Choosing a facelift surgeon in the UK

01The GMC register, and what it does and does not tell you

Every doctor practising in the UK must be registered with the General Medical Council and hold a licence to practise. The register is public, searchable and free, and checking it takes about a minute. It is the first thing to do and almost nobody does it.

What you are looking for has three parts.

02Plastic surgery, facial plastic surgery and cosmetic practice

The terminology in this field is genuinely confusing and it is worth taking a minute over.

Plastic surgery is a recognised surgical specialty with a defined training pathway covering reconstruction as well as aesthetics. A surgeon on the specialist register in plastic surgery has completed that training and been assessed against it.

Facial plastic surgery is generally practised by surgeons whose specialist training is in otolaryngology, that is ear, nose and throat surgery, with subspecialty focus on the face. Facelift surgery sits squarely within that scope and many highly experienced facelift surgeons come from this route.

Oral and maxillofacial surgery is a further route, with training covering the facial skeleton and soft tissues, and some surgeons from this background practise facial aesthetic surgery.

Cosmetic surgery is a description of what a practice does rather than a specialty in which one is registered. A doctor describing themselves as a cosmetic surgeon may hold specialist registration in one of the above, or may not.

The useful conclusion is not that one route is superior. It is that the route should be identified rather than assumed. What you want to know is which specialty they trained in, whether they are on the specialist register in it, and how much of their current practice consists of the operation you are considering.

03Volume in your specific operation

Of everything on this page, this is the question most closely connected to your outcome, and it is also the one patients are most reluctant to ask.

Facelift surgery, and deep plane surgery in particular, has a long learning curve. The relevant anatomy varies between individuals, and recognising that variation reliably is a product of repetition. A surgeon performing this operation weekly has a different relationship with it than one performing it occasionally between other work.

Ask directly: how many facelifts do you perform in a year, how many of those are the specific technique you are proposing for me, and what proportion of your practice is facial surgery. These are reasonable questions, asked routinely by well informed patients, and a surgeon who is uncomfortable with them has told you something.

04Where the operation happens

Independent healthcare providers in England are registered with and inspected by the Care Quality Commission, with equivalent regulators in Scotland, Wales and Northern Ireland. Inspection reports are published and worth reading.

The questions that matter about the facility are practical.

• Is it a registered facility, and can you see the inspection report?
• Is there a full theatre, and is a resuscitation capability on site?
• If the operation is under general anaesthetic, is the anaesthetist a consultant, and will you meet them beforehand?
• Is there an overnight facility if your operation or your health makes that prudent?
• Who is medically available on site during your stay, and afterwards?

A short operation under local anaesthetic with sedation in a well run day facility is entirely appropriate. A five hour deep plane lift with a neck lift is a different proposition, and the setting should match.

05What a good consultation looks like

06Second opinions and before and after photographs

Seeing two or three surgeons is normal, sensible and not an insult to any of them. The pattern to look for is not agreement on price but agreement on the diagnosis. If three surgeons independently describe the same anatomical problem and propose broadly similar operations, that is informative. If one proposes something markedly different from the other two, the useful step is going back and asking each to comment on the alternative.

Before and after photographs are useful only under conditions that are frequently absent. The lighting, angle, distance and expression should match between the two images. The time elapsed should be stated, and it should be at least six months. The specific operation performed should be described. And the images should be the surgeon's own patients. Photographs that fail those tests are decoration rather than evidence, and a surgeon who explains what was done and why in each case is giving you far more than a gallery does.

07Aftercare is part of the surgery

The arrangements for the weeks after your operation are not administration. They are the mechanism by which a complication becomes a manageable event rather than a serious one.

• Who do you telephone at two in the morning on day one, and who actually answers?
• How quickly can you be seen if something is wrong, and where?
• How many follow up appointments are included, and over what period?
• Who sees you at those appointments, the surgeon or a nurse?
• If a complication needs a return to theatre, who pays for what?
• What is the written revision policy?
• If the surgeon is away, who covers?

These questions matter most in exactly the situations where they are least likely to be asked: lower priced offers and surgery abroad. A complication that appears on day five is a straightforward problem when the operating surgeon can see you that afternoon and a serious one when they cannot.

Take the fourteen question checklist into every consultation, and read the risks page before you go so that you can tell whether the answers you get are complete.