Defining cosmetic surgery

An agreed definition for cosmetic surgery would be helpful for the purposes of discourse on ethics, patient safety, healthcare policy and health economics.  One of the problems with previous attempts at developing a definition is the narrow frame of reference and lack of engagement with the full spectrum of academics and stakeholders.  This review brings together the sociological as well as the surgical literature on the topic of cosmetic surgery and examines societal, ethical and healthcare aspects.  It outlines principles of constructing a definition and presents a provisional definition for further debate, namely:  Cosmetic surgery is defined, for the purposes of a healthcare payer, as any invasive procedure where the primary intention is to achieve what the patient perceives to be a more desirable appearance and where the procedure involves changes to bodily features that have a normal appearance on presentation to the doctor. In contrast, surgery performed with the goal of achieving a normal appearance, where bodily features have an abnormal appearance on presentation due to congenital defects, developmental abnormalities, trauma, infections, tumours or disease does not fall under the definition of cosmetic surgery.  It is a given that “normal appearance” is a subjective notion.  Determining whether patients have a normal or abnormal appearance on presentation will rely on the clinical assessment of the treating doctor.