patients who say their surgeons weren't there to pick up the pieces... he's just walked away and is just continuing doing other people's operations. quite the thing, like he's done nothing wrong. ..and say their clinic let them down. you're their patient, you go to them. so they should have a duty of care. we track down the doctor the patients couldn't find. mr ottaviani, lucy adams from the bbc. i've got some questions for you. mr ottaviani? catherine roan has always hated her nose. even a simple carjourney used to be full of anxiety. just every day, it would be one of the things i thought about most days, was my nose. coming up to roundabouts or traffic lights orjunctions where another car was parked next to me, and the drivers or passengers

could see my nose from the side. so, i would sit and fidget with my nose and try to take the distraction away from my nose by using my hand, just... and you felt like even someone in another car would be looking across because they're waiting for the traffic lights? it's just so stupid. and i'd be thinking they're staring at my nose. it sounds crazy, but it's just how i felt, because i was so insecure about my nose. i think, just from the years of getting called names, it just sticks with you. catherine owns a share in this hairdressing salon in fife. in 2010, after a lifetime of name—calling, she decided to get surgery. catherine went online and chose a company called transform. it describes itself as one of the leading providers of cosmetic surgery in the uk.

glossy adverts portray brighter futures after surgery. the biggest difference i would say would be how much more confident i feeljust looking in a mirror. and i think you can go through everyday life just not really looking at yourself or looking in the mirror... transform recommended this man, antonio ottaviani. this is how he appeared on transform's website. catherine met him. everything seemed fine. and did you have any worries about it? any misgivings? no, because ijust thought, these companies are doing things like that, they must be doing it every day. i never... it's not like i was paying and going abroad and getting it done cheap. i was going to somewhere in the uk. she paid more than £4,000 and had the operation. when the cast came off, she was distraught. this one's after the first surgery. yeah. and you can see that the septum is hanging down slightly.

there is obviously a lot of swelling, and there's also some sort of lump. even though there's swelling, you can still see there's something going to go wrong here... ..on the top bit. yeah. and then... and you could see that it's squint. and there's, like, a big lump thing on the top of my nose there, because the tip had all been done wrong. so, the tip here was kind of hanging forward. over time, as the swelling has went down, and the lump‘s been left on the top, it's gone squint. yep. mm—hm. catherine had revision surgery with mr 0ttaviani a year later. it was still wrong. so, after another year, he operated again, but catherine still felt her nose wasn't what she'd been promised. so, mr 0ttaviani agreed to operate for a fourth time. this is now four years after that initial surgery.

so, i went back a week later to get my cast removed, and as soon as the cast has come off, it was just an absolute mess. my nose was worse than ever. there was a big skin tag thing, skin fold, hanging down one side. it was squint. there was something wrong with the tip. straight away, i was just shocked, upset. and i said that to the nurse, i said, "something's not right," to which she agreed. she says, "i'll take some photos and e—mail them." she thinks mr 0ttaviani is in italy. he'll not be back for a month. what catherine had been left with was worse than what she had before. on top of that, her surgeon was in and out of the country. catherine chose to get her operation done in the uk because she thought it would be much safer. what she didn't know was that her surgeon was what's come to be known as fly in, fly out.

trish mcfadden is a lawyer who specialises in medical negligence. she has worked on a number of cases involving transform surgeons not based in the uk. fly in, fly out are when the doctors, surgeons, will come from abroad, fly into the country for a period of time, they'll perform operations, surgeries, and then they fly out again. there can be significant problems with that if the patient requires aftercare, or if there's any problems following the surgery. the difficulty is, the surgeon has probably left the country, and the patient then has a huge difficulty in trying to track down the surgeon, and if they have problems, to have them treated. today, catherine does have a nose she's happy with. transform paid for all her revision surgery and expenses. the surgeon who fixed her nose had to go to great lengths. they said that my nose was like someone had been in a bad car crash. and then he had to rebuild it

using part of my ribs, and he also used some liquid from my scalp to rebuild the nose. but since, i get some funny feeling at my rib, and i can't lie on my front if i'm sleeping. an expert report into catherine's care said mr 0ttaviani failed to adequately explain the risks of the three revision surgeries. his facebook page suggests he has carried on operating, flying in and out of italy and the uk. we've have discovered that at least six other women have complained about his practices. i just feel he's just walked away, and isjust continuing doing other people's operations. quite the thing, like he's done nothing wrong. 0n the high street, cosmetic surgery is booming. there were 65,000 private cosmetic operations in the uk last year, and they're no longer confined to private hospitals.

the largest providers are clinics with a presence on the high street, like transform. so, who picks up the pieces when things go wrong? nhs consultant david mcgill has had to fix problems caused by surgeons flying in and out of high street clinics. there's not always a great continuity of care, in my experience, and there have been occasions where patients have then represented with a complication, the surgeon who operated on them is not in the country, and they're being asked to either travel hundreds of miles for treatment to another centre or, more realistically, what tends to happen is they present to us at the nhs to deal with the complication instead. and in the worst cases that i've seen, there have been certain cases where patients have had very serious infections, combined with tissue damage, and that's required fairly extensive surgery to both reduce the risk of sepsis and severe infection, and manage that, and also correct some of the complications that have arisen from the surgery.

so, potentially, that could be fatal? if not treated in a rapid timescale, potentially, yes. david mcgill used to do private work for transform. he says they routinely used fly—in, fly—out surgeons to meet demand. from personal experience, that certainly has been the case. certainly very much up to the recent past, they have used that model regularly to provide enough surgical spaces for the patients that they want to operate on. you worked at transform for 18 months. what did you think of their practices, and why did you leave? transform, from my perspective... ididn't... ..agree with the way that the system was set up, the fly—in, fly—out aspect was an issue that i was concerned about. tracey foley is looking after her son, cian.

it should be a happy time, but she's spent the last four years struggling to get over the consequences of surgery. it was booked through transform, and her surgeon has now left the country. after you had the first surgery, tell me... like, show me what it was like. what had happened? well, basically, one of the nipples was so high, and it was, like, near enough under my armpit. the other one was not as high, but it was still higher than what you would expect. erm. . . but for the wounds, itjust seemed as if it was getting bigger and bigger and bigger, the wounds. tracey lived with these painful open wounds for six months, caused by the implants, which were too big. so from... ..say from, like, there round and then underneath, and the underneath bit here... mm—hm. there was, like, a big, large hole.

it was like the size ofa penny, and it was, like, really deep, as well. but the scarring's still there, even after... ..the corrective surgery, it's just the whole. .. ..underneath‘s just scars. her surgeon was dana vasilescu from romania. she worked for transform at clinics across the uk in 2015. six weeks after surgery, tracey returned to the clinic, concerned her wounds had still not healed. she and her mum saw a nurse. the smell of it was... if you were just sitting beside me, you could smell... it was just disgusting. we knew that something wasnae right, you know? well, i knew, anyway, cos i could see. it was just, it was horrible. an expert report found the decision to use such big implants was inadequate and inappropriate, and that her care was below

the standard expected of a consultant plastic surgeon. shortly after tracey‘s surgery, ms vasilescu went back to romania. national television reported on her treatment of tracey. she still works in a major hospital in the country. it makes me feel sick to think that she's still doing that. plus, transform, ithink... ..they've got a duty of care to their patients. because you're their patient, you go to them. so they should have a duty of care... ..no matter who does the surgery. and they should take some responsibility. transform paid for her revision surgery and her expenses. tracey had wanted the original operation to boost her confidence. her mum offered to pay for the surgery before tracey started a newjob. i got a credit union loan to pay for that. and itjust makes me sick to think...that i've done that. i feel as if...| feel guilty

for giving her the money to do it. you know. but obviously, it's all went wrong, you know. and ijust feel really guilty for paying for it. i'd rather see her the way she was to start, before it happened. but... ..what can you do? even after revision surgery, there was one final impact on tracey and her family. she'd been warned by her surgeon that she might not be able to breast—feed after the operation. that proved to be true. it kind of made you feel a wee bit useless, that you couldn't at least... ..give it a good go of it. but... ..i managed with his bottles, anyway, so... but it would have been better if i could have... ..gave it a good go with it, but...

hi, kirsty, i'm lucy. nice to meet you. thanks for letting me do this. kirsty adam also had breast surgery with ms vasilescu through transform. she's still living with the consequences. it's like... it's every time you look in the mirror, it's there every time you go shopping to buy an outfit or underwear. it's the first thing that comes to your head, before you look at the size of the thing or the price, it's whether or not you can see something, like... if i bought a dress, i'd need to make sure it covered everything. if i bought a bra, i'd need to make sure it covered completely. before she had surgery, she considered going abroad. she decided it would be much safer to have it done here. you always hear horror stories about people going abroad for things, and i know that myself, like, reading magazines and tv programmes, that things do go wrong abroad

quite a lot. but again, they can go wrong in the uk, but you think there's less chance of that in the uk because people are checked and there's, like, guidelines, legislation, there's things there to protect you if there is any complications. so that was kind of why i swayed more to going to the uk, rather than going to turkey or anywhere else abroad. she spent months researching clinics, and chose transform because of its reviews and celebrity endorsements. after looking into it, i decided to do something about it and i went to transform for breast surgery. i did it for me. kirsty showed me photos of the wounds she was left with after surgery. she'd rather we didn't broadcast them. they did say that there would be bruising and swelling. i kind of knew that from my own research, as well, that it wasn't going to be...

and you can see there, like, that's the stitches. like, that wee shiny line, that's the stitches, that are meant to be inside, that are actually coming out. and all this area is...is black. is that because the skin, the flesh was rotting? yeah, because it was dead or dying off, that's why it turns black. kirsty reported ms vasilescu to the general medical council. it started an investigation and she was suspended from practising in the uk. but before the investigation concluded, ms vasilescu returned to romania and came off the gmc register. that meant the case against her was dropped. and that was it. she was gone. i never heard anything from her. my doctor, my gp, never heard anything, like, no follow—up notes or anything about my infection. and transform had no contact with her, they couldn't get in touch with her at all. her insurance company,

they failed to provide any information or any knowledge about her. they said that they couldn't comment. we contacted ms vasilescu in romania, but she refused to engage with the bbc or answer questions. transform paid for kirsty‘s revision surgery and expenses, and refunded some of her originalfee. transform didn't want to be interviewed for this programme. in a statement, it said the experiences of all three patients did not meet its usual high standards. they were down to individual error on the part of two surgeons who no longer work there, and do not reflect the wider standards of the company or its surgeons. the patients each received extensive support from transform, including free consultations and revision surgeries. but there's another, wider problem that the patients we've spoken to face. they've told me that when they tried to get compensation, transform insisted that is between the patient

and the surgeon. 0n the one hand, transform, in their patient guide, will tell the patient before they sign the contract that all the surgeons that they use have got insurance. however, in their terms and conditions, they also say that they have no responsibility for anything that the surgeons do. so the patient is there, stuck in the middle. they can't go to transform, who say, "well, it's to do with the surgeon, you have to contact them." and they then can't trace the surgeon. they don't have their contact details and they don't know where to find them. recovering compensation and holding fly—in fly—out surgeons to account has proven almost impossible for patients and lawyers, because even getting their details is difficult. we discovered courts have ordered mr 0ttaviani to pay two separate patients compensation of £100,000 each. he didn't defend either case.

one of those patients is catherine. she has to date only received £1,000. the other patient has had nothing. we have no knowledge of whether or not mr 0ttaviani is insured or not. he's not given us any details, and the transform clinic told us clearly that they would not provide his contact details or details of his insurers. transform denied that the fly—in, fly—out operating model makes it difficult for patients to sue when things go wrong. it said that if a patient wishes to take legal action, this has to be done... it's a policy, it says, that applies... so, how is it that patients choosing cosmetic surgery in the uk are not fully protected?

it seems there's a loophole — to do cosmetic surgery you just have to be registered as a doctor. six years ago, a major uk government review recommended that only certified cosmetic surgeons should be allowed to do cosmetic surgery. that never happened. instead, a voluntary register was introduced. to date, fewer than 30 surgeons have signed up. ken stewart is one of them. he advises the scottish government on plastic surgery. personally, i think the certification scheme should be mandatory, but there's no incentive for surgeons to use the certification scheme. but there's a commercial pressure for people to want to do lots of operations and to do them quickly and early on with inadequate

experience, inadequate training. the royal college of surgeons believes a compulsory certification scheme would effectively end fly—in, fly—out surgery. as it stands at the moment, with the cosmetic surgery certificate that the college has set up, the vast majority of these surgeons would not be eligible to be awarded a certificate, and if it was therefore mandatory as part of a credential system, then their practice would cease. would that mean patients were better protected? well, we're suggesting that they would be, in that situation, because all of the people who have the certificate/credential would be aspiring to and have demonstrated very good practice in terms of their professional behaviours and their actual skillsets. back in the office, i tracked down mr 0ttaviani and found

he was working for another high street clinic in london. i wanted to make sure he was still on their books, so i phoned to make an appointment. well, now we know for sure that mr 0ttaviani is when we contacted mr 0ttaviani, he said he didn't want to be interviewed, that he was honouring his compensation agreement with catherine and he'd always been available to her when transform had asked — and he said he couldn't comment on individual cases because of patient confidentiality. i'm going back to see catherine to see what she thinks about what mr 0ttaviani has told us, and how she feels about the fact he is back in the uk working here again. catherine, since we came to see you last we've found out since then that he's actually back in the uk and that he's working in london. how do you feel about that? it's absolutely shocking. this man should have been looked into. it's terrible. there's no excuses. we went to mr 0ttaviani,

put your points to him. he has responded by saying that he believes he has punctually respected your agreement. that's an absolute lie. i keep in touch with my lawyers, and he's paid one payment, a one—off payment, which was nowhere near what he was asked to pay. so, he's a liar. how do you feel about it? it's just — it's terrible. it's disgusting. catherine clearly wasn't happy, so i wanted to confront mr 0ttaviani. i've come to london because i know mr 0ttaviani is working here this weekend and i want to try to track him down and see if i can get him to answer some of our questions. mr 0ttaviani? mr 0ttaviani, lucy adams from the bbc. i've got some questions for you. mr 0ttaviani? we wanted to know why you haven't

paid catherine roan, mr 0ttaviani. why you haven't paid catherine roan? i just want to ask that. would you apologise to her now? no, sorry... catherine roan, your patient... i don't want to speak with you. ..wants to know why you haven't apologised... sorry, i don't want to speak with you. sorry. ..or whether your aftercare was good enough, mr 0ttaviani. that was mr 0ttaviani, and he said he didn't want to answer any of our questions. he was quite forceful and quite pushy about it, as well. i think we need to look at improving regulation, improving oversight, improving the qualifications, and any medical practitioner shouldn't be allowed to walk into a hospital and say, "oh, i've done plenty of these, i'll start doing rhinoplasties." there needs to be more transparency, and clients have to be given information — they need to know who the surgeon is, their credentials, all their insurance details, and that the clinic has a responsibility.

the patients i've spoken to wish they could go back and make different decisions. they want others to understand this is not a normal high street purchase, but a life—changing decision which can have devastating consequences. so you'd look in the mirror now, but you don't like what you see? no. but i'm starting to get used to it. it's the best that they're... ..they're ever going to be now. they're not going to get any better, so ijust need to make do with what i've got. i'm just really angry that they're getting away with. .. ..with doing things like this, and no apology, no information on why it's went wrong, or what's went wrong, or... i'm trying to stay positive so that i can also get the message out to help other people so that they don't... but if they are thinking about it, they really need to do as much research as they can and, like, just ask questions. if you think it's a silly question,

sometimes the silliest questions are the most important to ask. hello. well, it's time to get a check on the weather for the next ten days or so. and it's hardly surprising if i tell you the weather is looking very unsettled over the next week or so. we will see spells of wind and rain, certainly very windy on saturday across southern parts of the uk. a powerfuljet stream developing out there across the atlantic, spawning areas of low pressure. at the same time, these areas of low pressure or bringing much milder

weather in our direction, which is what's happening right now. it's a mild night out there, whereas to the north, we have the colder air which is ready to tuck in behind these vortices and areas of low—pressure next week, so it'll chop and change. but in the short—term, it is the warning the met office that is the story, the high winds that are expected across southern parts of the uk starting in the early hours of saturday morning in the southwest of the uk, as this low—pressure approach is, then those high winds will spread to other parts of the country across the south during the morning and into the afternoon. so this is what it looks like early in the morning. we start to see the onset of the gaels on the coast of cornwall, devon, southern parts of wales, too. —— gaels. a spell of heavy rain, this is the centre of low—pressure here. that low—pressure will be tracking along the centre of it across the southern part of the uk, and this is where the strongest of the winds will be. same time in the north,

lighter winds with the southern portion of the uk in this yellow zone is where we will see gusts of 60—80 mph, which is likely to cause some tree damage and some disruption to transport. it is likely that if you are travelling during the morning and the afternoon, just take it steady across the south. in the north, the winds won't be as strong. it'll be rain around a scotland particularly in the east. temperatures, whether in the north or south, will be more or less the same, around 10—12 celsius. that's saturday, this is sunday. the area of low—pressure responsible for the gales decides to slow down and park itself across the uk, and basically blow itself out. so sunday won't be anywhere near as windy, but the weather will be still quite changeable. we are expecting sunny spells and also occasional showers. the temperatures will again be more or less the same through that low—pressure, around 12—13 celsius. now here is monday's weather. you can see the low—pressure is still with us, really domineering

weather across this whole chunk of europe and the eastern portion of the north atlantic here. so big showers circling within this low—pressure here, so we will call it sunny spells with occasional downpours. wouldn't be surprised if there's some cracks of thunder. but it's not all bad, just a very changeable day. now there is a change on tuesday, that low finally starts to move away and the high pressure starts to build on. but that means the wind is likely to change direction. and the thinking is that on tuesday, we will start to see some colder air from the north. see these wind arrows coming all the way from the norwegian sea and the arctic, bringing dryer, brighter weather with temperatures tumbling. seven celsius is optimistic for aberdeen, it could be as low as 11—5 celsius. the idea is that from tuesday into wednesday, we will see colder air coming in from the north atlantic, but then low pressures will be heading our way again to return the milder air with wetter and windier weather.

bye— bye.

tonight at ten, england are just a few hours away from taking to the field in the final of the rugby world cup in japan. they're fired up for the game after crushing the all blacks in the semis, but are taking nothing for granted. we can'tjust expect to do the same as last week and the same to happen. we've got to figure out ways to put ourselves in the best place possible to perform. their formidable opponents, south africa, are led by the team's first ever black captain. i'm live injapan as the queen sends her best wishes to the england team as they prepare for the game of their lives. also tonight...