Having cosmetic surgery, though often considered a vanity, still demands the same operating room standards as those in hospitals. A clean sterile environment, equipment, a skilled surgeon and surgical staff. Patients of the Elan Clinic often opt to have their surgeries done on the premises at the Bermuda Ambulatory Surgery. The small surgery is overseen by Director of Nursing, Trish Vootg who ensures strict adherence to international operating room standards and procedures. She and plastic surgeon Dr. Bruce Lattyak walked us through the steps in a typical surgery in the facility.

Surgical tray: All items used to perform the surgery have been sterilised and packaged. The scrub nurse nurse arranges them in the operating room just prior to the surgery.

Doing the checks: The circulating nurse (on the right) is not completely sterile. She moves around the operating room handling the unsterile but very necessary items. She goes over the patient's chart with the scrub nurse, pointing out all the instruments and items needed for the surgery and showing that the patient has given their oral consent to the procedure just prior to the start. Following this meeting, the scrub nurse becomes responsible for the patient and must account for each item used in the surgery. The scrub nurse will have counted how many swabs, pieces of gauze, etc are on the patient's tray before the surgery. He/she will do counts of the materials at specific times during the surgery to ensure that none are left in. This is a international operating room standard. At the end of the surgery the materials are counted again.

Making the cut: The patient also dons a sterile gown. A special sterile sheet which exposes the area to be operated on is also put in place. Depending on the type of operation and whether the patient is conscious (local anaesthetic) or unconscious (general anaesthetic) a curtain may be draped across their neck to help keep them calm.

Steady hand: In many plastic surgery procedures the surgeon has drawn on the patient's skin to help guide where inscisions should be made.

At the Bermuda Ambulatory Surgery, patients are lifted from their operation bed to a recovery bed and wheeled to a separate recovery room. The scrub nurse and surgeon do a formal handover to a recovery room nurse who monitors the patient's vitals and asks them how they are feeling. When appropriate, the patient is helped up, allowed to get dressed and checked out. A convenient back door allows for patients to move easily from the recovery room to a waiting vehicle in privacy and with minimum fuss.

The team: Plastic surgery and dental surgery are carried out at the Bermuda Ambulatory Clinic. Pictured from left to right are: scrub nurse Robin Chapman, plastic surgeon Dr. Bruce Lattyak, director of nursing Trish Vootg, dental surgeon Dr. Laidlaw Fraser Smith and his dental assistant Charmayne Lewis.