‘For many people, plastic surgery is not about vanity at all’

Plastic surgery is sometimes misunderstood by those not involved in it, says Dr Nora Nugent. For the Tipperary native, a consultant plastic surgeon with the National Health Service in Britain who also practises privately, the variety and the visual aspect of the work are the draw.

“It gets bad press and people can be judgmental about it, but actually we see patients for a huge number of reasons. People can dismiss it as vanity surgery, but we have a huge range of people coming to us and, for many of them, it’s not vanity at all.”

Having been "more science-oriented at school", Nugent did her medicine degree at UCD. Time spent in St James's hospital and Crumlin children's hospital developed her interest in plastic surgery. There followed a fellowship in Sydney and Melbourne, after which she accepted a consultant post in the UK at the Queen Victoria Hospital in East Grinstead, West Sussex. The hospital specialises in reconstructive surgery, helping people who have been damaged or disfigured through accidents or disease.

"In the NHS, the three areas I most commonly do are burn care, breast reconstruction after breast cancer and some skin cancer work," says Nugent. Alongside that, her private practice specialises in aesthetic surgery of the face, breast and body, as well as non-surgical procedures such as Botox and fillers.

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“There are some things that are very clearly on the reconstructive side and some very clearly on the cosmetic side, but there is an area in the middle where the line is blurred,” says Nugent. For someone who has broken their nose in the past and has breathing difficulties, rhinoplasty might be the solution.

“For women with very large breasts or very uneven congenital breast problems where the breast didn’t develop properly, it’s not purely cosmetic in terms of treatment.”

For other procedures where there isn’t a strict medical need, Nugent takes time to understand what the patient wants and why they want it.

“Some things are realistic to achieve and some are not. Some motivations are good reasons for surgery and some are not, so it’s about understanding that,” she says.

Physical and medical suitability is another factor. “It’s real surgery, and sometimes it’s quite long surgery. It comes with a recovery time and it comes with risks and complications that can happen with anyone undertaking surgery.” On hearing this, some prospective patients don’t proceed, while others she may turn away.

“Sometimes I decline people and sometimes people need psychological counselling as well as surgery. Surgery isn’t the answer to everything.”

Social media apps that enable people to edit their body shape in photos mean some people are chasing an impossible outcome.

“It’s becoming a problem,” says Nugent, who participated in a Channel 4 documentary on the subject. “People are seeing images that are not real images and are not realistic to achieve.” Apart from that, what is achievable for one person may not be achievable for everybody.

“It’s partly about what someone’s baseline anatomy is like, what’s done in surgery and how someone heals afterwards. Add in a filter or Photoshopped image and the boundary of what’s achievable is pushed even further away from what’s realistic.”

She says the terms “cosmetic doctor” or “cosmetic surgeon” aren’t widely regulated and not everyone describing themselves as such is actually a plastic surgeon. Some countries have stricter advertising standards than others. The ethical way to market cosmetic procedures is not to make unrealistic claims about the results, or gloss over the risks and recovery time, says Nugent.

Patient groups

Her patients are most commonly in three groups. “There are a lot of women in their 30s and 40s who have had breast and tummy changes after pregnancy who want to get back to where they were pre-pregnancy.

“There is a younger group of patients for rhinoplasty or breast surgery: they often come to us in their 20s. The final group are concerned about facial aging and they tend to be late 40s into their 60s and 70s,” says Nugent.

Practising during a pandemic has been challenging. NHS work with skin cancer and acute burns patients continued but other surgeries did not. "Breast cancer patients in the first wave who may have been offered an immediate reconstruction at the same time as their mastectomy didn't get offered that."

Those patients along with others are waiting. “We’ll be playing catch-up for quite a time to come,” says Nugent.

Working in the NHS, things are sometimes “more structured with more formalised processes” than with the Health Service Executive, says Nugent. “Sometimes it’s quite bureaucratic, but sometimes it is easier to get a change in [the NHS] because you know how to go about it.” She says Irish doctors are well regarded and their training stands up well abroad.

The effect of Brexit on her private practice is yet to be felt. "We do get overseas patients, but it's hard to tell if that's been affected more by the pandemic or Brexit yet. When Covid dies down, maybe I will feel the Brexit impact more. Also we would use products such as Botox or fillers that are imported – Botox is made in Westport. So we'll see."

She advises medical students to be open-minded about where they work when training and seeing how things are done in different hospitals and countries. “That has helped me enormously.”

She enjoys living in the southeast of England with easy access to London and Gatwick for trips home, though Covid has meant staying away for more than a year. “It would be nice to get to go this summer,” she says.