By Karen Allen BBC Health Correspondent

Five years after the Consumer's Association conducted its last investigation into cosmetic surgery clinics, it's latest look at how this lucrative industry is run still looks depressing.

This, despite a Health Select Committee report in 1999 exposing the lamentable lack of regulation in the private health sector; the creation of an inspectorate to check up on private health clinics and pressure from the Association of Aesthetic Plastic Surgeons to tighten up controls.

You don't have to be a specialist cosmetic surgeon to carry out cosmetic surgery - daft isn't it?

What was the case five years ago and is still the case now, is that you don't have to be a specialist cosmetic surgeon to carry out cosmetic surgery.

Daft isn't it? Why should this branch of surgery be treated any differently from say neurosurgery?

Peripheral area

Possibly because for too long it has remained on the periphery of healthcare.

Now, with liposuction, tummy tucks and breast enlargement surgery no longer being the sole preserve of the rich and famous, the need for tighter controls is more pressing than ever before.

To practice cosmetic surgery a doctor has to be on the General Medical Council's Specialist Register - but they don't actually have to be a specialist in cosmetic surgery.

That leaves the door open to dermatologists, ophthalmologists and any other specialist "having a go" at plastic surgery - worrying when up to 75,000 people in the UK entrust their health to those running cosmetic clinics every year.

Last year a GP was found guilty of 45 counts of professional misconduct for carrying out botched up plastic surgery for which he was not trained.

It is hard to be convinced that the same thing couldn't happen again today.

There are still no minimum standards of training for cosmetic surgery - a situation that the professional body representing aesthetic plastic surgeons regrets.

And, although the General Medical Council under its revalidation plans would require doctors to demonstrate that they have kept up to date with their skills - many will require a lot more convincing than that.

There are now moves for the rules to be tightened so that newly qualified "specialists" have to declare their specialism, but this only applies to a minority of younger doctors.

Some improvement

There is now a new statutory body responsible for inspecting private hospitals and clinics.

The National Care Standards Commission is certainly an improvement on the past.

Its brief is to inspect facilities to establish whether they suitable for clinical work; to investigate what kind of treatments they are carrying out and to ensure standards of emergency care are up to scratch.

But, crucially, they do not independently assess whether the surgeons carrying out procedures are up to the job - this is the responsibility of the hospitals and clinics themselves.

Of course, there are many cosmetic surgery clinics that go to great lengths an adopt a professional approach to checking their doctor's credentials and ensuring that it's doctors - not salespeople - that conduct medical consultations.

But, as the Consumer's Association report reveals, there are still far too many that aren't.