The cosmetic treatment industry is an ugly business

There's something grotesque in the business of selling beauty. Bruce Keogh's review into the regulation of the cosmetic treatment industry – covering implants, surgery, fillers, injections, and every other way of primping, plumping, shrinking and smoothing your face and body – reveals a world of hard sell for hard bodies. Loss-leading free consultations draw customers into clinics (and despite the fact that the industry offers invasive medical procedures, the review shows that it treats those in its care as customers, not patients), and multibuy offers put the decision to get silicon bags inserted in your chest or fat siphoned out of your thighs on a par with chucking an extra packet of chicken joints into your trolley during a Bogof offer.

And if your treatment doesn't work out quite the way it was sold? That, as they say, is tough titty: there's no clear legal responsibility for cosmetic practitioners to provide aftercare. During the PIP implant scandal, the Transform Cosmetic Surgery Group and the Hospital Group initially refused to pay for the removal of implants containing non-surgical grade silicon. Under pressure from the Department of Health and huge adverse publicity, they reversed that decision – but women were still left to pay for their own replacements.

If your supermarket chicken pieces are bad, the shop doesn't just take the bad pack back: it's also obliged by the Sale of Goods Act to replace or repair it. Yet the rules for surgical implants are apparently more lax. I can't even say the cosmetic surgery business treats women like meat, because actually it offers a lower standard of care to its patrons than your average butcher. And for decades, shamefully, this has been tolerated, with inadequate legislation allowing inadequate treatment to continue. Reading the report, the collective negligence of the industry sticks out like a bone in an eyeball (yes – one woman grew bone fragments in her eyes as a result of an experimental stem cell cosmetic procedure).

Slack regulation of advertising allows surgeries to use high-pressure tactics like time-limited offers while minimising the "cutting you open, putting something inside you" aspect of their procedures. There's no specialist register of cosmetic surgeons – and amazingly, the title "surgeon" isn't even protected, meaning that practitioners may use it while having no surgical expertise. Private providers currently aren't required to perform a clinical audit, and data collection is so sloppy and vague, we don't even have a figure for how many procedures are performed each year. Oh, and consent for your own personal slicing and dicing can be obtained with a single signature in a meeting with a sales rep.

The whole industry starts to look like a nightmarish, tentacled beast stretching secretively through clinics and salons, invading bodies and injecting its poisons, and the people who are undergoing these treatments are often those who should have a particular claim on protection. Another thing the cosmetic surgery industry doesn't have is a standardised psychological assessment for those seeking treatment: those giving evidence to Keogh felt that enough was already done to pick up potential patients with body dysmorphia or personality disorder, but isn't it somewhat remarkable that we accept the pursuit of radical, appearance-altering surgery as rational until proved otherwise?

There's a sorry lack of longitudinal research on the psychology of those who seek and have cosmetic surgery (another example of the industry's commitment to high standards of medical evidence and patient care), but some of what is known is worrying. Some studies have found an increased risk of suicide among women with breast implants – not necessarily suggesting that implants cause suicide, but perhaps that women who have implants are more likely to be pre-disposed to suicide. And while there's limited evidence that plastic surgery creates a short-term improvement in satisfaction with the relevant body part, there's no evidence that it's actually the best therapy for unhappiness about the way you look.

The cosmetic surgery industry is based on telling women (and increasingly men, though they're still in the minority of patients) that they could have better, happier lives if only they'd make themselves look a bit more perfect. As an individual decision, everyone has the right to do as they wish with their own body within reasonable protections; as the basis for an industry, with advertising designed to show up your flaws and credit agreements to help you pay for their remedy, it's repugnant. The Keogh review shows how much the cosmetic interventions industry needs to do to fix up its face, but its ugliness runs way below the surface.

This is courtesy of theguardian.