NOW THEY'RE SLAPPING A TAX ON FACELIFTS; Taxman Plans [Pounds Sterling]500m VAT Raid on Britain's Booming Cosmetic Surgery Industry; 'Ethical Minefield' as VAT Rules Risk Plastic Surgery Patients' Confidentiality; If the Treatment Is to Make You Feel Better, the Taxman Will Want 20%

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Byline: Jo Macfarlane MEDICAL CORRESPONDENT

CHANCELLOR George Osborne plans to raise up to [pounds sterling]500 million a year by slapping VAT on cosmetic surgery.

The move - already being dubbed a 'boob tax' by the cosmetics industry - would send the cost of operations such as breast enlargements, facelifts, tummy tucks and liposuction soaring by 20 per cent. Until now, VAT has been charged only on minor treatments including Botox injections and chemical peels carried out in High Street beauty salons. But new guidelines drawn up by HM Revenue & Customs officials and sent to plastic surgeons will mean that doctors performing more invasive procedures will have to register for VAT and pass the charge on to their patients.

The move would add about [pounds sterling]1,000 to a breast operation. Patients having such cosmetic procedures will pay the tax unless they can persuade a doctor the operation is being carried out for 'therapeutic' reasons.

The move could help plug the deficit in Britain's public finances, but Fazel Fatah, president of the British Association of Aesthetic Plastic Surgeons (BAAPS), said: 'The subjective proposals being put forward by HMRC will potentially harm large numbers of patients.

'They imply that, by definition, any procedure that corrects appearance rather than function is not a medical need. There has been no meaningful discussion with the professional bodies involved.

'We can only hope that common ground can be found that protects the wellbeing of patients while balancing the obvious need to increase tax revenues. With surgery, we are dealing with human lives.'

Treasury Minister David Gauke has written to concerned MPs defending the proposed policy, while tax officials deny targeting plastic surgeons because of the growing success of the industry, now thought to be worth [pounds sterling]2.3 billion a year.

The HMRC document, currently under consultation, says patients will avoid paying VAT only if a doctor or psychologist has diagnosed them with a medical condition or disfigurement that requires cosmetic surgery. It says no tax will apply if the procedure has 'the aim of protecting, maintaining or restoring the health of an individual'.

But it adds: 'Consequently, cosmetic services which are performed mainly for beautification or rejuvenation purposes, or done out of the individual's free choice rather than out of medical necessity, are liable to VAT at the standard rate.

'Such services may include: face lifts, tummy tucks, female breast enlargement, liposuction, hair and tattoo removal using lasers and intense pulse light source machines.'

The document is particularly unsympathetic to those who claim they benefit psychologically from surgery, saying: 'Cosmetic services are usually performed so that the individual concerned may feel better about their appearance.

'The mere fact that a cosmetic treatment may make a person feel more confident about their appearance is not in itself sufficient to make the treatment exempt.'

However, those with diagnosed psychological conditions, for example body dysmorphic disorder, may not have to pay VAT if their treatment is overseen by a qualified psychologist. The proposals also do not affect those who have plastic surgery for disfigurement.

BAAPS former president Douglas McGeorge said the proposals would create huge ethical problems.

He said: 'Everyone is in uproar about this. The amount of money HMRC will make out of this is astonishing. If it is backdated, the Government could easily bankrupt some surgeons. But for patients it will also create ethical problems.

'Many of these operations, like tummy tucks, have been excluded or rationed in the NHS. Such procedures must, at some point, have been deemed medical or the state wouldn't have offered them.

'The option of having all our patients rubber-stamped by a clinical psychologist is simply unrealistic. …