What is the Cosmetic Surgery Tribunal?

Cosmetic surgery is when you choose to have an operation to alter your appearance for non-medical reasons. As these types of surgical procedures are optional, they are not routinely provided by the Royal Free London or across the NHS. The Cosmetic Surgery Tribunal reviews appeals from a GP or consultant recommending that a patient should receive a specific cosmetic treatment despite these restrictions.

What will happen if I am referred to the tribunal?

The first step is for you to be referred to our plastic surgery team by your GP or other health professional. Once referred, you will meet with a plastic surgeon for an assessment. If the surgeon thinks your cosmetic procedure should go ahead, they will refer you to a psychologist to talk about your concerns and your expectations of the surgery.

You will also be asked to attend the medical photography department at the Royal Free Hospital. The area of concern on your body will be photographed so that the Cosmetic Surgery Tribunal can assess your request. Either the surgeon or the psychologist will arrange for your photographs. The tribunal cannot accept your own personal photographs, those taken by your GP, or at another hospital.

The tribunal will then decide whether an exception should be made to carry out your cosmetic procedure.

What happens during my surgical assessment?

You will have a consultation with a plastic surgeon to consider what cosmetic surgery procedures (if any) are appropriate for the part of your body that you wish to change. The surgeon will also be able to identify whether your case can be viewed as exceptional, when compared to other patients asking for the same procedure.

The surgeon will then decide whether you should be seen for a psychological assessment or discharged. If you are referred for a psychological assessment, the surgeon will write a letter detailing your case to the Cosmetic Surgery Tribunal.

What happens during my psychological assessment?

During the assessment, you will meet with a member of the psychology team to discuss:

  • The history of your concerns.
  • The impact your concerns have on other aspects of your life.
  • Your knowledge of the surgical procedure and its risks.
  • Your expectations of the surgery.

As part of the assessment, you will also be asked to complete some questionnaires. These will take about 10-20 minutes to complete and include questions about your body image concerns as well as your general psychological wellbeing.

Who is involved in the Cosmetic Surgery Tribunal?

The Cosmetic Surgery Tribunal consists of a surgeon, a clinical psychologist, and a member of staff representing hospital management. In this meeting your case is discussed, information considered from your GP, surgeon, psychologist and any other documents or information relevant to your case, including your questionnaires.

The Cosmetic Surgery Tribunal meets every four to six weeks.

How do I find out about the Cosmetic Surgery Tribunal decision?

Your GP will receive a letter letting them know the decision from the Cosmetic Surgery Tribunal. You will need to contact your GP to discuss this outcome as you will not receive a copy of this letter.

If your GP has not received this letter within two weeks of the meeting, they should contact the department directly.

What are the possible outcomes of the tribunal?

There are three possible outcomes from the Cosmetic Surgery Tribunal:


Your request for surgery has been rejected. The Cosmetic Surgery Tribunal is the last tier of the Trust’s appeal process and its decision is final.


Your request for a cosmetic procedure has been accepted and you will be placed on the waiting list for surgery.

Accepted – conditional

Your request may be accepted if specific conditions are met. These will be outlined in the letter sent to your GP. Examples of the conditions could be:

  • To stop smoking before going on the waiting list.
  • Achieve a particular weight target for certain operations (e.g., BMI of under 30).
  • Learn more about the procedure and associated risks.
  • Review and modify your expectations of surgery.
  • Improve your emotional wellbeing.

All conditions will be specific to you and the surgery you are requesting.

What can I do if my case is rejected?

If your request for surgical intervention is rejected, you cannot appeal this decision.

Research suggests that cosmetic surgery is not always the most effective solution for body image concerns, and that reducing how much you think about your appearance can also be a very effective form of treatment. The plastic surgery department offers psychological therapy, allowing you to work with a clinical psychologist to try to reduce the impact of your body image concern on your life.

You are also free to explore other ways of having the surgery you want, such as paying for the cosmetic procedure privately.