Cosmetic surgery that leaves a scar: If a nose-job goes wrong, what can you do about it asks Esther Oxford

SUE MACY had her back to her boyfriend when he came in the door. She was cocking her face at the mirror, examining her rhinoplasty. When she turned round he stared. Then he sat. Then he laid his forehead on the table and sobbed.

Since that moment Ms Macy, 39, has spent pounds 15,000 trying to re-build her nose. It had been scooped out. She has had five 'corrective' nose-jobs since that first operation. Four were disastrous.

Ms Macy now knows that she is not the only one to have been disfigured by the same surgeon. She has spoken to five others in the same area. One woman has not been out in daylight for six years. None has sued. Why not? 'I was too humiliated. I just wanted my nose put right,' Ms Macy said.

Every year 40,000 people in Britain decide to have some sort of cosmetic surgery. In this 'stinking, deceitful industry', the results are a lottery, said John Terry, 49, who has worked in the cosmetic surgery industry for 16 years.

Many of the 'botches' occur from lack of training. Of the 200 practising cosmetic surgeons in Britain, approximately 50 have had no formal training in plastic surgery, according to the British Association of Cosmetic Surgeons. Other 'mistakes' are due to time-tabling: some surgeons are expected to do a dozen operations within a 15-hour working day.

But ask a surgeon why so many patients request revisions and most will put it down to a 'break-down in communication'. There is nothing technically wrong with the surgery, they say. The results are just 'not as the patient hoped'.

The industry is self-regulatory. Most surgeons practising cosmetic surgery belong to one of two organisation: the British Association of Aesthetic Plastic Surgeons or its rival the British Association of Cosmetic Surgeons. The BAAPS was not returning calls last week. But the BACS says it has struck members off its register. Who are the blacklisted and what did they do? 'Confidential', was the reply.

The Medical Defence Union has a list of surgeons who have been successfully sued. Will they release it in the interests of the public? 'No. We represent the interests of our members,' said a spokesman. Although 'cosmetic surgeons' can remain members of the Royal College of Surgeons, the college is keen to dissociate itself from the profession. 'The title 'cosmetic surgeon' does not mean anything,' said a spokesman. 'We do not accept responsibility for their work.'

And the Department of Health? 'There are no guidelines on cosmetic surgery,' was the solemn reply.

John Terry set up his first cosmetic surgery clinic in 1978. He had become disillusioned with the hair transplant industry; the success rate was too low. By law surgeons are not permitted to advertise their services. Mr Terry took it upon himself to find 'the damned patients' for them. He also provided an operating theatre and after-care facilities.

In return up for arranging the set-up, clinic owners siphon off up to 80 per cent of the surgeon's operating fee. In present day terms that amounts to an average of pounds 2,000 per patient.

With between 30-40 clients a week the business was 'lucrative', Mr Terry admits. But there was a downside: the cost of the 'glossies'. 'If a clinic spends pounds 80,000 advertising, they have to do 40 nose-jobs to get their money back.' Salesmen were hired. They sold promises of Little Venus bodies. 'The women came in thinking we were God', Mr Terry complained.

As clinic manager it was Mr Terry's job to find the surgeons. But 'top drawer' surgeons willing to work in a clinic which advertises are hard to find. Instead poorly skilled surgeons with 'nowhere else to go' were taken on. For some procedures a GP was used.

'Lots of mistakes happened. We invested pounds 20,000 persuading one man to to train as a cosmetic surgeon. He nearly lost one patient. We had nipples sloughed off . . . or patients saying: 'I feel very numb here'. Yes, we'd think. The surgeon probably caught a facial nerve with the forceps.

'When we could correct the surgery we would. But most of the time we never saw our patients again.'

After seven years, Mr Terry decided he had had enough. He sold the company, moved, then set up another clinic: the National Hospital for Aesthetic Plastic Surgery in Bromsgrove, just outside Birmingham.

Today the clinic is surrounded by fields and sheep. It has a swimming pool, a sauna, and private bedrooms for 12 patients. Mr Terry is building a pounds 3m-wing to house more operating theatres and a further 40 patients. It will, says Mr Terry, be the biggest 'aesthetic' surgery hospital in the world by the time he has finished.

Mr Terry has four freelance surgeons who use his clinic. But his pride and joy is Paul Levick, a fully trained plastic surgeon. For his first four years of service Mr Levick was paid to spend much of his time correcting the work done by his predecessors. Up to 100 of Mr Terry's former clients had their surgery revised free of charge.

Mr Terry still offers the guarantee of free 'revision' surgery. But he knows that only the most assertive and trusting of patients will come back for a second operation. 'If a person comes out with one breast 30 per cent bigger than the other they don't want to show the damned world. They feel foolish and duped and they don't like the feeling. Most barricade themselves in a darkened room and stay there.'

A telephone call to the General Medical Council confirmed this. According to its most up-to-date records, 1,301 complaints were received from the public between September 1991 and August 1992. How many were from patients upset by their cosmetic surgery? 'I don't think we've had a complaint to do with poor surgical procedures,' the spokesman said.

Sue Macy (not her real name) was not treated at Mr Terry's clinic. But she was one of those who 'barricaded themselves in a room' It was a year before her surgeon agreed to do her nose again. During those 12 months her relationship collapsed ('I got short tempered, I was crying all the time, I couldn't bear to have him near me'), she became an alcoholic ('I would drink a bottle of Martini a night') and she tried to commit suicide.

When the surgeon finally agreed to operate again, it was to build up the nose he had sliced out. He put a bridge in it. It collapsed after six weeks.

Sue thought she was going mad. She found another surgeon. The implant he put in lasted 10 weeks. The fourth operation was equally unsuccessful and unpleasant: her surgery was done in a private North London clinic under 'twilight anaesthetic' by mistake; she was aware of every needle, every cut. When she came round from the anaesthetic there was no bed for her. She was sent home that night.

After the fifth operation, Sue was desperate. Her nose was so infected that the implant was bursting out of it. She called an independent network for women and men considering cosmetic surgery and was referred to Edward Latimer- Sayer, a cosmetic surgeon. He put her on antibiotics then operated six weeks later. The rhinoplasty was a success. After five years, six nose-jobs and pounds 15,000, Sue Macy had the nose she wanted.

Edward Latimer-Sayer, who works at the Belvedere clinic, Abbeywood, is one of an estimated 50 surgeons in Britain who practise cosmetic surgery with no specialist plastic surgical training. A member of the Royal College of Surgeons, he spent four years as a general surgeon before leaving the NHS to become a private cosmetic surgeon in 1978. He learnt the trade by 'seeing a few operations' and having someone stand over him for 'a few more'.

'You don't need any specific training to become a cosmetic surgeon. You just need aesthetic sense, enough technique to do what needs doing, and the communication skills to find out what the patient wants', he said. He has been sued successfully four times, although he denied negligence.

At present Mr Latimer-Sayer is secretary to the British Association of Cosmetic Surgeons. He believes the 20 members - all of whom are qualified surgeons in 'various' specialities - are better equipped to do cosmetic surgery than formally trained plastic surgeons.

'I do four face-lifts a week', he said. 'Plastic surgeons are lucky if they do 12 a year.'

His big worry is a pool of about 30 cosmetic surgeons who have no training in plastic surgery and whose work is so poor that they have not been permitted to join the BACS.

'We don't like the results of their efforts. They don't do proper counselling with their patients and they won't train,' Mr Latimer-Sayers said shortly. 'They work in sleazy clinics.'

Asked what a 'sleazy' clinic was, he replied: 'They are usually non-purpose built. Many are only licensed for day- care surgery. The hygiene is usually appalling: dirt, blood, dirty swabs everywhere. Surgeons who work in such places would not get admitting rights anywhere else.'

(Photograph omitted)