East Midlands Cosmetic Procedures Policy Review March

East Midlands Cosmetic
Procedures Policy Review
March-April 2014
The public image
• Public perceptions of cosmetic surgery have mainly been
shaped by images of celebrities and media coverage of
private ‘plastic surgery’ to enhance body image.
• Less information is in circulation about the cosmetic
surgery available to NHS patients.
What the policy is for
• The East Midland Cosmetic Procedures Policy sets out
the region’s approach to the treatments which are only
made available when specific criteria are met based on
medical need and effectiveness.
• The criteria have been drawn up based on clinical
evidence and expert opinion. The policy also details the
cosmetic procedures that are not normally provided.
• All NHS Clinical Commissioning Groups in the East
Midlands are now working together to review the 2011
East Midlands Cosmetic Procedures Policy.
The need for review
• In general, cosmetic procedures have relatively small
health benefits compared to many other forms of
• There must be compelling clinical evidence before such
procedures can compete for limited NHS funds.
Our approach
• The review of the current cosmetic policy has been led by
colleagues in public health across the region.
• The commissioning criteria set in the revised policy have
been decided on evidence of clinical and cost
effectiveness, local and national guidelines, and clinical
expert opinion from local GPs and hospital doctors.
The starting point of the review was ‘no change unless
compelling evidence of clinical effectiveness was available’.
The policy retains a single policy for adults and children with
age limits only being applied when clinically appropriate.
The proposed changes
The changes are not extensive and mainly affect the
eligibility criteria for treatment associated with:
the nose
both male and female genitals
male and female breasts
hair transplant to correct baldness will not be routinely
available on the NHS.
The proposed policy says that a patient will only be allowed
to have an earlobe repaired if it was completely torn. This
may be due to injury, for instance. This procedure will not be
funded if there is only a partial split or tear of the lobe or if
the lobe has elongated holes due to deliberate piecing.
The key change to policy is that this procedure is only
available if it was completely torn.
Guidance from the Royal College of Gynaecology concluded
there was little physical and psychological benefit to the
patient in vaginal labia repair. Therefore we will continue to
not routinely commission this procedure. The policy
rewording clarifies that this includes hymen ‘repair’.
Surgery may be performed to correct congenital defects with
male genitals. The key change to the policy is that the
surgery will only be routinely funded following cancer, injury,
and small number of specified conditions.
Removal of breast implants
Breast implants may need to be removed if they rupture or
cause breast disease, repeated infections, severe pain or
they interfere with breast x-rays. The proposed policy says
breast implants will only be removed from patients who have
undergone cosmetic surgery, either on the NHS or privately,
if they have any of the following:
breast disease
implants causing repeated infections
implants associated with severe pain
implants that interferes with breast x-rays
rupture of silicon gel-filled implants.
Removal of breast implants
The key change is that for women who comply with the
criteria, and whose original surgery was funded by the NHS,
we will also fund the insertion of replacement implants. Reinsertion was not previously commissioned. This is in line
with Department of Health guidance following issues with
Poly Implant Prothèse (PIP) implants in 2011/12.
Removal of breast implants
• We will not fund the insertion of replacement implants
where the original surgery was funded privately
• We will also not fund or part-fund corrective treatment in
the private sector, irrespective of whether part of that
procedure involves removal of a breast implant.
• Co-funding to have the breast implants replaced is not
permitted in the NHS.
• The East Midlands Cosmetic Procedures Policy does not
cover the surgery available to cancer patients, whose
treatment is based on other clinical considerations.
Enlarged male breasts
• the patient must have reached sexual maturity
• in men under 25 a period of at least two years has been
allowed for natural recovery
• screening done for glandular and drug related causes
• non-surgical treatments have been tried but failed
• BMI is 18 to 25 and has been for a year
• the patient is a confirmed non-smoker
• no history of steroid use for body enhancement
• photographic evidence of the condition is available.
The key change is that men with a history of use of steroids
for body building will not be eligible for surgery.
Structure of the nose
Correct airway obstruction causing serious breathing
problems, due to injury or an inherited condition, such as
cleft palate, or prevents access to perform other surgery, if:
symptoms remain despite treatment for 3 months or more
photographs show the deformity form all sides
history of accidental, surgical, or congenital defect
documentation about duration and degree of symptoms
the recorded results of the basic treatment of symptoms.
The key difference in new policy is that doctors are asked for
more to detail on patients, in order to show the valid need for
treatment and to clarify what is required.
How to have your say
You may complete the questionnaire on our website,
Please submit a paper based survey form to:
Vivienne Parish
Public Health Specialty Registrar
Room G58, County Hall, Glenfield
Leicestershire LE3 8TB
The survey lasts until until 9am on Thursday 17 April 2014.
Decisions will be taken during the summer of 2014, when
the latest version of the policy will be published.
Any questions?

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