Surgeons up for grilling

By Robin Stride

Many independent practitioners will face intensified verbal grilling from both patients and the press following the launch of a campaign to get the public to probe the true value of new product claims and procedures.

Surgeons themselves called in national tabloid journalists to their annual scientific meeting in London to brief them on what they and their readers should look for to try and ensure treatment transparency.

The British Association of Aesthetic Plastic Surgeons also warned of possible financial or conflicts of interest among those involved in some clinical businesses.

Consultant plastic surgeon and new BAAPS president Mr Michael Cadier said new so-called ‘clinically-proven’ treatments promising unbelievable results were launched almost daily. ‘We believe that asking the right questions, doing a bit of research and engaging in a dose of scepticism is the healthiest approach for the public.’

Outgoing president Mr Rajiv Grover described a huge rise in media reporting of  aesthetic treatments but he urged the press and patients to ‘cut into bombastic claims – even from surgeons.’

He said consumer press journalists had their work cut out keeping pace with many issues in the sector. ‘I don’t envy the challenges of reporting credible developments from such a murky field, but that doesn’t mean the cosmetic surgery sector should be allowed to stitch people up.’

The BAAPS is calling for the media and public to use a measuring system similar to those used in surgical journals which ‘grade’ the levels of evidence behind new procedures and claims.

Preston-based consultant plastic surgeon Mr Reza Nassab – who conducted studies presented at the conference entitled ‘Evidence-Based Hype’ and ‘Cosmetic Surgery in the Press’ – called the evidence supporting many new devices ‘low level’.

He said increased education was needed to ensure people understood treatments might not be as effective as portrayed in their marketing materials.

His evaluation of high-profile non-invasive liposuction technologies showed the number of patients studied varied wildly: from just two cases to a few hundred. Only 16% involved more than 100 and more than half involved under 50. All but one were based on under six months’ follow-up.

Only one trial followed patients – just two people – for five years. The BAAPS said 36% of authors disclosed a financial or conflict of interest ‘which means the device company either made a payment, provided the equipment or the author has a financial interest in the business.’

BAAPS said media reports of complications and regulation in cosmetic surgery rose by over 17,000% and 20,000% since 1991, respectively. Three quarters of consumer press coverage involved publicity driven by a commercial provider or practitioner offering the treatment and 15% involved celebrity endorsements.

Mr Grover said in the clinical world a widespread use of ‘tiers’ allowed determination of how much research backed findings, so enabling informed decisions based on evidence that went further than skin deep.

But without a similar filter there were pitfalls for those who might be swayed by weak data, manipulated photos or paid-for celebrity endorsements. ‘There urgently needs to be a traffic light or warning system for new devices and techniques promoted to the public.’

The BAAPS is promoting use of an evidence pyramid (see below) to stimulate questions such as when was the treatment launched?, how many people were involved in trials?, for how long were they followed?, where has the data been published/presented, and was it sponsored (paid for)?

Top tier: Has been studied for more than five years, easily researchable with over 50 non-sponsored studies in medical/scientific journals. Examples include botulinum toxin and cohesive gel implants.

Second tier: Studied two to five years and has over 20 non-sponsored studies in medical/scientific journals. Examples include the CoolSculpt (fat freezing) device and surgical facial treatment ‘Silhouette Lift’

Third tier: Studied at least a year with a minimum of five non-sponsored papers in medical/scientific journals. Examples include novel fat transfer technique ‘nano-grafting’ and body contouring filler Macrolane – taken off the market after being promoted for use in the breas.t

Below Surface (or ‘BS’) level: Studied under a year and may be based on a single case study. Information on the treatment is found almost exclusively via promotional channels rather than presented to peers via scientific conferences or publications. Includes vague or unrealistic claims ‘Boob Job Serum’, ‘Electrode Facelift’, ‘[Insert celebrity name] Lift’, ‘Fat dissolving/melting/zapping/bursting’.

Mr Rajiv explained: ‘Whilst arguably many long-established, proven techniques started with an adventurous expert opinion and one humble case study, it’s only fair for people sampling a product billed as ‘boob job in a bottle’ or ‘lipo in a can’ to be aware of how much real scientific evidence has been established first.’