Selling doughnuts and pasties to fat people is is a different thing to altering someone's appearance with major surgery.
Guidelines need to be in place so that people aren't ripped off by unscrupulous surgeons who are told that they need cosmetic surgery when they don't. People with BDD like Alicia Douvall are vulnerable in this case.
It is the same principle though and cosmetic surgeons are selling a product. As far as I know there are already guidelines in place (see the BAAPS website) but of course some are unscrupulous. I do have some sympathy for this woman but the world is full of people who will take advantage of you if you let them.