Article by Jana Torres-Grau

What should you expect at your child’s first paediatric plastic surgery consultation?

Many parents assume a first consultation means surgery is already being planned. It is a specialist assessment: I discuss the concern, take the medical history, examine your child where appropriate, explain the findings, talk through options including no treatment, and answer questions. It can be in person or online, but some concerns need examination.

Preparation before the consultation begins

Parents rarely arrive with a perfect set of papers, and I do not expect that. A first paediatric plastic surgery consultation starts with the story: what you have noticed, how long it has been present, whether it has changed, and what worries you most.

A few details help me make the appointment clearer:

• Previous GP referral letters or clinic letters, if you have them.
• Photographs, where the concern has changed over time or is hard to see on the day.
• A list of medicines, allergies and previous operations.
• Notes about symptoms, such as pain, bleeding, feeding difficulty, movement problems or change in size.
• Your main questions, because parents often remember them after they leave the room.

For a private consultation with a paediatric plastic surgeon, a GP referral is not needed, although it helps if you already have one. I also offer in-person and online consultations, which helps families in London, across the UK and overseas. Online appointments work well for some first discussions, but they do not replace a physical examination where touch, movement or a close visual assessment matters.

Consultations are available in English and Spanish. The aim is simple: I use the information you have, then make sense of the concern with you.

The appointment follows a clear assessment sequence

A child’s plastic surgery appointment is different from an adult cosmetic surgery consultation. I am assessing a baby, child or young person with a parent or responsible adult present, and the child’s role in the discussion matters.

During the appointment, the sequence is usually straightforward:

• I listen to your concern first. You explain what you have noticed and what has prompted the appointment. I ask focused questions so I can place the concern in context.
• I take the medical history. The relevant details depend on the problem. For a scar, I need to know how it happened and how it has healed. For a hand difference, movement and day-to-day use matter. For a birthmark or lump, change over time can be important.
• I involve your child in a way that fits them. A young child may only need simple explanations. An older child or teenager should have space to say what they think and ask questions. NICE guidance on babies, children and young people’s healthcare says children and young people should be supported to take part in decisions in a way that fits their age and development.
• I examine your child where appropriate. I explain what I need to look at before I do it. Royal College of Surgeons England guidance says surgeons should get verbal consent before a physical examination and support a request for a chaperone.
• I explain what I find in plain words. At a first appointment with me, Miss Torres-Grau, I assess your child myself and explain the findings myself. I avoid technical language unless it is useful, and I explain any medical term I use.
• I answer your questions before decisions are made. Parents often arrive asking whether surgery is needed. The better question is whether any treatment fits the finding, the child and the timing.

That structure gives the consultation a clear order, but it still leaves space for the part that matters to you. That is the concern that brought you there in the first place.

Surgery and non-surgical options are discussed without pressure

A good first consultation can end with advice not to operate. That is not a failed appointment. It is often the most useful answer a family can receive.

My role is to explain what I find, what choices are reasonable, and what each choice involves. Surgery may be one option, but I also discuss non-operative care, monitoring, referral to another service where that is the better fit, or no treatment where that is the safest advice. The Royal College of Surgeons England describes consent as a process of giving information for a decision, and not simply signing a form.

Consent for a child’s operation needs careful discussion. Parents or responsible adults make decisions in the child’s interests, and children and young people should be included in a way that fits their age and maturity. For a teenager, that may mean a fuller conversation about the reason for treatment, the limits of surgery and what recovery would involve. For a younger child, it may mean clear, simple words and a check that they know what will happen next.

Risks and benefits belong in the same conversation. If surgery is being considered, I explain the expected benefit, what the operation involves, the likely recovery issues and the uncertainties. I also say when the balance does not favour surgery. Clarity is the purpose of the appointment.

Written follow-up turns the appointment into a usable plan

After a consultation for a scar, birthmark, ear concern, hand difference or lump, parents need more than a memory of what was said. Medical decisions are easier to think through when the findings and options are written down.

After the consultation, I send a clinic letter and a written quote where relevant. The private consultation fee stated for my service is £250. I do not give total treatment costs in a general article because the right plan depends on the individual assessment and the treatment being considered.

Continuity also matters. In my service, Miss Torres-Grau is the same consultant from the first consultation through any procedure and follow-up, where treatment is the right step. That means the person who gives the first specialist view remains involved in the later decisions.

Written information gives you something you can read again, share where needed and think about without relying on memory alone.

The first consultation is a decision appointment, not an operation plan

A common misconception is that seeing a paediatric plastic surgeon means choosing surgery. That assumption is wrong.

The first consultation is where I test whether treatment is sensible at all. Sometimes the right advice is to wait, monitor, use non-surgical care or leave things alone. I would rather give you a clear no than move a child into a procedure that does not fit the finding.

Questions parents ask me about first paediatric plastic surgery consultations

Do I need a GP referral to see a paediatric plastic surgeon privately?

No GP referral is needed for a private consultation with me. A referral is helpful if you already have one, because it gives background information before we meet.

Can my child have an online consultation with a plastic surgeon?

Yes, online consultations are available for some first discussions. Some concerns need an in-person examination or close visual assessment, so an online appointment is not suitable for every child.

Will my child be examined at the first consultation?

I examine your child where examination is appropriate. I explain what I need to look at first, and I ask for verbal consent before any physical examination.

Will surgery be booked at the first consultation?

Surgery may be discussed, but the consultation may also lead to monitoring, non-surgical care or advice that surgery is not the right step. The appointment is for assessment and decision-making.

Who gives consent for a child’s operation?

Consent is an informed decision-making process involving parents or responsible adults. Children and young people are also involved in a way that fits their age, maturity and ability to take part.

This is general information, not medical advice.