It’s not just plastic surgeons who are calling for major reforms.

The recent crackdown on doctors who perform cosmetic surgery without surgical training by AHPRA and the federal government does not go far enough, plastic surgeons say. And it’s not just plastic surgeons who want ‘cosmetic cowboys’ banned.

Of the 386 GPs who answered Healthed’s survey question in August, more than three quarters (78%) said doctors who were not qualified surgeons should not be allowed to perform cosmetic surgical procedures, such as liposuction and breast implantation.

Only 7% of GPs surveyed said doctors who were not fully qualified surgeons should be allowed to perform cosmetic surgical procedures, while 15% were undecided about whether or not this group should be allowed to perform cosmetic surgery.

Under the existing regulations, anyone with a basic medical degree can perform cosmetic surgery (including invasive procedures such as liposuction, facelifts, butt lifts, tummy tucks and breast implants) without undergoing the eight to 12 years of additional training that is required to become a registered surgeon.

Registered surgeons who perform cosmetic procedures are called plastic surgeons. Doctors who are not fully trained surgeons but choose to perform cosmetic surgical procedures call themselves ‘cosmetic surgeons’.

This group of ‘cosmetic cowboys’ is largely made up of GPs who have taken an interest in cosmetic procedures.

Over the past year, an investigation by the SMH, The Age, 60 Minutes and Four Corners uncovered disturbing practices by some cosmetic surgeons, with hundreds of patients coming forward with stories of sepsis, liver damage, disfiguration and near-death experiences.

A class action has now been launched by Maddens Lawyers against one cosmetic surgery clinic.

Australia’s $1.4 billion cosmetic surgery industry performs around 500,000 procedures every year.

A review into the term ‘cosmetic surgeon’ was established by former health minister Greg Hunt in November 2021.

On 1 September this year, AHPRA made 16 recommendations concerning cosmetic surgery, including creating a $4.5-million enforcement unit inside AHPRA, a confidential hotline (1300 261 041), a complaints committee, and banning patient testimonials.

Writing in the The Age last week, Associate Professor Nicola Dean, the president of the Australian Society of Plastic Surgeons, said AHPRA’s recommendations were “inadequate”.

“The proposed lift in penalties will have no adverse effect on rogue practitioners,” she wrote. “Those who carry out surgery with no accredited surgical qualification should be deregistered. And their interventions should be regarded as assault.”

On 1 September, Royal Australasian College of Surgeons president Dr Sally Langley told SMH that authorities should ensure surgical procedures “are only undertaken by properly qualified surgeons”, who study surgery for eight years and have ongoing professional development obligations.

On 2 September, Health Minister Mark Butler called a meeting with the state health ministers to discuss a legislative crackdown on unqualified cosmetic surgeons.

Speaking with Healthed on 7 September, Dean said she had just left a meeting with Minister Butler at Parliament House in Canberra and that the changes were a “work in progress” but she still had concerns that AHPRA would not go far enough.

“I’ve gained an appreciation of how difficult it is to completely restrict scope of practice in Australia’s current model,” she said. “And I do appreciate that it may not be possible to completely ban doctors from doing particular procedures.”

“I still have significant concerns that the penalty for this sort of harm to patients is insufficient, and that the mechanism for harm being identified is only by notification after the fact rather than AHPRA proactively saying who is and is not allowed to perform surgery.

“In an ideal world, there should be a change so that there is a way of stopping it from happening rather than waiting until someone is harmed.”

Dean said the provision of cosmetic surgery by non-surgeons is “fundamentally dangerous” as “cosmetic surgery is real surgery” and anyone performing it “needs to have full specialist surgical training”.

Dean said the Australian Society of Plastic Surgeons “absolutely recognises that there are procedures that specialist GPs perform, like skin cancer excision, that are very valuable and the Society has no desire to encroach on that practice by specialist GPs”.

GPs pick up the pieces

In August, Healthed asked GPs how many patients they had seen over the past year who had reported a negative outcome as a result of a cosmetic surgical procedure performed by a doctor who was not a fully qualified surgeon.

Around 16% (of the 377 GPs who answered this question) reported seeing one or more patients in the last year in this unfortunate position.

“I mean, that’s just shocking,” Dean told Healthed in response to the survey.

“It shows how important it is to improve the situation. We need to make changes so that it’s only Australian Medical Council-accredited surgeons that are doing these procedures.”

A total of 439 GPs responded to Healthed’s email survey, which opened on 30 August 2022. GPs were allowed to skip questions, which is why each question has a different number of GP participants. 

Felicity Nelson is a freelance journalist & editor. Yasmin Clarke is a freelance data analyst & journalist.