So You've Decided You Want Cosmetic Work? What To Do Next: Part One (Research Phase)
First in a three-part guide to what to do and expect next
Ok, so you’ve read and re-read The Rules and you’re absolutely sure that you’re ready for some responsible and conscious cosmetic work?
Congrats! Now the fun starts. This is the first in a 3-part guide to what to do and what to expect during the 1)research, 2)prep and 3)recovery phases of cosmetic work.
This is Part One - the guide to the Research Phase
First of all, go back and re-read Rule 3
I mean it. Go on. See you back here in a moment.
Actually, fuck it. Read them all again.
Especially Rule Four. Shit is about to get REAL (real expensive).
Make sure you absolutely, definitely know what you’re after
You shouldn’t be walking into this with the goal of a practitioner telling you what you ‘need’. Truth be told, none of us ‘needs’ elective cosmetic work, but many of us want it because we believe it will improve our wellbeing. No-one else can tell you what will improve your wellbeing.
Absolutely do not go in brandishing photos of someone else and saying “make me look like this.” That’s not how healthy cosmetic work outcomes are achieved.
Don’t decide to get work done because you’ve had a bad week and you want cheering up.
You should be able to easily articulate to someone specifically what it is that you want. This is NOT “Make me look younger” or “I want to stop worrying about how I look” or “make me more beautiful/lovable/desirable”.
None of those lead to positive, sustainable outcomes. The language of cosmetic work should not be emotional, even if the effects are.
It should look something like this:
“I don’t want crows feet any more”
“Remove these thread veins”
“I want a better proportioned forehead-to-face ratio”
“Remove the bump from my nose and make the tip less bulbous”
“Smooth out my jowls to give me a more sharply defined jaw”
“Can my eye bags be removed or filled so that they’re less noticeable?”
“I’d like this redundant skin removed”
“My clothes don’t fit and I believe surgery is the only solution in my circumstances”
Your practitioner will have opinions and recommendations, but you should research and meet with them based on defined, objective outcomes.
Talk to your regular confidants about your decision1
You don’t need to announce it on your socials or anything, but don’t keep your intentions completely to yourself. You likely have a small group of friends, family or lovers to whom you’d usually tell the minutiae of your life.
You’re not asking them for their permission, nor their opinion, but treat your decision to get cosmetic work the same as any other thing that you have going on. Cosmetic work should not be a dirty secret2.
Talk to anyone you know who has had cosmetic work that you admire
This is your absolute best starting point for research. Even if they’ve not had the procedure you’re considering, they’ll likely have some useful advice for cosmetic work in general and they may know someone who knows someone, etc.
If you’re not sure whether they’ve had work, just ask. Neither of you will fall down and die because you asked the question. I promise3.
Start Googling
And look, I know this is hard.
I set up this entire site specifically because of how needlessly difficult it is to find someone who does good work.
In the absence of a personal recommendation, Google will be the main tool at your disposal. I’ve spoken here about Insta and Tik Tok and I’m not wildly keen about that being your resource, but YOU ARE AN ADULT and so I CANNOT STOP YOU.
If you decide to source your practitioner via social media, make sure you consult multiple sources before proceeding with a consultation: Google reviews, Facebook pages, the comments under their posts, Yelp, if that’s a thing where you are.
During this phase, you are very vulnerable to discovering enticing new treatments that you’d never heard of before4. Don’t get distracted. Focus on the body part you’ve already decided on. One thing at a time.
If the treatment is adjacent to the one that you were considering (e.g. you start off researching a facelift and then wonder if a thread lift would actually work better, or you’re not sure whether you want Botox or Daxxify), your practitioner will be able to give you their opinion of what’s most suitable for you when you’re in front of them.
If you’re really starting from absolutely nothing, then:
I’ve linked to The Tatler Guide previously.
The Times and Harpers Bazaar generally offer pretty decent coverage of cosmetic surgery and treatments,
Remember that all recommendations in newspapers and magazines have likely been paid for or incentivised. Tread carefully and don’t just blindly trust them.
Be wary of websites that look somewhat neutral, but that have handy buttons where you can “book a procedure”, or “speak to an expert”. These sites are a conduit for clinics and surgeons to advertise to you. That doesn’t make them inherently ‘bad’, but exercise caution, please.
If you start reading peoples’ personal accounts/reviews of their cosmetic work experiences, these are a mixed blessing. Whilst first-hand accounts can be really useful, be aware that the majority will represent the most extreme experiences (most delighted/most devastated). Exercise some discretion when reading them.5
If you’re getting surgery (as opposed to non-surgical work) in the UK, you want a surgeon who is a member of BAAPS6 or BAPRAS.
Ideally, you want someone who’s additionally held a senior role within either organisation
The US equivalent is ASPS. So is the Australian equivalent.
UK surgeons should also be FRCS qualified.
Avoid the multi-site clinics that offer free consultations, payment plans and a wide-range of surgeries on different, unrelated body parts. They often advertise heavily and many have influencer endorsements. You are looking for an expert specialist, not a giant corporate engine that’s churning out scores of patients a day.
Your surgeon should be a specialist in the body part that you want surgery on, not a generalist7
For non-surgical work, the UK is unregulated for the foreseeable.
The JCCP has been set up in the interim. It’s not a replacement for a proper government-regulated, legally accountable body but it’s more or less all we have for now. They list practitioners who have registered with them, all of whom must have been practising in their modality for at least 2 years.
I will repeat my entreaty to only go to an aesthetic specialist doctor for injectables. For the avoidance of doubt, your dentist is not a doctor8.
The US is more protected as only doctors and nurses are legally permitted to administer injectable treatments.
If you’re getting non-surgical (aka ‘non-invasive’) work that isn’t injectables (e.g. a peel, microneedling, microdermabrasion, laser-resurfacing/Fraxel, Coolsculpting, EMSculpt etc etc etc until the end of time) all of the advice in this post still applies.
Don’t just lurch into the nearest salon that was doing a Groupon when you were bored. There are absolute horror stories of faces and bodies being ruined by non-surgical procedures that were touted as ‘safe’. No.
Beware cut-price work
You should be researching multiple places before making a decision about with whom you’re going to consult. If you find someone who’s remarkably cheaper than any other practitioner in your area, assume the worst.
You can still meet with them, but (again and in bold) assume the worst.
Remember Rule 4. It’s for your own good, etc.
Once you’ve got your shortlist, it’s time to book in with some practitioners for consultations.
N.B. This is still the Research Phase.
Know roughly what to expect when you start meeting with cosmetic practitioners
Non-surgical work:
If this is the first work you’re having done, I would advise you to leave a gap of at least a week between your consultation and your treatment.
It is common practice to have the consult and procedure for non-surgical work on the same day, but if you’re new to this, some breathing space before you take the plunge is wise.
Any reputable practitioner will agree to this. If they won’t, take your face and your money elsewhere.
You may have to pay a deposit - usually redeemable against a procedure - when you book. This is normal, if annoying.
You’ll have to fill out a form - they may get you to do this online beforehand - in which they ask you lots of invasive/terrifying questions. Just grit your teeth and fill it out honestly. You can wonder later why on earth you having syphilis might be relevant to you getting a spider vein removed.
That form will probably also give consent to the practitioner taking photos of you. This is reasonable, because otherwise you may come back claiming a refund for ‘no effect’ when they’ve actually taken 10 years off you. But be very careful of ticking any boxes in which you consent to your photos being shared with others/used for promotional purposes. This is quite common and a bit gross.
You are hopefully seeing a doctor9, so I’d expect you to be in a clinic or obvious treatment room of some description.
A lot of doctors freelance in injectables on the side, and hire space in laser hair removal clinics or similar. They’re ok for basic work if you really can’t find anyone else, but your goal here is to find an established expert/specialist in whatever treatment you’re getting and they don’t tend to work out of another business’ broom cupboard.
There are also treatment rooms available for rent by the hour/day on Harley Street. If your practitioner is in a part-time space, make sure you understand the reasons why.
There are rare occasions where the best injector in all of Yorkshire may come down to London once a month, so they don’t bother to keep a permanent base in their secondary location, but these guys are the exceptions.
Surgical work:
If you’re getting surgery, you should only be meeting with consultants. As is the etiquette in the UK and US, this means that they’ll usually be referred to as ‘Mr’ or ‘Mrs/Miss/Ms’ rather than ‘Doctor’10.
Meetings will tend to be either at one of the hospitals at which they operate or in their consulting rooms.
Surgeons and their consulting rooms can be a bit grand/daunting. Just breathe. You belong there because you are there. Don’t let the surroundings overwhelm you.
Their secretaries will be indomitable forces and will usually call you breathlessly from their mobile phones having ignored your calls/emails for the last 10 days. They are almost always women in their 50s and 60s.
Be nice to these women. They hold ALL OF THE POWER and can fit you into a last-minute cancellation slot if they remember you fondly.First-meeting consultations with surgeons are almost always paid for. Some are redeemable against surgery, some are not.
If you’re baulking at paying three or more consultants £500 each for the privilege of their time, go back and read Rule Four AGAIN. These are the most important conversations that you can have to limit the risks of your surgery. They are worth investing in.
Bear in mind how many enquiries the best surgeons in their fields get. A fee discourages the time-wasters and at least some of the kooks, giving your surgeon more time to devote to your outcome. And any fee is likely to be a massive discount on how much you’re ultimately willing to pay for their time (which will be anything from £2k-6k per hour in surgery).
You should, though, get half an hour of your surgeon’s undivided attention and his/her genuinely helpful advice for this fee. They are there to answer your questions and ensure you get the best possible outcome. If you don’t think you’re getting your money’s worth or (eeurgh) that you’re paying to listen to a sales pitch, tell them so. It is normal for you to direct the conversation when you meet with them.
There will probably be even more forms. Then the surgeon will likely ask you a bunch of information that’s *on* the form. Try to remember that it’s their surgical expertise that you’re there for, not their reading skills. It is fucking annoying though.
Get amongst it
OK, so now you’re THERE, in the room where it happens and it’s time to move and shake and ask questions of the man or woman who’s potentially going to stick stuff in you or slice you up. Huzzah!
N.B. This is still the Research Phase
When you get there
You may have to fill out more forms when you get there and you will often have your photo taken on arrival.
Now… chat!
For both non-surgical and surgical work, ensure that the practitioner explains:
What they’ve understood your desired outcome is
Exactly what the proposed procedure is
Their qualifications to perform this work
Exactly what they’ll be doing/how they’ll be administering the work
When you can expect to see results
What the potential side effects/complications are
What the recovery time/aftercare is (there will often be a leaflet or a web link but get them to also actually talk you through it)
Also, check that the person you’re speaking to is the person who’ll be performing the work on you. Some places have a nasty habit of wheeling out their in-house expert for the consult, and then palming you off to a junior to carry out the procedure. Do not get work done at these places.
Similarly, if you find yourself having to talk to a salesperson - likely wielding leaflets and grinning wildly - before you are admitted to see your doctor/practitioner, do not get work done at these places.
I’m going to do a separate post on specific questions to ask, but this a decent (minimum) starting point.
Also, ask questions of your own. This is your procedure, your face, your body. It would be weird if you were only asking what I’m telling you to.
You have the right and, frankly, the responsibility to ask these questions. You’re not wasting their time. You’re not being silly or annoying. You’re about to drop a good deal of money in the hope of tackling a personal vulnerability. Actual experts love talking about their work and the answers will come easily to them.
Most surgeons will ask questions11 (either in person or on the form) pertaining to your emotional/mental fitness to undergo surgery. This may feel invasive, but is absolutely appropriate and is designed to protect you both.
For both surgical and non-surgical work: don’t let yourself get talked into additional work that you didn’t intend to get and that you’re unsure of.
I’ll do a separate post on this too, but it’s an insidious practice throughout this industry and is one of the reasons why a breathing space between consultation and procedure is a very good idea.
My scorching hot take on before and after photos is here.
TLDR12: Other peoples’ before and after photos are irrelevant to your cosmetic work process and liable to cause more harm than good.
Don’t @ me.
Non-surgical work:
I’ll leave the number of people you consult with to your discretion.
This is a tough area to gauge as there are many very straightforward procedures and excellent practitioners, and I don’t want to send you off into multiple clinics needlessly.
But please don’t let cosy little words like ‘tweakment’13 lull you into a false sense of security.
Done well, these procedures are straightforward, with limited recovery time and final results that you’ll see within hours to a couple of weeks.
However, as I type this, there are currently 745,000 results for a Google search of botched facial laser, 560,000 for botched filler and 1,330,000 for botched botox. Linda Evangelista went public with her story of how Coolsculpting went horribly wrong for her.
Don’t assume that because the website is glossy and your favourite TV presenter has extolled the procedure’s virtues that there is no risk attached. Keep yourself safe and make sure you are 100% certain about your practitioner’s methods and expertise before you proceed.
It is absolutely ok to leave and to ask for your deposit back if you feel that going ahead with the procedure would be unsafe. Listen to your gut. Don’t let social awkwardness put your face, body or well-being at risk.
Surgical work :
Meet with a minimum of 3 practitioners for a first consultation.
Even if you’ve checked the astrological pairings and you’re absolutely sure that you want this done with Surgeon X, you must meet with at least Surgeons Y and Z as well.
There is a chance that you’ll realise that Y or Z are actually a better fit. Far better to realise that ASAP.
It’s useful to experience different approaches. One of your other consultants may ask or answer a question in a way that you then want to take back to your ‘chosen’ consultant.
When you’re laid out on the gurney, about to go into surgery, you want to be certain that you’ve picked the right person for the job. The last thing that you want when you’re lying there, sweating in your hairnet, is to be wondering if you should have seen Consultant Y as well/instead.
If you don’t immediately warm to your consultant, this isn’t necessarily a red flag, and this is why it’s important to meet with several before you commit to one. You want to choose a surgeon who’s going to give you the best possible outcome and who can give you a realistic expectation of what is possible. Not someone that your mother might enjoy playing tennis with.
Be aware that the foremost consultant at the time that you meet them might not be the right surgeon for you. Don’t get obsessed with having your surgery with Consultant X because you saw them on This Morning or you know that they’ve worked with supermodels14.
You may have had a recommendation from someone who, it turns out, actually has a different face or body type to you and their fantastic surgeon’s expertise isn’t a fit for your desired outcome. Move on without a backward glance. Your person is coming 😊.
As above in a previous section, but it bears repeating: You should get half an hour of your surgeon’s undivided attention and his/her genuinely helpful advice during the consultation. They are there to answer your questions and ensure you get the best possible outcome. If you don’t think you’re getting your money’s worth or (eeurgh) that you’re paying to listen to a sales pitch, tell them so.
It is normal for you to direct the conversation when you meet with them, but it should also be a dialogue to which you’re both contributing equally.
It is really, really important that you are able to communicate effectively with your surgeon. If you feel that your consultant is dismissive, talking over you or not understanding your expectations, think carefully before proceeding with this consultant.
‘Red flag’ negative responses from your consultant:
“Well, obviously I know what I’m doing, I wouldn’t be here otherwise.”
Just leave it all up to me. Don’t worry, this is my job.
”I don’t know why how many revision procedures I’ve done is relevant.”
“Yes, yes, it’ll all be fine. You’ll love it. I guarantee it.”
“I didn’t get to where I am without knowing a thing or two.”
“[Procedure X] isn’t the right option, trust me, it’s [much more expensive Procedure Y]” without a detailed and compelling explanation as to why.
‘Green flag’ ‘negative’ responses from your consultant:
“Your [insert body part’s] appearance can’t be meaningfully improved by surgery. I would not/could not recommend surgery in your case.”
“That surgery is not available/possible/legal/does not exist.”
If you don’t believe them, Google it whilst you’re in their office - they’ll wait, don’t worry - and feel free to challenge them if you find evidence to the contrary.
“You are not a suitable candidate for this surgery” when accompanied by a detailed, compelling explanation as to why. Even if it’s disappointing/devastating to hear.
“You do not have a realistic expectation of the outcome of this surgery.”
And there you have it - now you’re ready to move on to the prep phase, if you decide to proceed with the work.
A final note on doctors:
I’m aware that this post and site are extremely pro-doctor for non-surgical work. I’m also aware that there are some terrible, even unethical, doctors out there.
To be absolutely clear: don’t assume that every doctor is great, just because they’re a doctor.
However, in the UK, the relative lack of regulation means that UK consumers are at substantially greater risk of cowboy practitioners - people who’ve literally done a day-long course and come out brandishing a certificate, now suddenly ‘qualified’ to treat your face and body.
In my opinion, you can mitigate some of the inherent risk of cosmetic work in the UK by going to a doctor. You should still subject that doctor to the same rigorous scrutiny and research that you would that random salon on Treatwell that has 3 stars, but is running a special for their newly-qualified trainee15.
The US has state-level licensing laws, forbidding anyone unlicensed from carrying out cosmetic work (hairdressing, eyelash extensions, facials, laser hair removal, microblading, waxing, microneedling etc).
All injectables in the US can only be done by a licensed doctor or nurse.
So the landscape is quite different and US consumers are accustomed to seeing government-regulated/medical professionals for much of their cosmetic work. It should be more like this in the UK.
In summary: Not all doctors are equal. Being a doctor is not a guarantee of quality. Find the good ones. And don’t roll the dice on some non-doctor rando just because they’re cheaper.
If your friends and family are assholes to whom you don’t feel comfortable talking about your life decisions, first find new friends and establish your chosen family. Come back here in a year. You may find that you’re already much happier by then and don’t feel you need work any longer. Spend the money you’ve saved on a big dinner for you and your new crew. Mazel!
There will be a post next month about how to navigate any emotive or triggering conversations about cosmetic work. This topic can bring out surprising, and sometimes disappointing, reactions in people, but - as ever - I’ve got you.
I mean, obviously, at some point you will both die. Life is ephemeral. But I’m 99.9% certain that neither of you will drop dead on the spot as a direct result of you asking them this question. You knew what I meant, I’m sure, but I still felt the irrepressible need to clarify down here. I exhaust myself sometimes, honestly.
I was *this* close to getting silicon lip implants after reading about them during my nosejob research way back in 2008. Actual insanity. I’m not even going to link to them as they’re such a catastrophically stupid idea.
I wouldn’t trust any restaurant review from someone who says that they had the best sushi of their life in an all-inclusive resort in Morocco. It might be perfectly *fine* sushi and you even survive eating it, but Morocco is a fucking long way from Japan. The same principles apply here. If people seem naive/unhinged/off, take anything they say with a pinch of salt. Or wasabi, if you’ll allow me to extend this metaphor. #sorrynotsorry
BAAPS. Fnaar.
There is one much-vaunted guy in London who does faces, boobs and stomachs. All of his procedures for each body part look identical across his patients. All his noses look the same, regardless of his patient’s face and his boobs can be spotted from 50 paces away. He’s technically extremely competent, but he’s generic as fuck. I’d suggest that you don’t want this but you are free to consult with him if you do.
Unless, like my best friend’s much-missed late dad, they are. But he wouldn't have given me Botox IN A MILLION YEARS and would likely have called it “a load of fucking nonsense. YOU LOOK PERFECTLY FINE”. We shall not see his like again 🖤
Most aesthetic doctors offer a wide range of non-surgical treatments, so I’d recommend you find someone you like and go to them consistently. If you’ve found an expert facialist who also offers non-surgical treatments as part of their treatment, I’ll leave this at your discretion.
They are still doctors, obvs.
It’ll be along the lines of: “do you have obsessive thoughts about your appearance?”, “are you sometimes unable to undertake tasks because of invasive thoughts about your looks?”, “do your concerns about your appearance interfere with your social life?”
This stands for Too Long, Didn’t Read, if you don’t yet speak fluent internet
God, I loathe this word
Fun fact: the surgeon who took out Kate Moss’s wisdom teeth also removed mine. I still got dry sockets though.
DO NOT GO TO THAT FUCKING SALON