There is nothing on the brass-plated door of his Harley Street address to suggest a problem. Cosmetic surgeon Dr Fayez Abu Mahfouz promises 'guaranteed results in writing', and has a website welcoming customers who are fed up with their wrinkles, acne, birthmarks or cellulite. There is certainly no shortage of visitors to his smart treatment rooms, men and women desperate to have more perfect complexions.
But it astonishes and frustrates the healthcare regulators that he is continuing to practise. The Egyptian-born surgeon has been accused of serious professional misconduct and both he and his clinic have been refused a licence to operate. Despite the attempts of the official watchdogs overseeing private healthcare to stop him, Mahfouz is still touting for trade.
His clinic is not supposed to be operating, yet it will still be open for business this week. Patients' groups have called for tougher action against rogue doctors, particularly those who practise facial procedures.
Mahfouz had to appear before the General Medical Council last year after five patients complained that they endured months of pain after his laser skin treatments. One woman described having a 'weeping swollen crust of skin'. Another said she was left with severely burnt and weeping skin, which was inflamed for months.
The GMC then charged Mahfouz with making inappropriate and inaccurate claims about the success of his treatments, failing to provide enough information for patients to enable them to give appropriate consent, and failure to provide appropriate post-operative care.
Mahfouz denies all the charges and even went to the High Court in an unsuccessful attempt to get the case thrown out. The GMC hearing will resume in the summer. In the meantime he can still practise.
Mahfouz was struck off in 1987 when he was working as a GP's assistant and failed to refer to hospital a patient he knew to be in a critical condition. The GMC accused him of a 'lamentable standard of professional care and attention'. He was reinstated by the GMC in 1992. If found guilty this time, Mahfouz could be struck off again or ordered to retrain. Alternatively the GMC could suspend him, restrict the sort of operations he can carry out or order him to be kept under supervision.
During last year's GMC hearing, a committee heard how a woman patient, named only as Mrs B, paid £2,500 for cosmetic treatment. 'It was extremely painful and there was a smell of burning flesh,' she said.
'The next day, my face was swollen, my eyes mere slits and the skin was weeping. Gradually a scab, a crust formed over the entire face, the area that had been treated. My face was burning.'
Other attempts have been made to close down his clinic. Two months ago the Care Standards Commission, the body that regulates private clinics, refused Mahfouz a licence as a manager and refused his clinic, the London Cosmetic Laser Centre, a licence to operate. It did so on the grounds that the clinic did not meet acceptable standards of care or safety.
Mahfouz refused to comply with the ruling, refused to meet officials and has registered an appeal. Lawyers for the regulators say that Mahfouz is breaking the law by carrying out procedures without registration.
Patients' groups are angry that both the GMC and the Healthcare Commission, which replaced the CSC in April, appear unable to protect the public from doctors determined to defy the system.
Peter Walsh, chief executive of Action for Victims of Medical Accidents, said: 'It's a ridiculous situation where a doctor is openly flouting the ruling of a regulator. More robust procedures need to be established to ensure doctors comply with registration or patients will be put at risk.' The organisation is now setting up a group for victims of cosmetic surgery bungles.
But cosmetic surgery is becoming ever more popular. Over 75,000 procedures, from simple Botox or skin treatments to complex face, breast, stomach and even genital surgery, were carried out last year at a cost of £211 million.
The surgery has become especially popular in the 25-35 age group. Demand is particularly strong in the North of England, where one in 10 says they are considering surgery to improve their looks.
When The Observer called 10 days ago to inquire about acne scar treatment, we were not told that the clinic was no longer registered. Instead the receptionist said there had been a last-minute cancellation and Mahfouz could see us the next day. We were told that prices for removal of facial acne scars using lasers ranged from £2,000 to £5,000.
When we phoned again to ask Mahfouz why he was breaking the law, he said: 'You are shit. You know nothing. Are you the law?' Asked what he thought the GMC would make of the way he was flouting registration rules, he said: 'I am taking the GMC to the High Court. They are biased.' He then rang off.
We called again on Friday to see if he was still operating. His staff said that he was away at a medical conference, but that he was expected to be back operating this week. If we were interested in making an appointment we were advised to call back this week.
A spokesman for Mahfouz later told The Observer that the surgeon had treated thousands of patients a year without complaint. 'He denies all the charges which relate to events that go back three or four years and is determined to clear his name.' The spokesman said feedback revealed 'overwhelming satisfaction' among clients.
A senior Department of Health source said the Healthcare Commission must act. 'We put private and NHS providers under the same regulatory body and have given them teeth, so they should use them.'
But the case of Mahfouz is far from isolated. As people become more convinced that the path to happiness is via the scalpel, needle or laser, the number of complaints and payouts has risen sharply.
