more_vert
The cosmetic surgery industry in Australia has undergone significant regulatory reform in recent years in direct response to horrifying media reports of appalling patient stories and devastating outcomes. Plastic surgeons have been advocating for various reforms to the industry for many years, informed by our own experiences of seeing patients who had been harmed by those with inadequate surgical training and experience.
An independent review into the sector, published in August 2022, outlined several recommendations to improve patient safety, tighten guidance for practitioners and their advertising, and strengthen the processes for reporting and managing complaints. The Clinical Guidelines (and Advertising Guidelines) for medical practitioners who perform cosmetic surgery came into effect mid-2023 and mandated several changes in practice, including the requirement for a referral from a general practitioner, pre-operative assessment for psychological conditions, and specific cooling-off periods before surgery could be booked. These still placed the onus of compliance on practitioners and so had little effect on rogue practitioners within the industry.
The pitfalls of the cosmetic industry
Unlike the traditional medical model, whereby patients are referred by their general practitioner to see an appropriate specialist for their particular concern, the cosmetic industry functions more like a commercial marketplace. Patients are often attracted to practitioners through their pricing and advertising (now much more online and on social media, rather than traditional methods) and commonly lack the nuanced understanding of the meaning of specific experience, training and titles.
It is noteworthy that our legislative framework under the National Law does not restrict practitioners on scope of practice, but rather on the title that they are allowed to use, and an expectation that they practice within the limits of their training and experience. Unfortunately, despite years of advocacy, the title of ‘surgeon’ was not restricted and could be used by any medical practitioner in Australia, even those without appropriate surgical training. This allowed practitioners that had not completed any type of formal surgical training to refer to themselves as cosmetic surgeons. Predictably, this misled many patients to assume that their treating practitioner had completed some form of surgical training when, in fact, they had not.
To the public, the title of ‘surgeon’ infers a depth of understanding, a level of skill, and a breadth of knowledge acquired over many years of rigorous and often arduous surgical training. It was this discrepancy between the public understanding of the title and its implied standards of professional practice and accountability, and the ability of those without any surgical training to use it, that misled many patients into decisions that they later regretted.
Restricting the title of ‘surgeon’
Thankfully, this has now been rectified with the state and federal health ministers agreeing to restrict the use of the title ‘surgeon’ through the Health Practitioner Regulation National Law (Surgeons) Amendment Act 2023 that was passed through the Queensland Parliament in September 2023. The bill now restricts the use of the title surgeon to those that have completed AMC-approved training and are registered specialists in the fields of surgery (all specialties of the Royal Australasian College of Surgeons), ophthalmology, and obstetrics and gynaecology.
Importantly, the legislated use of the title now matches the public’s understanding of its meaning. This has had a significant effect in the industry, allowing patients to more clearly understand the qualifications and training of their practitioner, and help them make more informed decisions about their care.
For the same reasons, it is worthwhile noting that the restrictions on the use of protected titles applies to all practitioners. Whilst the title ‘surgeon’ is restricted to those with AMC-approved surgical training, the title ‘plastic surgeon’ is restricted to those that have completed a formally recognised plastic and reconstructive surgery training program. It cannot be used by any other surgeon to describe their practice, regardless of the use of additional qualifying words. The law was introduced to ensure patients are appropriately informed about the training and knowledge of their practitioner and applies equally across the profession.
Continued vigilance needed
Nonetheless, continuing vigilance is required to ensure patient safety protections are maintained and that unscrupulous practitioners are not lowering standards to the detriment of patients or using titles that might mislead them. It is therefore important that Ahpra has a robust compliance and enforcement process to protect the intent of the law.
Broad reforms across the cosmetic industry continue with guidelines being introduced for health (non-medical) practitioners performing non-surgical procedures in July 2025, and ongoing consultation occurring with respect to the current laws around the prescription, supply, storage and administration of S4 medicines, including botulinum toxin and soft-tissue filler substances. Further reforms are also introducing stricter standards with regards to facilities in which cosmetic surgical procedures are performed.
These changes, affecting all elements of a burgeoning industry, are clearly designed to improve transparency and standards of care. The Australian Society of Plastic Surgeons remains supportive of changes designed to improve patient safety but warns that complacency will undermine the effectiveness of these changes if they are not consistently upheld by regulators, practitioners, facilities and the broader health system.
Mr David Morgan is a Specialist Plastic Surgeon and President of the Australian Society of Plastic Surgeons.
The statements or opinions expressed in this article reflect the views of the authors and do not necessarily represent the official policy of the AMA, the MJA or InSight+ unless so stated.
Subscribe to the free InSight+ weekly newsletter here. It is available to all readers, not just registered medical practitioners.
If you would like to submit an article for consideration, send a Word version to mjainsight-editor@ampco.com.au.