News

---

Cosmetic surgery safeguards undergo major facelift

---

UPDATED*

Patients must now pass a psychological assessment before going under the knife, according to a new set of Cosmetic Surgery Standards released on Thursday by the Australian Commission on Safety and Quality in Health Care.

The new standards complement the Medical Board’s revised Guidelines for medical practitioners who perform cosmetic surgery and procedures, which came into effect on 1 July 2023.

Surgeons and facilities will be forced to comply with the new rules, which are designed to better protect patients, as well as ensure they are aware of surgical risks and are equipped with appropriate aftercare arrangements.
 
The Commission was tasked with writing the standards by the Department of Health and Aged Care in 2022 following a ‘litany of appalling stories of poor practises’.
 
The Commission said it was particularly concerned with the disproportionate number of people seeking out cosmetic procedures who were also burdened by mental health challenges.
 
It also said surgery advertising must comply with legislation to prevent ‘poor-quality ads that may deceive or manipulate consumers’ and that services must seek feedback from patients about their experiences and outcomes. Practitioners advertising cosmetic surgery must also comply with the Medical Board’s Guidelines.
 
Additionally, the Commission said services must have credentialing processes to verify the qualifications and experience of all practitioners, as well as a plan for post-operative continuity of care.
 
The Cosmetic Surgery Standards ultimately are comprised of seven individual components:

• Clinical governance to ensure ‘good clinical outcomes’  
• Partnering with consumers so patients are fully informed of the risks and costs of services
• Preventing and controlling infections through appropriate prescribing
• Medication safety to ensure clinicians are competent to safely prescribe, dispense, administer and monitor drugs
• Comprehensive care and the implementation of an individual care plan
• Communicating for safety between patients, clinicians, carers, and clinicians
• Recognising and responding to acute deterioration, both physically and mentally

The new standards also reinforce that all patients seeking cosmetic surgery must have a referral before going ahead with the procedure, preferably from their usual GP, which has been a requirement since July last year. 
 
Australian Commission on Safety and Quality in Health Care Clinical Director, and former RACGP President, Associate Professor Liz Marles told newsGP one of the most important assessments performed ahead of a surgery is the suitability of a patient.
 
‘Around 20% of people who are going to have cosmetic surgery have body dysmorphic disorder, and GPs are going to be very familiar with that sort of thing,’ she said.
 
‘People with eating disorders, for instance, don’t see themselves the same way as others see them, so I think that recognition that a person’s judgement might not be accurate at that point in time is important.
 
‘Any cosmetic surgeon or facility will need to ensure that when someone comes to the cosmetic surgery, that they’ve had a psychological assessment, that they’re actually suitable.’

Medical defence organisation Avant highlighted that the Medical Board’s Guidelines stipulate that it is the practitioner intending to perform cosmetic surgery who must assess patients for underlying psychological conditions, and this cannot be delegated. 
 
Associate Professor Marles said facilities themselves and the surgeons carrying out procedures also need to be appropriately credentialed, whether that be in a day care or hospital setting.
 
Patients likewise need to be given a realistic idea what to expect before, during and after any procedure, and the risks associated with going under the knife.
 
The standards come after the Australian Health Practitioner Regulation Agency (AHPRA) launched its Cosmetic Surgery Hotline in September last year, receiving 179 formal complaints or notifications since then.
 
As a result, 14 doctors are no longer practising cosmetic surgery or have significant restrictions in place as an interim measure while investigations continue.
 
Australasian Foundation for Plastic Surgery Director Dr Garry Buckland said the new standards provide a framework for ‘gold standard clinical practice in a field that has lacked direction for too long’.
 
‘The reputation of cosmetic surgery and the integrity of those who practice it has reached an all-time low,’ he said.
 
‘Compliance to the Cosmetic Surgery Standards is a win-win for patients, practitioners, and the broader community.
 
‘In a field that has lacked regulatory rigour, patients can be reassured by these standards that they will be able to receive the best possible care, in a safe environment, by trained medical professionals.’
 
According to the Commission, Australians spent an estimated $473 million on cosmetic surgical procedures in 2023, with the most common being breast augmentation, eyelid surgery, and liposuction.
 
Associate Professor Marles said this exponential growth has led to GPs facing an increase in questions from curious patients.
 
‘As a GP, I know the general risks associated with surgery and if it’s one of my regular patients, I know whether they’re in the right headspace to make that decision or not,’ she said.
 
‘I can have a completely unbiased conversation with them about what their reason for doing it is, the right time for them to be thinking about it, and the general risks associated with surgery.
 
‘GPs can really assist patients a lot in this space and although it may feel like it’s another job for GPs, I think if we think about it in the context of that continuing relationship, it’s really about protecting our patients from harm.’

The Medical Board has published FAQs to provide clarity regarding the role of GPs in referring patients for cosmetic procedures.

Avant confirmed the role of the GP is two-fold:

• provide referrals for suitable patients
• provide ongoing management of patients referred to them by medical practitioners performing cosmetic surgery after a psychological assessment has identified the patient may be unsuitable for surgery 

The standards end by detailing a range of consumer outcomes, including ‘I am confident the service is well run and that I will receive safe, high-quality clinical care’, ‘my opinion is valued in designing and delivering services’, and ‘my risk of getting or spreading infection is assessed and minimised’.
 
Associate Professor Marles said every patient has the right to safe and appropriate care, as well as the right to knowledge of what their procedure will entail.
 
‘We’re in a first world country, somewhere with healthcare that looks after our patients, and I think it’s totally essential that the general public is protected,’ she said.
 
‘This is actually a good news story for the medical profession, because none of us want to be dragged down or to be associated with practices that are substandard and end up harming patients.
 
‘Especially for vulnerable patients who are already suffering from low self-esteem and self-confidence, if they go through a procedure which has a bad outcome, it’s really tragic.’
 
As of Thursday, all services where cosmetic surgery is performed can start the process of accreditation under the new standards.

*This article was updated to 18 January 2024 to clarify aspects surrnounding GP responsibilities under the new standards.
 
Log in below to join the conversation.

---

---

AHPRA cosmetic procedures cosmetic surgery patient safety

---