Jeffrey LaGrasso | Things should consider before having cosmetic surgery in Ireland

We are vainer than ever, but exploring cosmetic treatments can be a minefield. Our reporter gives tips on keeping your nose natural and avoiding the human-cat hybrid look

If we didn't know the boom was back from the busy bars and crowded restaurants, we could see it in the buffed, polished and frozen faces at their tables. Like therapy, 'getting a little work done' was once considered 'so American' but now Irish people are splashing out on cosmetic procedures like never before, with the most marked upswing in non-invasive procedures, like botox.

Male vanity has long since entered the mainstream. Hair transplants have become normalised, thanks to the likes of Louis Walsh and Wayne Rooney. And a full Hollywood smile is now almost de rigueur, with the cosmetic dentistry market booming here over the past few years. The problem with all of this has been that many Irish people cannot tell when they've gone too far.

As with make-up, a very 'done' look is in vogue here, except that for surgical procedures and dental work the results don't wash off; obvious plastic surgery, frozen foreheads and garish rows of veneers are the middle-aged equivalent of the tattoo regrets of the young.

The whole area of beauty is also still very much a wild west in this country, meaning that it's up to the punter to really make sure they are getting the right procedure done with the right person, and not merely falling prey to their own desperation.

You don't want to look like a human-cat hybrid or one of the Real Housewives if she melted in the sun. You do want to be a subtly improved version of the self you already are. With those noble aims in mind, we have a list of 'dos and don'ts' for those pondering the prospect of knife or needle.

Pin-point exactly what you feel you need

The first thing to remember is that you are the only one at the wheel in terms of knowing what's necessary and what's too much. Do you need a brow lift or do you just need your eyebrows waxed? Cosmetic surgeons and others who make their living from people's vanity will take your money, and they won't ask too many questions about your aesthetic choices.

No amount of money will buy good judgment - as we see from the entire industry of magazines devoted to stoking schadenfreude for celebrity surgery mishaps. We don't really see ourselves as we appear in the mirror. So make sure you can trust yourself, or someone around you, to tell you when you've done enough. Or at the very least make sure you have someone like Walsh, who always tells Sharon Osbourne "this is your best face yet."

Connected to this is having realistic expectations. Angelina Jolie's luxurious pin cushion lips look good on her because of her facial proportions, but they wouldn't look good on everyone. Face work is fine until people look at your neck or hands, and realise the carpet and curtains don't match.

An overall sense of harmony and proportion is what you're aiming for. Don't be like Eddie in Ab Fab, whose facelift instructions were "just shake it up and down and chop off the slack." Maybe you really do need liposuction. Or maybe you have crippling body dysmorphia and nobody can talk sense into you.

Beware

Beware that this area of medicine is as yet largely unregulated. Two years ago the Irish Association of Plastic Surgeons (IAPS) repeatedly made representations to both the medical authorities and politicians to tighten up the entire area of medical beauty treatments, but as yet little has been done.

This means it's still very much a caveat emptor situation. A fully-qualified surgeon would need to have completed around 15 years' training and continued to train every year in an area of medicine that is evolving rapidly. Doctors who have not completed the training cannot appear on the Medical Council's register of specialists in plastic, reconstructive and aesthetic surgery.

The patient can ensure their practitioner is competent by going to medicalcouncil.ie and searching for the doctor.

There, they can see their registration details (it is a criminal offence for someone to practice medicine who isn't registered). The Medical Defence Union, which provides indemnity cover to doctors in the UK and Ireland, says clinical negligence claims against cosmetic surgeons have risen significantly in the past two decades.

Research your doctor

Whoever is doing the surgery or administering the treatment - take a good, hard look at their face. We've all seen the ad for the botox doctor who looks like they can barely smile or frown.

As with a hairdresser, if they look terrible themselves, there's a good chance they might do the same to you. The best way to find a doctor is to source one that other doctors use themselves, or alternatively, one that trains other doctors.

Irish Clinics vs Foreign Clinics

Medicine is a very international field and this is no different. You might like to buy Irish the rest of the time, but some of the best doctors and cosmetic people in this country are non-Irish.

Beware of companies, however, that aggressively market or use pressurising sales techniques, as has been noted with some foreign-based clinics which market to Irish customers.

Subtlety is everything when it comes to teeth

Dentistry is tricky, precisely because people assume that the same thing looks good on everyone. We've all seen the middle-aged person who trots off to Hungary and goes from 'crystal meth mouth' to rows of crowns so dazzlingly white they are almost blue. As you get older your teeth naturally darken and overly white teeth 'jar' for people looking at you, in the way that Donald Trump's orange tan jars on a 70-year-old.

The clinic might tell you they're just going 'to match the white of your eyes' but many people have heard this and come home looking like Ross from Friends - teeth glowing. Subtlety is everything here. In 2012, the EU ruled that only dentists - or dental health professionals working to a dentist's prescription - are allowed to carry out whitening, but there are some cowboys offering the procedure in beauty salons.

Don't forget about the pain

Do not underestimate the physical pain involved in cosmetic surgery. A nose job, for instance, is three days of excruciating agony and feels, survivors say, as though you had been punched repeatedly between the eyes. What makes it even worse is that sympathy is thin on the ground - you brought the pain on yourself, after all.

The comedienne Kathy Griffin (who refers to her life stages in terms of nose jobs - "oh that was two noses ago") was open about the pain, scarring and bruising that her liposuction entailed. She compared the images of it to a crime scene photo and said: "I want women to know when you get liposuction trying to be Jennifer Aniston, this is what it really looks like."

Deny, Deny, Deny

Once you've actually decided to take the plunge, denial is the name of the game. Again, this is another lesson we must learn from celebrities. No matter how many bra sizes you magically jumped overnight or how much your lips now resemble those of the late Pete Burns, you must brazen it out.

At a pinch you can put most things down to 'dental work' or, if it's a nose job, 'an operation to deal with sinus issues' (a frequent celebrity alibi in the 1980s) works fine too. According to one plastic surgeon we spoke to, the key is to change something else about your appearance - perhaps your hair - so that people can't quite put their finger on what exactly is different.

Breast augmentation comes with its own set of problems

Boob jobs, or breast augmentation to give them their proper name, seem to throw up an unusual number of post-surgery problems. We've all heard of the PIPs drama in the UK - thousands of women were left in the dark over dangerous implants. But even when there isn't a medical issue, many people regret theirs from an aesthetic perspective - everyone from Victoria Beckham to Kourtney Kardashian has been open about this. When it comes to boob jobs, remember they will never feel the same again and issues with loss of sensitivity in the nipples are common.

So, just as it's said that women of a certain age need to choose between a nice ass and a line-free face - so those who want to emulate a circa 1990s Pamela Anderson in the mammary department may be faced with a choice between form and function. Osbourne said of hers: "They've put these bloody great bags in that are too f***ing round - it's like a water bed on your chest."

And Sharon knows nearly as much about plastic surgery as she does about doddery old rockers, so listen to her.

Patience is the name of the game

After cosmetic surgery, people forget that after any major procedure there is a substantial healing period. For most operations you can be 'restaurant ready' in two weeks, but it can take up to six months for something like a nose job to really 'bed down' and assume its final form.

Give the mirror a break

While it's important to have solid advice about how you really look (see point number 1), if you do opt to go ahead with a procedure, don't fall into the trap of allowing your family and friends to offer armchair diagnoses of exactly how they feel you're doing.

Equally, give the mirror a break for a few days. Staring at it hundreds of times a day won't expedite your healing. It's extremely common for people to attribute old flaws on their face to the surgery or procedure that just happened - the issue is usually that they are looking at themselves so much that existing flaws are magnified in their minds.

Not every one is suitable

Laser eye surgery is a quickly evolving area of medicine that sort of straddles the line between genuine need and pure vanity. There are tons of dodgy clinics offering cut price operations, but with this you really get what you pay for.

Professor Michael O'Keefe from the Mater hospital, Dublin, turns down a good number of patients who are not entirely suitable for the operation, but he has an outstanding record for getting terrific results from the patients he does select.

Don't be a botox zombie

In moderation the treatment can turn back the years and give a refreshed appearance, but go overboard and you might begin to resemble the Joker in Batman. Cindy Crawford's doctor has said he applies 'sprinkles' of botox, and she still looks as good as she did in the 1990s.

Beware of duck lips

Dermal fillers have seen an explosion of popularity in the past few years. They can be useful for people who have lost a lot of weight, which can leave the face appearing aged.

Most people confuse dermal fillers with the more popular treatment using a muscle relaxant. Though both involve injections, each addresses different areas of the face. The latter is generally administered at the top half of the face, while dermal fillers are for the bottom half. It is key here to get someone who is the best at what they do, as it's easy for the doctor to overfill or give you duck lips.

A facial injury doesn't necessarily mean a plastic surgeon

As regards children, a common complaint from plastic surgeons is that over anxious parents involve them too often when a child gets an injury to their face. Unless the injury is severe, you don't need to involve a plastic surgeon as the results may be little different.

There are some insurance loopholes

Plastic surgery can be as expensive as hell, but it's not usually covered by insurance. However, there are loopholes. Your drooping eyelids might also be obscuring your vision, for instance, meaning an operation would be medically necessary.

Going abroad is always an option and there can be a big difference in price. For instance, a facelift in Ireland costs in the region of €6,500 whereas in France it will set you back €3,900 and in Poland, which has a good reputation for surgery, the figure would be €2,000. It's very important if you do make the decision to go abroad that you research the clinic and make sure the doctors have a satisfactory reputation and the correct national certification.