Cosmetic surgery is an essential component of plastic surgery training and is required in order to CCT. However, the training opportunities in UK are limited. The current operative requirements for plastic surgery trainees are 100 procedures during specialist training, either as primary or assisting surgeon, but there are no stipulations about the breadth of operations. The RCS has introduced a system of voluntary cosmetic certification for consultants establishing the minimum recommended level of experience to operate independently in nine subspecialty areas of cosmetic surgery (cosmetic breast, cosmetic nasal, cosmetic periorbital, cosmetic ear, etc). The authors retrospectively reviewed the operative cosmetic surgical experience of UK specialist registrars from 2010-2016 from elogbook, and formulated national means for each year of training which were then summed to calculate average experience across the six-year registrar training. They found that mean average number of cosmetic procedures was 122, but that the majority of operations were cosmetic breast (33%) and body contouring (33%). The least exposure was in cosmetic nasal (5%) and facial contouring surgery (4%). Therefore, whilst requirements for CCT are set quite low, without a requirement to demonstrate a defined breadth of procedures and no distinction made for if you are the primary operating surgeon or assistant, trainees would not meet the criteria at the end of their training programme for RCS certification in the other areas such as cosmetic nasal or facial contouring. Interestingly this concern re lack of exposure to cosmetic procedures is mirrored by studies in Ireland, Germany and Canada and fellowships are cited as a way of augmenting your experience. In some UK training programmes, there is an opportunity to follow consultants’ practice in the private sector and assist them there. In America there is greater exposure through the practice of having a ‘chief resident cosmetic clinic’ where patient’s fees are reduced and the chief resident gets the opportunity to perform the clinic consultations and operations under the supervision of the consultant. Perhaps similar schemes could be considered in the UK or rotations in the private sector to augment cosmetic training.
