Intended for healthcare professionals

Clinical Review Fortnightly review

Cosmetic surgery

BMJ 1999; 318 doi: (Published 20 February 1999) Cite this as: BMJ 1999;318:512
  1. Jeff L Hoeyberghs, director (
  1. Wellness Kliniek, Grotestraat 42, PO Box 103, 3600 Genk, Belgium
  1. Correspondence to: Dr Hoeyberghs

    Cosmetic surgery is a rapidly growing medical specialty both in the numbers of patients treated and in the techniques and approaches available. This review consolidates the information available on cosmetic surgery from popular literature, the media, and advisory services.

    Doctors differ in their attitude to surgery for cosmetic reasons only. Patients requesting such surgery are usually normal individuals, but with a heightened consciousness about their looks. A proportion of them may seek advice on what, to them, seems an unsatisfactory appearance. They deserve the same professional approach and empathy as patients seeking help for clinical disorders. I would like to encourage the non-specialist to approach cosmetic surgery objectively. By understanding what may be achieved cosmetically, patients can receive invaluable advice, and appropriate referrals can be organised.

    Summary points

    Cosmetic surgery remains highly dependent on the skill of the operator,and technological advance should be viewed with this in mind

    Large volume infiltration can reduce the cost to benefit ratio for selected indications

    Lasers have a relatively limited niche in medical aesthetics

    No single method of breast augmentation has all advantages

    Three surgical procedures can correct facial ageing: resurfacing, subdermal augmentation, and face lift surgery

    Multidisciplinary team work is a practical way to provide a comprehensive service for the patient requiring cosmetic surgery


    This article is based largely on my experience in a multidisciplinary medical team dedicated to aesthetics and health. Recent concepts that have changed the management of patients undergoing cosmetic surgery are incorporated. I have supplemented reviews with articles from high quality journals, and general references are from textbooks.

    Extent of cosmetic surgery

    Requests for cosmetic surgery can be divided into three categories: correction of abnormal features (eg prominent ears, a large nose, gigantomastia, breast hypoplasia, hirsutism); reversal of the signs of ageing (eg facial wrinkles and creases, thinning hair and baldness, irreversible skin stretching, drooping …

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