By Dr Naveen Somia
Policing the use of the title ‘cosmetic surgeon’ will prevent doctors from holding out as specialists and improve patient safety.
We are led to believe cosmetic surgery is all about a ‘nip here and a tuck there’. We often see marketing terms such as “lunch time lipo”, “lunchtime liquid facelift” and “rapid recovery technique” that entice and mislead the consumer into believing that cosmetic surgery is quick and easy with minimal risk. This is not so.
Marketing “low cost” or “cheap cosmetic surgery” is an enticing strategy that will influence consumer choice and the decision making process. Unfortunately, patients have no idea that the lower cost of the procedure may mean that the “surgeon” may not be a registered surgical specialist due to lack of accredited training and expertise, and the cost savings may come from lack of proper anaesthetic support and failure to obtain a facility licence for cosmetic surgery.
Registered specialist surgeons are profoundly concerned about the number of patients they see with adverse outcomes following cosmetic surgery performed by doctors who are NOT registered specialist surgeons. At best, these patients need ongoing corrective surgery; at worst, these patients present to the emergency department with life threatening complications.
While cosmetic surgery can help achieve a patient’s aesthetic goals, it can go horribly wrong. As more and more cosmetic surgery patients are harmed by avoidable surgical complications, it becomes painstakingly evident that there is no comeback for these patients. Cosmetic surgery is real surgery with risks, complications and failure. Avoidable complications in cosmetic surgery highlight the need for enforcement of the national law and transparency of titles to avoid patient harm.
The community expects surgery to be performed by registered specialist surgeons. It also expects doctors to be truthful and transparent and not indulge in deceptive advertising practices to hold out as specialists.
In Australia, the use of the term “cosmetic surgeon” is a free-for-all that can be appropriated by a doctor fresh out of medical school with no surgical training. The use of the title “cosmetic surgeon” by doctors who are not registered surgical specialists to advertise cosmetic surgery is not only at odds with the community’s expectation of truth and transparency, it breaches the National Law Sec 118 (b) (d).
This deceptive advertising by using the title ‘cosmetic surgeon’ confuses consumers who seek cosmetic surgery. Consumers assume that all cosmetic surgery is performed by registered specialist surgeons and the person behind the title “cosmetic surgeon” is a registered specialist surgeon. This is not true, because doctors who use the title “cosmetic surgeon” are, in fact, not registered specialist surgeons. While the majority of cosmetic surgery is performed by registered specialist surgeons, a small percentage of cosmetic surgery is performed by doctors who are not registered specialist surgeons.
Despite the abundance of information on Google and the extensive research conducted by consumers on cosmetic surgery, many do not understand that there exists a difference between a registered specialist plastic surgeon and a practitioner who uses the term “cosmetic surgeon”. Since both the titles sound the same, patients assume that doctors who use the title plastic surgeon and cosmetic surgeon have the same training, qualifications, registration and expertise. This is not true, because doctors who use the title “cosmetic surgeon” have not completed AMC accredited surgical training (the Australian Standard) unlike registered specialist surgeons.
In Australia, the use of the term Cosmetic Surgeon is a free-for-all and is used by doctors who are not registered specialist surgeons but wish to impress upon patients that they are registered specialist surgeons. It is interesting to note that registered specialist surgeons do not use the title “cosmetic surgeon” because registered specialist surgeons have a protected title that accurately reflects their AHPRA registration status and area of specialisation.
In contrast, the title “cosmetic surgeon” does not accurately reflect the practitioners AHPRA registration status and the area of specialisation. The title “cosmetic surgeon” is underpinned by the lack of AHPRA registration as a specialist surgeon, the lack of AMC accredited surgical training and the lack of recognition as a specialist surgeon by Medicare Australia, Health departments of the states and territories and tier one private hospitals.
Holding out to be specialists
Cosmetic surgery is a regulated health service and using the title “cosmetic surgeon” amounts to advertising a regulated health service. The public expect doctors not to hold out to be “cosmetic ‘surgeons” when they are not registered specialist surgeons.
Upon seeing the title “cosmetic surgeon”, the consumer is highly likely to infer that behind the title Cosmetic Surgeon is a Registered Surgical Specialist. The McNair Study 2019 that surveyed 2000 Australians confirmed that 81% of those surveyed believed that the title Cosmetic Surgeon implied the doctor was a registered specialist. Doctors who use the title “cosmetic surgeon” are well aware of the influence and impact the title “cosmetic surgeon” has on the consumer’s decision. Despite this, they continue to knowingly and recklessly use the title that adds to consumer confusion and affects patient safety.
Cosmetic inquiries into patient harm
Cosmetic Surgery has been practiced since the 1960s by registered specialist plastic surgeons. In the 90s, doctors who were not registered specialist surgeons started to advertise the regulated health service of cosmetic surgery by using the title “cosmetic surgeon”. Following reports of numerous cases of patient harm due to cosmetic surgery, there have been 4 inquiries in the 20 years between 1998 and 2018. The findings are summarised in the table below.
| Year | Inquiry | Findings |
| 1998 | NSW committee of inquiry into Cosmetic Surgery | Fewer patient safeguards for those seeking cosmetic surgery |
| 2010 | AMWAC interjurisdictional cosmetic surgery working group | Use of titles and qualifications Should not imply that the practitioner is more skilled or has greater experience than is the case.Use of titles and qualifications Should not mislead public into believing that the practitioner is a specialist if not so recognised through established processes |
| 2013 | QLD health quality and complaints commission – report based on 115 consumer complaints in cosmetic surgery 2006-2012 | Identified instances of medical practitioners misrepresenting their qualifications when advertising Recommended that use of titles and qualifications should not imply that the practitioner is more skilled or has greater experience than is the case |
| 2018 | NSW Parliament: Cosmetic Health Service complaints | Identified health providers who do not comply with the lawIdentified use of the title cosmetic surgeon being problematicRecommended restriction of the title cosmetic surgeon |
Summary
Doctors who are not registered surgical specialists continue to hold out to be specialists by using the title “cosmetic surgeon”. Despite findings of four inquiries and numerous media reports of patient harm, the regulators turn a blind eye to this practice. In the interest of patient safety, neither the practitioner nor the regulator can justify this deceptive practice of holding out to be a specialist. Cosmetic surgery has risks, complications and failure. To protect patients, practitioners should be transparent about their title, registration and accreditation. AHPRA medical regulator should enforce the National Law. Transparency is the key to patient safety.
