make ourselves as accessible as we can so that you can always ask questions or voice concerns with me or one of the team but sometimes it is nice to hear from someone who has actually been through surgery.

We are very lucky to have a group of patients who are happy to talk about their experiences and this can really help when it comes to areas like choosing the right breast implants or things like driving or going back to work after surgery.

If you would like to talk to someone who has had surgery with us, or if you have had surgery and are happy to share your experiences with others “ please let us know and we will make it happen.

 

Facebook SPS Support & Discussion Forum

This was Tish’s idea (our clinic nurse) and it has been a great success.

It is a closed group and we only invite patients who have been to the clinic to join.

It is an extension of the Buddy Scheme and is another way for us to connect patients to help you to share experiences.

Because it is a closed group, you know that your mum or your neighbour will not be able to see your posts or comments (well, unless they happen to have been to the clinic too).

I know Facebook isn’t everybody’s cup of tea, but there is no doubt that it is very popular and the beauty is that you can private message us or one of the other members if you want to take your discussion off-line.

 

The Book

Of course 2016 has been the year that I got my book published.

‘Wow’

It is one of those things that you can think about and plan forever.

I am very proud of this accomplishment and I really hope that I can get the message out to as many people as possible.

Whenever I talk to people about the lack of regulation in the cosmetic industry, they are always shocked to hear about the fact that ‘junior’ doctors can practice without supervision in the private sector, but would have to work under a fully trained consultant surgeon if working in the NHS.

We are trying to get the book in to as many hands as possible and we have moved about 200 copies. However, because we have been promoting and selling them through my website, we have not had any reviews on Amazon so far.

If you have managed to hold of a copy and would like to leave a review on Amazon then it would really help me to get the message out to a wider audience.

If you haven’t managed to get hold of a copy yet and would like one, of course you can buy one from Amazon, but I have an offer on my website where you can get your hands on a copy for free (you only pay postage and packaging) if you type in the promotional code ‘webinar’ at the checkout.

Facebook Live

You may have seen me on Facebook Live in 2016.

Every Tuesday evening at 7pm, I do a live Q&A where you can ask questions directly, or email them beforehand to laura (laura@staianoplasticsurgery.estaging.co.uk) using the hashtag #AskJJ.

These live videos seem to get some of the best engagement of all my Facebook posts and so I will continue to do them, although I am yet to feel completely comfortable with the technology!

Effie

I am very pleased to have Effie Katerinaki working with me at the Clinic in 2016. Effie is a Consultant Plastic Surgeon at City Hospital and she specialises in breast surgery. In fact, Effie took over from me when I left my NHS post at City Hospital in 2012.

She is a great addition to the team because she is a specialist in her field and has a particular interest in surgery under local anaesthetic and sedation, which is a growing area and one in which we are able to lead the country in in terms of what is possible with this technique.

Tish leaving

I was personally very sad to say goodbye to Tish, our clinic nurse, who relocated to USA to be with her husband in 2016. We always knew that she was planning this, but it was still a shock to us all as she had been such a great part of the team and it will be very hard to fill her shoes.

Fortunately, we have lots of friends who are able to fill in for the clinics, but we are looking for a permanent replacement on a part-time basis, so if you know of any dynamic and caring nurses who have an eye for detail and are keen to work in a small team, please let us know!

Laura arriving

The staff at The Staiano Clinic is our greatest asset and just as we have lost Tish, it is great that we have gained Laura. Most of you will have met or spoken with Laura as she is usually your first point of contact with the clinic. Her role cannot be underestimated and it is one of the reasons that I opened my own clinic in the first place!
I found that the reception that I received at some of the private hospitals could be quite variable and I do not think that the hospitals put enough effort in to making sure that the ‘front of house’ is looked after.
Coming to a plastic surgery clinic can be a daunting and nerve-wracking experience, so it is important that we put you at ease and make you feel welcomed and looked after throughout the process. Laura is a wonderful combination of a calm and gentle manner with efficiency and determination so you can be sure that she will see things through if she is set a task.

Plans for 2017

We are looking forward to growing the team in 2017 and we hope to expand the range of the services that we can offer, particularly in terms of developing our repertoire with local anaesthetic and sedation.

We have already successfully performed abdominoplasty, liposuction, mastopexy and gynaecomastia correction under sedation, removing the need for a general anaesthetic and in the right patient “ it is a great service to be able to offer.

There are not many clinics in the country that can offer this option, so we are proud to be at the forefront.

Never Accept A Lift From Strangers

I have finally finished my book

It has been to the editors and we have made some last minute changes, I have now just got to finalise the cover design and get it all to the publishers.
It has taken me 18 months to write and it is about something that I have been championing for many years.

It is called ‘Never Accept A Lift From Strangers
“ How to Choose the Best Plastic Surgeon for your Cosmetic Breast Surgery’

It is about providing information so that you can make sure you are treated by a fully trained professional. Having worked in the industry for many years, I am very aware that the majority of cosmetic surgery is performed by surgeons who are not trained in plastic surgery and sometimes by surgeons who are not trained in any speciality at all. Unfortunately, since there is no law preventing untrained doctors performing surgery, the onus falls on us to make the public aware of what is involved in surgical training and how to tell what training your doctor may have.

The PIP scandal

Where a French manufacturer was using non-medical grade silicone in breast implants, was a tragedy for many patients and I was only recently talking on the radio about the European Commission’s decision to investigate the potential harmful effects of these implants. If any good can come out of this, it is that it has raised awareness among the public of the need to ask questions and not to just assume that your doctor necessarily knows best. I think the time has passed when people will blindly accept what a doctor says, particularly with the advent of the internet. However, it is surprising the number of patients who were shocked to hear that they had some of the cheapest and poorest quality implants available when they had paid for what they thought was a quality surgeon performing a quality procedure.
I see similarities with the MP’s expenses scandal a few years ago. When this came to light, the public were horrified at what was going on but the MP’s who were involved in it felt that there was nothing wrong in what they were doing as it was the accepted norm within the government and everybody knew what was going on. In the case of PIP implants, very few fully trained plastic surgeons ever used the implants as we knew that they were of poor quality and were significantly cheaper than the premium brands of implants that most of us used. I have to stress that none of us knew that there were illegal activities in the factory and that they were using non-medical grade silicone but we did know that they were not good quality.

Cheap Implants

My first thought when I heard patients say that they were devastated to hear that they had cheap implants, was did they not know about the type of implants they were getting? But a few years ago no one ever asked what type of implants we were using and on reflection, I wonder if we as an industry are to blame for not educating patients and informing them of the different qualities of implants available and the different standards of manufacturer and warranty.

In the hospital setting…

Plastic surgeons often think of themselves as being an elite group as our numbers are limited and we are often called in to help in complex cases and in situations where surgery may have gone wrong. However, among the general public, we have not been good at promoting ourselves and letting people know the difference in training and qualifications between a fully trained plastic surgeon and other types of doctors and surgeons. For a long time, advertising was banned and although it is no longer banned, it is still frowned upon amongst many plastic surgeons and there are calls that it should be banned again. However, given that it is not banned, I feel that we are doing ourselves a disservice in not promoting ourselves more because we are allowing others to promote themselves and so we can hardly be surprised when we discover that the majority of cosmetic surgery in the country is performed by non-plastic surgeons.

Educating

I stress in the book that there is nothing wrong in itself with other surgeons performing cosmetic surgery as they may well have appropriate training and experience in the procedure that they are performing. It is all about educating the public to look at the training and experience of their surgeon to make sure that what they are doing is appropriate.
I will continue to campaign for cosmetic surgery standards to be upheld and the book is my way of helping to get the message out there so that people can do their own research and go into any procedure with the knowledge that they will be in safe hands.

If you would like to order a copy of my book

Go to www.neveracceptaliftfromstrangers.co.uk and grab a FREE copy.
Thanks for reading and thanks for sharing.

Never Accept A Lift From Strangers

Cosmetic Surgeons Should Work Within Their Scope of Practice

I am delighted to hear that the Royal College of Surgeons is highlighting the need to ensure that only fully accredited surgeons should perform cosmetic surgery.  Unfortunately, cosmetic surgery is an area that people embark upon without considering the qualifications and experience of their surgeon.  Cosmetic surgery is the only area of surgery where this applies.
There is a link to my radio appearance on my website here
No one would consider having a hip replacement with anyone other than an orthopaedic surgeon, or a heart bypass with anyone other than a cardiothoracic surgeon.  However, plastic surgery is performed by general surgeons, GPs, dentists, dermatologists and surgeons who are not fully trained in any speciality at all!
Surgical training involves many years of working as a junior doctor before you are allowed to sit an exit exam which are designed to test whether you are capable of working without supervision.  Only when you have passed these exams are you eligible to apply for a Consultant Post and start training other surgeons.  You can tell if a plastic surgeon has passed this exam by whether they have FRCS(Plast) after their name. There are many surgeons who have not passed this exam and would not be eligible to perform surgery without supervision in the NHS, but who are operating without supervision in the private sector. There is no regulation to prevent this.
Even amongst plastic surgeons, there are subspecialities and we all have certain areas that we regularly treat “ some specialise in the head and neck, others may do burns or cleft lip and others specialise in the breast.  However, many plastic surgeons tend to operate on all areas of the body in the private sector.
This is something that I feel particularly strongly about and I am writing a book about it entitled:

Never Accept a Lift from Strangers “ 

How to Choose the Best Plastic Surgeon for your Cosmetic Breast Surgery

I also have an Ebook that you can download with the 5 Questions that you should ask your surgeon to ensure that he or she is a fully trained plastic surgeon.  You can download it here
For the last 7 years or so, I have specialised in breast surgery and body contouring.   I do not do facelifts, nose jobs, botox or fillers.  I do not work outside my scope of training and this gives me a depth of experience that could not be achieved if were to offer a wide range of treatments. I believe that facial cosmetic procedures should be left to people who have an interest and expertise in that area “ it is not something to dabble in.
This is exactly what the Royal College Surgeons are calling for “ that surgeons should only operate within the field they have been trained in.  Listen to it here
Staiano Plastic Surgery is my clinic and I own and run it.  My special interest is the breast and body, but I have other specialists that work with me with their own scope of practice including facial plastic surgeons, skin specialists and non-surgical experts. Until we have regulation to prevent untrained doctors from performing surgery, it is up to us to continue to educate the public about what to look out for so that you can know the qualifications and experience of your surgeon.