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Abdominal hernia in adults Adult Snoring Surgery (in the absence of Obstructive Sleep Apnoea) Arthroscopic shoulder decompression for subacromial shoulder pain Arthroscopic surgery for meniscal tears Artificial urinary sphincters for post-prostatectomy incontinence Assisted Conception Benign Skin and Subcutaneous Lesions Commissioning Policy Blepharoplasty (upper and lower lid) including brow lift Botulinum Toxin A for the management of focal hyperhidrosis Breast implants - removal and replacement Breast reduction surgery Carpal tunnel syndrome (surgery) Cataract Surgery Chronic rhinosinusitis with or without polyps Circumcision Cosmetic Treatments Cryopreservation to Preserve Fertility Dilatation and curettage for heavy menstrual bleeding in women Dupuytren's contracture treatment Ear Wax Removal Femoro–Acetabular Impingement, open or arthroscopic surgery Fusion surgery for non-specific, mechanical back pain Haemorrhoids in adults Hallux Valgus (Bunion) - Commissioned pathway Heavy Menstrual Bleeding - Referral for Surgical Management Hip and knee replacement surgery in obese patients (those with a body mass index of 30 or greater) Individual Funding Requests (IFRs) Injections for non-specific low back pain without sciatica Knee arthroscopy for patients with osteoarthritis Lumbar spine procedures – for simple lumber back pain Meibomian cysts (chalazia) Myringotomy/grommets with or without adjuvant adenoidectomy for the management of otitis media in children under 12 years Myringotomy with and without grommets in adults and children aged 12 years+ Open Magnetic Resonance Imaging (MRI) Scanning Radiofrequency Denervation Reversal of male and female sterilisation Spinal injections for sciatica Surgery for ganglion cyst Surgical procedures for the treatment of LUTS caused by BPH Tonsillectomy Trigger finger release in adults Varicose vein referral
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Cosmetic Treatments

This is a summary of the NHS Devon policy for cosmetic treatments.

Cosmetic treatment is surgery or non-surgical medical treatment carried out solely to change a person's appearance to achieve what they feel is a more desirable look.

Cosmetic treatment is not routinely commissioned. This policy lists commonly encountered cosmetic procedures which are not commissioned except under the circumstances described, but this policy applies to all treatment which is being carried out for cosmetic reasons.

It excludes surgery to repair and reconstruct missing or damaged tissue that has occurred through accident or illness. It may be difficult to restore normal appearance and this exclusion does not constitute an ongoing agreement to fund surgery until an ideal appearance is achieved. Under normal circumstances the reconstructive surgery is commissioned when it is part of an ongoing package of treatment for the accident or illness, including where the patient has chosen to defer taking a decision on the surgery. Once the patient has been discharged from this treatment plan further procedures are not routinely commissioned.

The revision of treatments originally carried out outside of the NHS is not routinely commissioned.

Cosmetic Treatments commissioning policy

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Breast Procedures

These procedures are not commissioned:

  • Breast Asymmetry Correction
  • Breast Augmentation (enlargement)
  • Breast Lift (Mastopexy)
  • Breast Reduction
  • Removal of male excess breast tissue
  • Inverted Nipple Correction

Body Contouring Procedures

These procedures are not commissioned:

  • Abdominoplasty/ Apronectomy
  • Brachioplasty (arm reduction and lift)
  • Buttock Lift
  • Labiaplasty (reduction and/or reshaping of the labia)
  • Lipomodelling (surgical fat transfer)
  • Liposuction (removal of body fat)
  • Testicular Prosthesis
  • Thigh Lift (removal of excess skin and fat from the thighs)

Facial Procedures

These procedures are not commissioned:

  • Cosmetic dental treatments
  • Face Lift
  • Laser Surgery for Short Sight
  • Pinnaplasty (reshaping and/or pinning of ears)
  • Repair of ear lobes
  • Shave excision of Rhinophyma
  • Sympathectomy for facial flushing
  • Treatment to change appearance of face (including botulinum toxin injections /fat transfers/ fillers)

These procedures are not routinely commissioned however there are some criteria under which treatment is funded without the NHS Devon panel approval:

  • Rhinoplasty/Septorhinoplasty (reshaping of nose)
    • Immediate post trauma nasal manipulation which normally occurs two to three weeks after the trauma is funded without NHS Devon panel approval

Skin Procedures

These procedures are not commissioned:

  • Chemical peels
  • Dermabrasion of skin
  • Dermal fillers
  • Micropigmentation (permanent make-up)
  • Skin lightening
  • Tattoo Removal

These procedures are not routinely commissioned however there are some criteria under which treatment is funded without the NHS Devon panel approval:

  • Hair Removal (Electrolysis or Laser Treatments)
    • Treatment for recurrent pilonidal sinus is funded without NHS Devon panel approval
    • Treatment following hair bearing flap reconstruction is funded without NHS Devon panel approval
  • Scar Revision (reduction in the appearance of scars)
    • Is funded without NHS Devon panel approval as a clinically necessary part of a staged procedure to allow for improved functional outcomes
  • Wigs, hairpieces and hair transplant/ replacement systems
    • Treatment is funded without NHS Devon panel approval when hair loss is the result of previous surgery or trauma, including burns
    • Hair pieces and wigs for patients experiencing total or severe hair loss as a result of alopecia totalis, cancer treatment, previous surgery or trauma are available from local NHS Trusts through commissioned pathways
    • Wigs are available from the NHS but patients will be charged for them unless they qualify for help with charge

Policies exist for procedures which could be undertaken for medical reasons. There are specific separate policies for these setting out the criteria or circumstances under which they are funded.

Where the circumstances of treatment for an individual patient do not meet the criteria described above exceptional funding can be sought. Individual cases will be reviewed by the appropriate panel of NHS Devon upon receipt of a completed application from the patient's GP, consultant or clinician. Applications cannot be considered from patients personally.

Please see panel policies for guidance on submitting applications for cosmetic treatments.

Date of publication: 22 November 2018

This policy has been adopted from Northern, Eastern and Western NHS Devon

and South Devon and Torbay by NHS Devon from 1 April 2019