In a sign of growing tension about the lucrative trade, the British Association of Aesthetic Plastic Surgeons criticised two of the largest providers of cosmetic surgery for "trivialising" and "degrading" the specialty. The association criticised the Transform Medical Group, the largest provider of cosmetic surgery in Britain, for offering a "loyalty card" that encouraged patients to return for multiple procedures. It condemned the group for selling gift vouchers for surgery and for offering non-surgical procedures as raffle prizes in an exhibition.
Bupa, the health insurer which runs a network of private hospitals, was criticised for appointing sales representatives paid on commission. "They may be briefed to target young women," the association said.
Magazines including the women's title Top Sante and Zoo magazine for men came under fire for offering cosmetic surgery and "extreme makeovers" as prizes in competitions, and reality television programmes were attacked for their "increasingly sensationalist" coverage of cosmetic surgery.
At the association's conference in London yesterday, plastic surgeons produced £250 gift vouchers, loyalty cards, raffle tickets and magazines offering prizes of cosmetic procedures, collected from commercial organisations.
Adam Searle, president of the association and a consultant plastic surgeon at the Royal Marsden Hospital in London, said: "This trivialisation and commoditisation of medical procedures is appalling. It seems to have come down to the level of loyalty cards, money-off vouchers, competition prizes and even a raffle prize of a procedure of your choice.
"This belittling of the seriousness of undertaking a medical procedure degrades not only our specialty but also the medical profession as a whole.The true tragedy is that within this epidemic of rather tasteless activity, there are going to be patients who experience significant complications and lifelong damage from pursuing ill-planned and ill-thought-out operations. Sensible and educated decision-making about cosmetic surgery is in danger of being lost."
Mr Searle said casualties of the hard-sell approach were regularly seen by him and his colleagues. He described a young woman who had been talked into having a breast operation and later regretted it. "She had an unhappy result and she needed further attention to put it right. It was a combination of a bad decision [to have the surgery] and a bad operation."
Andrew Batchelor, a consultant plastic surgeon at the Bupa hospital in Leeds, said some clinics hired doctors with inadequate training who then performed inappropriate operations. "The classic case is of a fat woman who goes to a surgeon to be made thinner with liposuction. She gets inexpert treatment and ends up as a fat woman with lumps and bumps and dimples. I have seen that scenario on literally dozens of occasions in the past 10 years."
A clampdown on cosmetic surgery clinics was announced by the Government's chief medical officer, Sir Liam Donaldson, in January. An estimated 20,000 clinics and beauty salons face prosecution if they fail to comply with new rules governing advertising and procedures.
Demand for cosmetic surgery is accelerating. There were 16,367 procedures performed on women last year, compared with 10,738 in 2003, according to the British Association of Aesthetic Plastic Surgeons. The number of men paying for cosmetic surgery rose 60 per cent from 822 in 2003 to 1,348 in 2004.
A Bupa spokeswoman rejected the allegations but admitted advisers were paid on a commission system. "Bupa strongly refutes that we would ever attach sales incentives to any medical procedure," she said.
In a statement, Transform said it offered patients the best clinical standards and worked closely with the Healthcare Commission. It defended its advertising as a means of bringing the benefits of high-quality surgery to the public at prices it can afford.
Karen Buchanan, former model: 'I looked like I had fought Mike Tyson'
Karen Buchanan was working as a model in Italy when she underwent a minor operation to straighten her nose. It ended her career.
She flew to Glasgow, her home city, to have the operation in a private clinic.
She said: "My family couldn't see anything wrong with me. But my mother and grandmother were both successful models and perhaps they understood how important my looks were."
Two days after the operation, she was devastated when she discovered its results.
"When the bandages came off, I was lost for words. I had paid £2,500 and my nose had been transformed into a shapeless nub.
The tip had fallen and was drooping downwards at a funny angle, while the bridge was bumpy and twisted. I looked likeI had done 10 rounds with Mike Tyson."
She flew back to Milan to try to salvage her career, but found employers were reluctant to take her on. Another plastic surgeon told her that part of the cartilage that supported her nose was missing.
"We will probably never know whether the cartilage issue was an existing one that was exacerbated by the surgery, or whether it was the result of gross incompetence," she said.
"I went from being happy and secure to being withdrawn and miserable."
She had further surgery for a cartilage graft, which repaired her nose. She now works as a beautician, but said: "I would think twice before messing around with my face again."