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New VAT rules target cosmetic plastic surgery

Cosmetic procedures carried out mainly for aesthetic or rejuvenation purposes should be liable for VAT at the standard rate.
This is one of the recommendations of a document drawn up in October 2011 by HM Revenue and Customs officials and sent to plastic surgeons throughout the UK.
Dubbed the “Bo-Tax” or the “Boob Tax” the new guidelines – which are currently under consideration – have been criticised for mainly targeting women at a vulnerable time in their lives. Former cosmetic plastic surgery patients including some celebrities have spoken out about the psychological implications of their procedures – such as breast enhancements, facelifts, gastric bypasses and tummy tucks.
Twenty-eight year old model Imogen Thomas who has had her breasts enlarged told the Daily Mail that women suffer mentally if they don’t like their bodies. “That’s a very real condition. I don’t like the idea of the government paying off debt with money from cosmetic surgery. It penalises people who want to better themselves”, she said.
Journalist and author Virgina Ironside disagrees claiming that elective cosmetic surgery is a luxury and as such should carry VAT (Daily Mail 20th October 2011). However she does not include necessary operations such as correction of ugly protruding ears or young women whose FF cup breasts cause them back ache and anguish in this category.
“No, I’m talking about those very young girls who have cosmetic surgery before their bodies have even had a chance to become fully formed; before they’ve given themselves a chance to accept the figures they were born with.
“Girls too young to understand that cosmetic surgery isn’t necessarily the answer to the problems and insecurities that come with adolescence”, she writes in her article in the Daily Mail October 20th.
The 66-year-old writer explains that she had a facelift fifteen years ago – at an age when she was mature enough to make such a decision based not on peer pressure but because it was something that she wanted for herself.
Oculoplastic and consultant ophthalmic surgeon Jane Olver agrees.
“Yes, cosmetic surgery is ‘non medical’ or ‘non functional’ like a luxury good and it is therefore not unreasonable that VAT should be applied”, said the founder and director of Harley Street’s Clinica London where the tax is already included in all such procedures including rejuvenation non surgical treatments such as Botox and fillers. Clinica London registered for VAT and introduced a VAT charge on all cosmetic procedures several months ago, but instead of passing on a price increase to their patients, they kept the original prices unchanged, but including VAT. “This seems a fairer way of introducing this tax for patients. We have loyal cohort of patients who regularly receive Botox and Filler injections or have had a blepharoplasty and want more cosmetic surgery – we did not want them to suddenly pay 20% more for the same treatment.” The 20% VAT will be phased in January 2012.
The majority of Clinica London patients are in their mid-thirties or older. “We get very few enquiries (for cosmetic procedures) from people under the age of 25. I try very hard NOT to operate on anyone younger than twenty five – and seriously consider asking them to see a psychologist before doing so”, said Jane.
Under the new guidelines patients will avoid paying VAT only if a doctor or psychologist has diagnosed them with a medical condition or disfigurement that requires cosmetic surgery. However procedures that are carried out as a matter of free choice, rather than medical necessity, would carry an additional 20% charge for the taxman.
“Surgeons and patients must be honest about the indication for surgery”, said Jane. “For instance blepharoplasty (eyelid surgery) is regarded as cosmetic if the patient finds it a cosmetic problem and it is being done on the upper eyelids for aesthetic reasons – that is without significant visual field defect. Any lower eyelid blepharoplasty is cosmetic be definition as this cannot interfere with vision, but is medical if it is causing the patient undue distress.”
However, not all oculoplastic conditions are as clearly defined.
A chalazion , or meibomian cyst, appears as an inflamed lump on the eyelid and is caused by a blocked oil duct opening on to the eyelid margin. Although benign they can be extremely uncomfortable and unsightly.
“As it is present for some months on the upper eyelid it is likely to interfere with vision causing astigmatism and redness due to the feeling of heaviness and weight. In my opinion this is a ‘healthcare treatment’.
“However, surgical incision and curettage of a chalazion on the lower eyelid could be regarded as a cosmetic operation. I have not yet ever charged VAT in this cases ”, explained Jane.
Other medical procedures – such as reconstruction after an accident or following cancer removal or on a patient whose quality of life is suffering due to constantly watering eyes – should remain VAT exempt.
London, 28th October 2011

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