• Sharon A Cook, Robert Rosser, M Ian James, Sue Kaney, and Peter Salmon.
• St. Helens and Knowsley Hospitals National Health Service Trust, Whiston Hospital, Prescot, Merseyside, United Kingdom.
• Med Decis Making. 2007 May 1; 27 (3): 311-20.

BackgroundCurrent guidelines for surgeons' decisions about whether to offer cosmetic surgery are ineffective. Therefore, surgeons have to make difficult decisions on a case-by-case basis. The authors sought to identify the patient variables that influence surgeons' decisions in practice.DesignA qualitative study first delineated, from observation of consultations and interviews with surgeons and other staff, variables that might influence their decisions. Then, in a cross-sectional survey of patients seeking cosmetic surgery, the authors measured these variables and tested whether they predicted the surgeons' decisions to offer surgery.ParticipantsParticipants were 6 consultant plastic surgeons who assess cosmetic surgery referrals and 276 new patients aged 16 years or older referred to these surgeons.ResultsThe qualitative study suggested that, as well as clinical factors (the probability of a satisfactory surgical outcome and the risks v. benefits of surgery), surgery was more likely to be offered where it was of low cost (i.e., minor skin surgery), physical symptoms or dysfunction were present, and abnormality of appearance was extreme. The role of patients' quality of life was unclear. The quantitative study confirmed that the probability of surgery was increased where requests were for minor skin procedures and by abnormality of patients' appearance. In patients seeking major body procedures, surgery was less likely when patients reported poor quality of life.ConclusionSurgeons' decisions about whether to offer elective cosmetic surgery follow systematic rules. By incorporating the factors that surgeons use in their decision making, more effective guidelines about elective cosmetic surgery provision than are presently available could be developed.

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