Royal Free London NHS Foundation Trust

5. Mr F complains about the lack of treatment offered to him by Royal Free London NHS Foundation Trust (the Trust) on 31 January 2024.

6. Mr F had private surgery to have his ears pinned back. He says that the surgery was performed wrong, and he has been left with ‘botched’ ears that are ‘wrapped around his head’.

7. Mr F says that the Trust have refused to offer him surgery to fix his ‘botched’ ears as they say it would be a ‘cosmetic procedure’, and they do not fund these on the NHS. Mr F agrees that it would be a cosmetic procedure, however, feels he should be offered this as the appearance of his ears are affecting his mental health.

8. Mr F says that this has affected his mental health, and he feels he is unable to live his life as he normally would because he is ridiculed by people in the street due to his ears.

9. Mr F would like the Trust to review its decision to not offer him the surgery.

10. In 2009 Mr F had private surgery to have his ears pinned back. He was unhappy with the outcome and says that the surgery has been ‘botched’. He says he explained this at the time to his previous GP however he was ‘fobbed off’.

11. In November 2023 Mr F requested a referral for revision surgery of his 2009 surgery through his GP.

12. On 31 January 2024 Mr F was informed that the referral had been rejected, Mr F told his GP that he was unhappy with this outcome, and they advised him to raise this with the Trust and ask for the decision to be reviewed.

13. On 13 February 2024 Mr F again contacted his GP to explain that he was frustrated that he was initially offered an appointment with the Trust and then had follow-up contact from it where it cancelled his appointment and told him the referral had been rejected.

14. On 4 and 6 March 2024 Mr F called the 111 service to ask it to book him a revision surgery. He also told it that he is unhappy that his referral had been rejected and that the condition of his ears is making him suicidal.

15. On 20 March 2024 Mr F’s GP contacted him and explained that they had discussed the rejection of his referral with the Trust. The GP explained that this was because revision of cosmetic surgery is not funded on the NHS.

16. On 28 March 2024 Mr F’s GP made a referral to the National body dysmorphic disorder (BDD) mental health service.

20. Before we decide if we should conduct a detailed investigation of a complaint, we look at whether there are signs the organisation has got something wrong. We do this by comparing what should have happened with what did happen. We have done this and have not found any indications that something has gone wrong.

21. In 2009 Mr F paid privately to have an otoplasty (his ears pinned back). Mr F explained that he was unhappy with the result of the surgery and explained this to his GP at the time.

22. Mr F told us that he continued to be unhappy with the condition of his ears, and so in November 2023 requested revision surgery through the NHS via his GP. Mr F told us that his ears were pinned back too far, and it is causing him distress. He said that he is unable to have a relationship, socialise, and is ridiculed by his neighbours due to the look of his ears. He also said that he cannot not tuck his hair behind his ears and is struggling to have his glasses fit properly.

23. On 31 January 2024 Mr F’s GP Practice told him that his referral for revision surgery had been rejected. In its complaint response on 18 November 2024 the Trust explained that it did initially book Mr F an appointment, however cancelled it as the ‘request was purely cosmetic and declined as cosmetic surgery is not routinely funded on the NHS’.

24. In its response the Trust also referenced that Mr F has been diagnosed with body dysmorphic disorder (BDD), a condition where an individual has an obsessive focus on perceived flaws in their appearance. The Trust said the NICE guidance on OCD and BDD explains that healthcare professionals should triage patients for assessment by a mental health professional specialising in BDD if they are seeking cosmetic surgery for a minor disfigurement.

25. Mr F told us that he was unhappy with the Trust’s decision not to offer him revision of his private surgery to get his ears pinned back as the look of his ears is significantly affecting his mental health. Mr F told us that he understood that the surgery he was requesting was cosmetic, and the condition of his ears was not having any impact on his physical health. However, he feels that the surgery should be offered to him, because of his poor mental health.

26. Our adviser explained that surgery to ‘improve’ any body parts is not funded under the NHS. The NHS guidance explains that cosmetic surgery is not routinely provided on the NHS.

27. Our adviser explained that surgery for complications from private surgery may be funded if they are acute or life threatening. However, not in cases where the patient is requesting surgery purely for cosmetic reasons.

28. The BAPRAS guidance explains that ‘the NHS will always look after you in the event of a life-threatening emergency, such as bleeding or blood poisoning, however NHS Trusts and commissioners will usually refuse treatment for less serious complications or bad outcomes following cosmetic surgery in the UK or abroad.’

29. Mr F’s records and the information provided to us by Mr F shows that the request for surgery was due to Mr F being unhappy with the look of his ears, rather than them having any impact on his physical health. In line with the BAPRAS guidance the Trust rejected the referral as cosmetic surgery, which was not life threatening, is not funded on the NHS.

30. We discussed with our adviser if cosmetic surgery would be considered on the NHS if, as in Mr F’s case, the patient’s appearance was significantly affecting their mental health. Our adviser explained that there is no specific guidance or legislation that says that patients should be offered cosmetic surgery on the basis of poor mental health.

31. The OCD and BDD guidance says that in patients, such as Mr F, who are diagnosed with BDD, a referral should be made to a relevant mental health professional if they are seeking cosmetic surgery for a minor disfigurement.

32. We asked our adviser if the Trust had responsibility to refer Mr F for mental health treatment in line with the above guidance. Our adviser explained that as the referral from the GP had been rejected, Mr F’s care had not been transferred over to the Trust, and therefore any onward referral would be the responsibility of Mr F’s GP.

33. We can see that Mr F’s GP made this referral in March 2024.

34. We recognise that the condition of Mr F’s ears is distressing to him and that this decision may be difficult for him to read. Upon consideration of all the evidence, we consider the Trust followed the BAPRAS guidance when it rejected his referral for cosmetic surgery as this was not life threatening and is not funded on the NHS.

35. We will therefore not be looking into this complaint any further as there are no indications of any failings. We would like to wish Mr F all the best with any ongoing treatment he may seek to alter the look of his ears.

1. We have carefully considered Mr F’s complaint about Royal Free London NHS Foundation Trust (the Trust).

2. We recognise that Mr F found the rejection of his referral for revision of the surgery to have his ears pinned back very difficult. We understand that it will have been disappointing for him not to be happy with the outcome of his private surgery, and that this will have been compounded by learning that the surgeon who performed his surgery has since had many complaints against him.

3. After consideration, we have found no indication that the Trust made the wrong decision to not offer him surgery.

4. We understand that this may be difficult for Mr F to hear, as we know that he has found the look of his ears distressing for a number of years. We would like to thank him for taking the time to bring his complaint to us.