Know the Difference: Interview with Dr Rob Sheen

know the difference

Recently, ASAPS President Dr Rob Sheen was interviewed on radio station 2GB about our ‘Know the Difference’ campaign. You can listen to the podcast here or read the transcript of that interview: Nights with John Stanley below.

 John: The Australasian Society of Aesthetic Plastic Surgeons (ASAPS), the specialists in the area of plastic surgery, have started a campaign called Know the Difference. We spend something like a billion dollars a year on cosmetic procedures. ASAPS is talking about people who are calling themselves “cosmetic surgeons”, who are not the specialists that they are. Let’s try and bring in Dr. Robert Sheen. He is the President of the Australasian Society of Aesthetic Plastic Surgeons. He joins me now. Good evening to you, sir.

Dr. Robert Sheen: Good evening to you, John.

John: I guess the best way for us to understand this is we know there are medical specialists in all sorts of fields that we get referred to when we have an issue, a very specific issue. And from my understanding, people who become medical specialists have many years of training beyond their time at medical school. Is that your group?

Dr. Robert Sheen: That is absolutely correct, John. Our group consists of specialist plastic surgeons who have done on average between eight and 12 years of surgery beyond medical school to achieve specialist recognition in Australia.

John: So then, cosmetic surgeons, they’re still doctors though, aren’t they? But they’re different to the people you represent.

Dr. Robert Sheen: So let’s take things one thing at a time, John. People who call themselves cosmetic surgeons are doctors. The category of cosmetic surgeon is not one that is recognised by the regulators in Australia as an approved specialty.

John: Right.

Dr. Robert Sheen: So this name “cosmetic surgeon” has been made up or fabricated by these doctors in order to convince patients that they are qualified to perform cosmetic surgery. Now, we find this very problematic, because we believe a lot of patient harm comes from this, because patients think, when they go and see someone with the title cosmetic surgeon, they are seeing a specialist, a surgical specialist. And our internal research has shown that over 80% of people in Australia believe that someone who calls themselves a cosmetic surgeon is a registered specialist, but that’s simply not the case.

John: Is the suggestion here that, you think to yourself, ‘I want to go and maybe get rid of some lines, get rid of the turkey neck’, whatever it is. Cosmetic surgery sounds a more appealing way than plastic surgery. Is it just the terminology that’s being used here?

Dr. Robert Sheen: I think the terminology has a lot to do with people’s perceptions. I think you’re right. But I think it’s probably more correct to say, if someone perceives they’ve got a problem with their appearance and wants to get that changed for self-esteem reasons, we would call that a cosmetic procedure.

John: Yes, yes.

Dr. Robert Sheen: But the fundamental surgical principles behind that are actually extremely complex. And in order for a practitioner to do that effectively, they need years of training in all sorts of surgery in order to deliver treatment that is effective, but also very safe for people.

John: Is there also an element where cosmetic surgeons are charging less? Is that one of the appeals? I haven’t checked it out. I don’t know.

Dr. Robert Sheen: No, and I haven’t checked it out either, John, but one of the things that we’ve found is that a number of patients who have been treated by non-plastic surgeons require revisionary surgery afterwards to fix a number of problems. So what may turn out to be a very inexpensive procedure in the beginning, could turn out to be very expensive in the long run, if the patient requires multiple operations to get things right.

John: Is there also an element here because of what you do, people assuming that you do, because you mentioned getting rid of lines and trying to straighten people’s faces out and that kind of thing, that people assume you do that exclusively when you say this is what I’m doing, I’m a specialist plastic surgeon. When in fact, you deal with burns, skin cancers, some quite severe conditions that have to be dealt with.

Dr. Robert Sheen: That’s exactly right. And it’s in fact, our knowledge and understanding of these severe conditions that give us the background knowledge and the confidence to go on and treat people who have aesthetic concerns as well. The underlying principles are exactly the same. People are having operations, which are invasive, potentially risky procedures. And they need to be treated by people who understand exactly what’s going on with their medical care.

John: Just the name of your organisation, Australasian Society of Aesthetic Plastic Surgeons – what kind of work would be predominantly done by your members?

Dr. Robert Sheen: Our members do a range of work, and most have mixed practices. So, our members do things like breast enlargement surgery, nose jobs, removing wrinkles from people’s faces. But they also do things like treat facial skin cancer, because people want to have their cancer treated, but come out of that treatment not having their appearance altered. Our members treat young children, babies with congenital deformities. Our members treat people with severe burns. They do a range of treatments, but they also provide world-class aesthetic surgical services.

John: You mentioned breast enlargement, so I imagine that’s one of them, and even people who get their breasts reduced, that would be something that forms a fair bit of your practice for your people.

Dr. Robert Sheen: That is correct, yes.

John: And cosmetic surgeons are doing the same thing, but they’re not as qualified to do it.

Dr. Robert Sheen: Well, as a group they’ve used this title. So let me give you a very specific example. If someone qualifies from medical school and never, ever goes on to do specialist training, in other words, they’re a general practitioner, they can call themselves a cosmetic surgeon quite legally.

John: Yes.

Dr. Robert Sheen: Have people believe that they are registered specialists. And then go on and do this type of work. It’s our view that this is very dishonest. We cannot find any legitimate reason why a doctor would want to misrepresent themselves to a patient, unless it’s to deceive them.

John: And have you talked to the regulators about this plan that you have?

Dr. Robert Sheen: We are talking to the regulators, and the regulators understand our concerns. And we are developing a very good relationship with the regulators to try and have these problems addressed. And you’ve got to remember that there’s a very, very strong public interest case to have clear and transparent titling so that people can choose their medical practitioner with confidence, understanding exactly what they’re getting themselves into.

John: I want to ask you a couple of questions about what you do, because I assume in the time you’ve been doing it, the techniques have got better, and the results presumably have got better, as well. Are there any areas where you’ve really made some big strides, say the last 10-20 years?

Dr. Robert Sheen: Over the last 10 to 20 years, the most important things have been a lot of what we would call adjunct treatments or nonsurgical treatments, devices such as laser, better skincare, understanding some of the biological and molecular mechanisms behind ageing. And that’s really helped us to improve our techniques. The other big advance is that we are learning to do things in ways that can speed patients’ recovery. In other words, they can have less downtime, get through their procedures with less hassle, less inconvenience in their daily lives, and enjoy the benefits of surgery in a much safer way.

John: We all know, going back years when we saw perhaps the early days, when people’s faces wouldn’t move. You do it better now, don’t you?

Dr. Robert Sheen: Oh, definitely.

John: You’ve seen those results, haven’t you, over the years? And maybe there are people who get to a certain age, is this part of what you do as well? Maybe you’ve got to do a bit of counseling and say, listen, you don’t look that bad. Stick with what you’ve got.

Dr. Robert Sheen: You’ve got to remember that we’re primarily doctors. We’re not there to perform an operation at all costs. We’re there to give patients the best possible advice that is in the patient’s interests, not in the doctor’s interests. So yes, our members are very cognisant of the fact that they have to put the patient first in all their decision-making.

John: So do you get to that point where you’ve got to say, listen, I don’t think this is a great idea. And do you give that advice?

Dr. Robert Sheen: We give this advice every day of the week to people, because at the end of the day, we have to act in the patient’s interest. That’s our primary duty as doctors.

John: It’s a most interesting field that you’re working in, and I wasn’t aware of this distinction. I wasn’t aware that there is your society of specialists. So I think we’ve learned a little bit tonight, and I thank you very much for your time. 

Dr. Robert Sheen: It’s been my pleasure, John. Thank you.


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