Plastic surgery in the press: Is it all about nip and tuck?

We all understand the role the media plays in informing and educating the public on issues of the day, but it seems that when it comes to plastic surgery the press has a one track mind - that leads them to cosmetic surgery.

Plastic surgeons are often portrayed in the media as glamorous beings who give people a new lease of life through a ‘nip and a tuck’. However, the reconstructive side of our work goes largely unreported. As Reid and Malone highlight,¹ of 1191 articles published in British newspapers in 2006, 89% used the term ‘plastic surgery’ in the context of cosmetic surgery, with only 10% referring to reconstructive work.

So why is it that the aesthetic seems to be the only aspect of plastic surgery that the media covers, and does it matter? What can BAPRAS, as the body representing UK plastic surgeons do, to widen the horizons and educate the press and the public?

There has been a dramatic increase in the number of people having cosmetic surgery in the UK over the last few years, with one organisation reporting 10,738 procedures in 2003 to 32,453 in 2007.² It is now more affordable and there is less stigma attached to having procedures such as rhinoplasty or breast augmentation. Cosmetic surgery is no longer just the province of the rich and famous. This in itself means that cosmetic surgery is a popular topic of discussion, so it is little wonder that the media want to cover it.

The issue is not just about unequal column inches for reconstructive compared to cosmetic, but that the risks of cosmetic procedures are often downplayed or barely considered. Reid and Malone found that only 33% of articles looking at cosmetic surgery even mentioned potential problems or complications.

We know that risk is always present in surgery and cosmetic procedures are no exception. BAPRAS members agree that anyone considering plastic surgery, cosmetic or otherwise, should know the risks involved.³ So when interviewed by the media on the subject we must not avoid discussing the seriousness of undertaking cosmetic surgery but highlight it.

For BAPRAS and its members, plastic surgery is not just cosmetic, so how can we educate and inform the public as to what it is that plastic surgeons actually do? A current TV advertisement commissioned by the Training and Development Agency for Schools has a student posing the question 'Is plastic surgery right or wrong?’ This highlights that the rise of programmes such as ‘10 Years Younger’ have exacerbated the stereotype that cosmetic surgery is the total extent of a plastic surgeon’s role.

Is it possible to give the public a greater insight into the breadth and scope of plastic surgery, and is this necessary?
Park et al. looked at perception and knowledge around the work of plastic surgeons.⁴ They found that, 23.7% of the local lay population could not think of five conditions treated by plastic surgeons, while 27% felt that the majority of the work plastic surgeons did was cosmetic in nature.

It is not just the general public who have this perception. We interviewed journalists across the national press, from The Times, The Daily Mail and BBC News Online⁵ for this editorial, and found that journalists catering for a consumer audience feel that plastic surgery is synonymous with cosmetic surgery.

When asked what came to mind when thinking about plastic surgery, one journalist responded ‘The first thing I think about is breast implants and facelifts.’ Another said ‘I know plastic surgery can treat any part of the body but I think of it as more cosmetic than medical.’

When prompted, all the journalists said that they were aware of the reconstructive side, for example, one commented ‘I know there is another layer to plastic surgery, treating burns, birth deformities and breast cancer but primarily I think of it as something that is cosmetic - done entirely to improve appearance.’

These few comments are indicative of the current perception of plastic surgery in the UK and demonstrate that the cosmetic side of plastic surgery is at the forefront of media and the general public’s perception of the profession. Is it possible to shift public perception?

The name change of this journal’s host organisation from the British Association of Plastic Surgeons (BAPS) to the British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS) in July 2006, was an important first step in trying to improve understanding of what plastic surgeons do. This was one makeover that was not just cosmetic. Instead, it was about helping to change the mindset of peers, stakeholders and members of the public.

For many patients reconstructive and aesthetic surgery goes hand in hand, and we know that restoration of both form and function are usually the goal of what we do. But for most plastic surgeons in the UK, it is the challenges of reconstruction that inspires them to go to work every day.

BAPRAS recognises how important it is that we get this message across and so it is this work that Forster, the communications consultancy retained by BAPRAS, is working hard to highlight in the media. To do this successfully, it is vital first to understand that the media is not a public information service, but an entertainment industry that needs to sell its wares. The job of newspapers, magazines, radio and television programmes is to entertain as well as inform. Therefore, plastic surgeons need to provide strong stories that the media want to report. Working with Forster we look to find innovative ways of reaching the public everyday, from exemplifying pioneering techniques to lobbying government.

For example, to coincide with the name change from BAPS to BAPRAS we worked with a young filmmaker to produce a short film that was aired before the Channel 4 News, where then President Chris Khoo, showed how tissue transfer is used by plastic surgeons to reconstruct following trauma or disease.

More recently, we highlighted the work of BAPRAS member Ken Stewart and international colleagues, who perform reconstructive ear surgery for children with severe trauma or congenital deformities. We placed stories in The Sun and The Scotsman, looking at how plastic surgery techniques can be applied to improve and enhance more than the cosmetic.

The anniversary of the 7th July London bombings was chosen to highlight the breadth of the role of a plastic surgeon in treating trauma. On this basis a two-page feature based on an interview with London Plastic surgeon, David Ross was placed in The Times.

We have also worked to lobby organisations and the Department of Health on issues where the Association’s expertise and standing can add valuable input to a debate. Facial transplantation and cut price cosmetic surgery are probably the most prominent but we also placed an interview with the Daily Mail, highlighting problems with the restrictions Health Commissioners had placed on breast reduction surgery and which had been causing concern to members across the UK.

Why is it important for the media to understand the role of plastic surgery in modern medicine?
The public, in the main, are not aware of the role plastic surgery plays in the NHS and its value in repairing injuries and congenital deformities. People increasingly want to know how their taxes are being spent and by educating the public, that the primary task of plastic surgeons is not to enhance the faces of the affluent but help care for those who need their expertise, we can promote the role and value of plastic surgery and all its manifestations.

We want to attract the best and brightest of medical students into the specialty too, so as a group, plastic surgeons can continue to be at the forefront in medical advances. By raising awareness of the breadth of the plastic surgeon’s role, the speciality can attract students who want to do more than nip and tuck and are inspired by its contribution to patient care. Articles in student career publications have been used to get the message to medical students across the UK.

We need to be realistic about what ‘PR’ can achieve but unless we continue to feed the media stories about the breadth of the profession and try to redress the balance, we will continue to be on the back foot, albeit it a perfect one!

References
1. Reid AJ, Malone PSC. Plastic surgery in the press. J Plast Reconstr Aesthet Surg 2008;61:866e9.
2. British Association of Aesthetic Plastic Surgeons. Annual audit data. Available from: http://www.baaps.org.ukcontent/view/280/62/ [accessed 27.05.08].
3. Dreammill. Attitudinal survey of BAPRAS members November 2006. Available from: http://www.bapras.org.uk/cms_cat/214/Membership-Survey.htm [accessed 20.05.08].
4. Park AJ, Scerri GV, Benamore R, McDiarmid JGM, Lamberty BGH. What do plastic surgeons do? J R Coll Surg Edinb 1998;43:189e93.
5. Personal communication, May 2008.

​Hamish Laing, BAPRAS Full Member