Cosmetic Procedures

v3.0 March 2025 

Policy:

This policy applies to all non-breast cosmetic procedures, even if a specific cosmetic procedure is not explicitly named within this, or another local EBI policy.

The following policies can be found at https://www.hweclinicalguidance.nhs.uk/clinical-policies .

Cosmetic Interventions for Gender Dysphoria
Cosmetic Breast Surgery
Breast Surgery (Reconstruction Post Cancer)
Breast Reduction
Breast Prosthesis Removal

General Principles

Cosmetic (or aesthetic) procedures in adults undertaken exclusively to improve appearance will not be funded.

Conditions resulting from major trauma or burns or significant congenital deformity, which need reconstructive surgery, will usually be funded by the NHS. Correction of pathological abnormalities causing a significant functional problem will usually be funded by the NHS.

Hertfordshire and West Essex ICB would only consider funding cosmetic surgery for children aged less than 18 if there is a problem likely to impair normal emotional development. Children under the age of five rarely experience teasing and referrals may reflect concerns expressed by the parents rather than the child, which should be taken into consideration prior to referral.

Hertfordshire and West Essex ICB does not fund cosmetic surgery to treat mental health symptoms in adults. 

Some patients are only able to seek correction surgery once they are in control of their own healthcare decisions and again this should be taken into consideration prior to referral.

Cosmetic surgery should be supported where a patient has been accepted onto an NHS waiting list prior to taking up residence locally, providing the existing clinical evidence has remained the same.

Photographic evidence and copies of clinical records may be required to effectively demonstrate that the patient meets any policy criteria or to support IFR panel decision making.

The Institute of Education (2013) carried out a systematic review of research into cosmetic procedures on the request of the Department of Health and found as part of their research that patients who had cosmetic surgery were found to be significantly more likely to suffer from psychological issues such as depression and in particular Body Dysmorphic Disorder (BDD). The study indicated that cosmetic surgery often did not improve the conditions and, in some cases, made it worse. Psychological and medical treatments such as anti-depressants or CPT were shown to be more effective at reducing depression and other mental health in those with BDD. A study by Tilmann von Soest (2012), focused on females, also concluded that a series of mental health problems predict cosmetic surgery, but cosmetic surgery does not in turn seem to alleviate such mental health problems.

The NICE clinical guideline CG31: Obsessive-compulsive disorder and body dysmorphic disorder: treatment (2005, updated 2022) states that for people known to be at higher risk of BDD or people with mild disfigurements or blemishes who are seeking a cosmetic procedure, ALL healthcare professionals should routinely consider and explore the possibility of BDD.

Therefore, clinicians seeing a patient who requests cosmetic surgery should perform a BDD triage as per NICE guidance (Clinical Guideline 31: obsessive compulsive disorder and body dysmorphic disorder. Full guideline section 10.4.2.2; page 230) and those with suspected or diagnosed BDD seeking cosmetic surgery or dermatological treatment should be assessed by a mental health professional with specific expertise in the management of BDD (section 10.4.2.3).

Patients’ whose desire for surgery reflects serious psychopathological disorders (such as Body Dysmorphic Disorder (BDD), or irredeemable relationship problems would not normally be suitable for surgery but should receive appropriate alternative treatment and support.

Policy Position on Specific Cosmetic Procedures

Hair Transplantation

Hair transplantation or the use of ‘interlace’ or other hair systems has been assessed as low priority and is not funded.

Removal of abnormally placed hair and hirsutism

Hair removal for patients with gender dysphoria is outside the scope of this policy and is covered in the local EBI policy: Cosmetic Procedures for Individuals with Gender Dysphoria.

Laser hair removal or electrolysis are considered low priority treatments and are not routinely funded. 

In clinically exceptional circumstances, where individual funding has been approved, only one course of treatment will be funded.

Repair of earlobes

Primary suture in A&E at the time of the trauma is outside the scope of this policy.

Non-emergency repair of earlobes is not routinely funded.

Surgical treatment for rhinophyma with no functional impairment

Surgical treatment to correct functional impairment due to rhinophyma is outside the scope of this policy.

Surgical treatment for rhinophyma with no functional impairment, including excision and laser treatment, has been assessed as low clinical priority and is not routinely funded.


Tattoo Removal

Tattoo removal has been assessed as a low clinical priority and will not normally be funded.

Tattoo removal if the tattoo is the source of an allergic phenomenon is outside the scope of this policy.

Patients who are not eligible for treatment under this policy may be considered on an individual basis where their GP or consultant believes exceptional circumstances exist that warrant deviation from the rule of this policy. Individual cases will be reviewed as per the ICB IFR policy. Medical photography may be required to support IFR panel decision making.

References:

Brunton G et al (2013) Psychosocial predictors, assessment and outcomes of cosmetic interventions, Institute of Education London.

Soest, Tilmann M. von; Kvalem, I. Lundin. (2012) Predictors of cosmetic surgery and its effects on psychological factors and mental health: a population-based follow-up study among Norwegian females

NICE (2005) CG31: Obsessive-compulsive disorder and body dysmorphic disorder: treatment. https://www.nice.org.uk/guidance/cg31 Full guideline available at: https://www.nice.org.uk/guidance/cg31/evidence/full-guideline-pdf-194883373