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the removal and replacement of PIP implants in the instance of a private fi rm going bust or refusing to replace the implants. In February this year Keogh and Professor Sir Kent Woods,


Chief Executive of the Medicines and Healthcare Products Regulatory Agency (MHRA) were among a panel of experts who gave evidence to the Health Select Committee on cosmetic surgery regulation. The discussion pointed to a fear over the lack of accountability


in surgical staff carrying out cosmetic surgery in privately-set clinics with a strong business focus which has led to there being no clear responsibility of aftercare. The overwhelming lack of record-keeping has also led to Keogh


calling for the establishment of a database for all medical devices fi tted by privately-owned clinics to be shared with the NHS. He hopes work will get started on the database once the expert


group fi nishes its investigations. Professor Simon Kay, a surgeon at Leeds Infi rmary Hospital


who carries out private cosmetic surgery work two days a week in a Spire Healthcare clinic in Leeds, said a practice nurse’s biggest responsibility is providing guidance, advice and a shoulder to cry on when faced with cosmetic surgery gone wrong. While Professor Kay told NiP he would be “very disappointed” if


one of his patients were to take up the time of a practice nurse, he said it is important for them to be aware of the potential problems that can arise from cosmetic surgery and educate themselves on what they can and should do for every eventuality. “Even if a practice nurse only sees one patient every six months


who is suffering from complications from a cosmetic surgery procedure, it is important they are up-to-date with the right advice and treatment options,” he said. The three most common cosmetic surgery procedures in the


UK are breast augmentation, eyelid surgery and abdominoplasty. Professor Kay outlines some of the main issues that can present in these three operations, and also provides advice for a practice nurse on what they should and can do in practice and when they should refer to cosmetic surgeons and A&E.


Complications that can arise in the


acute phase of breast augmentation surgery are: Bleeding. Wound infection. Infection of the implant. Deep vein thrombosis (DVT).


Long-term risks are: Lose feeling in nipples. Hardening of the implant. Visible imperfections – one may appear bigger/smaller than the other. Adverse scarring. Rupturing of the implant.


Again, bleeding, wound infections and DVT should be treated in practice as any other patient. Professor Kay said the draining of fl uid collecting beneath the skin is a “worrying” procedure if a nurse is not used to carrying it out and as such should be referred to a surgeon or A&E. It is important that those men and women facing complications from cosmetic surgery procedures feel as though they can turn to general practice for help and guidance, and in this shaky era of cosmetic industry regulation, it is crucial to


be clued-up to cope.


Practice nurses are advised to treat any bleeding, wound infections or suspected DVT in the same way as any other patient. But chronic complaints, such as the hardening or rupturing of the implant cannot be treated in practice and patients should be referred to their surgeon or A&E. Complications that can arise in the acute phase of eyelid


surgery are: Bleeding. Swelling. Watering of the eye. Dry eye. DVT. Retraction of the lower eyelid.


Long-term risks are: Lumpy scarring at the corner of the eye. Ectropion – where the lower eyelid turns outwards.


While the watering of the eye and dry eye should resolve itself, lubricating eye drops may be needed over a course of two weeks to clear up the condition. Professor Kay advises nurses in general practice to refer any


bleeding of the eye or abnormal scarring of the eye to the cosmetic surgeon or A&E. Ectropion and lower eyelid retraction are rare complications and


should resolve themselves. Complications that can arise in the acute phase of abdomino-


plasty are: Bleeding. Wound infection. Gaping of the wound. Blistering of the wound. DVT.


Long term risks are:


Fluid collecting beneath the skin. ‘Lumpy’ scarring.


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Nursing in Practice March/April 2012 19


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