NHS cosmetic surgery
Exception criteria to exclusion list

Northumberland Health Authority guidelines for referral

1. BREAST SURGERY
   1. Augmentation Mammaplasty (Breast enlargement procedure)
      Patients should be considered for surgery in the following circumstances:
      1. Asymmetry eg of congenital cause or following surgery
      2. Disabling psychological distress attributable directly to breast volume
   2. Female Reduction Mammaplasty (Breast reduction)
      Patients should be considered for surgery in the following circumstances:
      1. Physical symptoms attributable to breast size, eg back/neck pain, shoulder pain, intertrigo - providing the patient is not overweight
      2. Asymmetry - usually congenital - may follow surgery
      3. Disabling psychological distress attributable directly to breast size
   3. Male Reduction Mammaplasty (Gynaecomastia)
      Patients should be considered for surgery in the following circumstances:
      1. Asymmetry - occasionally enlargement is unilateral
      2. Disabling psychological distress
   4. Mastopexy (Uplift procedure for ptotic female breast)
      Patients should be considered for surgery in the following circumstances:
      1. Asymmetry - eg following breast reconstruction
      2. Extreme disabling psychological distress
2. SURGERY OF HEAD AND FACE
   1. Face Lift
      
   2. Occasionally a face lift procedure (unilateral) can be helpful to patients with facial nerve palsy following CVA, Bell's Palsy or following acoustic neuroma
   3. Brow Lift
      No exceptional circumstances
   4. Upper Lid Blepharoplasty (Removal of excess skin of upper eyelid)
      Patients should be considered for surgery in the following circumstances;
      Vision is obscured
   5. Lower Lid Blepharoplasty (Removal of excess skin of lower eyelid)
      Only exceptional circumstances would be severe psychological distress
   6. Pinnaplasty (Correction of prominent ears)
      In adults, ie above the age of 16 years, only exceptional circumstances would be severe psychological distress
   7. Repair of split earlobes
      Only exceptional circumstances would be severe psychological distress
   8. Rhinoplasty
      Patients should be considered for surgery in the following circumstances;
      1. Disruption of normal nasal pattern following trauma
      2. Interference with nasal airway because of disturbed anatomy
      3. Asymmetry of nose eg congenital abnormality - bifid nose, cleft lip
      4. Disabling psychological distress attributable directly to appearance of nose
   9. b
      Should not be available
3. MISCELLANEOUS
   1. Abdominoplasty Apronectomy
      Patients should be considered for surgery in the following circumstances:
      1. Physical symptoms attributable directly to the abdominal apron, eg infection, lower back pain
      2. Disabling psychological distress
   2. Buttock lift
      Not available at all
   3. Buttock reduction
      Not available at all
   4. Surgery for obesity
      Not available at all
   5. Arm and thigh reductions
      Availability - following gross weight loss - will need discussion on basic principles
   6. Liposuction
      Not available for purely cosmetic reasons but may be needed to reduce bulk of flaps etc
   7. Tattoos
      Tattoos should be referred to a Laser Clinic as this is the most appropriate method of removal

Disabling psychological distress is obviously a subjective measure. Significant treatment requirements (drugs or otherwise) probably represent the most objective indicator.

Bradley Cheek 1999