Opinion
Worse than Wild West: cosmetic cowboys must be reined in
Mark Ashton
Professor of surgeryCosmetic surgery in Australia as it is currently practised exposes the public to significant risks. Untrained or inadequately trained practitioners pretend they are the same, or even better trained, than fully trained Fellows of the Royal Australasian College of Surgeons.
It’s worse than the Wild West – at least in the Wild West you had an understanding of the inherent risks and knew it was a dangerous environment.
Social media plays a key role in the promotion of cosmetic surgery.
Every day, I see maimed patients asking me to fix the results of cosmetic surgery they were told was safe. They were led to believe their operator was a fully trained “surgeon”. How has it come to this? That in a society with access to the best in medical care, we allow our young and vulnerable to be exposed to avoidable and unnecessary harm?
Under regulations as they now stand, practitioners with very basic or no surgical training are deliberately obfuscating and blurring their credentials to beguile a trusting and medically illiterate public that mostly does its research on the internet and through social media.
These patients are enticed to undertake operations they would never have considered had they been presented with a full understanding of the risks of the procedure and the lack of surgical training of the person operating on them. To make matters worse, often this surgery is performed in substandard environments dressed up to look like licensed medical facilities. These would not ordinarily meet the requirements for regulation and accreditation by state departments of health.
Moves to lift a ban on patient testimonials would open the floodgates on social media.Credit:
When challenged, this small subset of cosmetic practitioners, who are not trained and examined to the standard set by the independent Australian Medical Council, claim that modern cosmetic surgery is a new specialty and that no one is trained in it. They claim not even plastic surgeons are fully trained in cosmetic surgery. They then go further and allege that, in fact, they are the experts, and that they should dictate and control cosmetic surgical training.
These statements audaciously and deliberately overlook the two basic tenets of all plastic surgery: function and form. Any plastic surgical reconstruction must seek to maximise restoration of function, but equally must achieve the best possible cosmetic outcome.
They conveniently overlook plastic surgery’s origins in the reconstruction of facial wounds inflicted upon soldiers in World War I. Indeed, one of the things about the plastic surgeons undertaking what was then a new speciality was that the master reconstructive surgeons could be identified by their capacity to produce a beautiful cosmetic result for the courageous young men trying to reintegrate back into society with horrific facial injuries. This is still true for all plastic surgery, be it in reconstruction of a cleft lip and palate, a breast mastectomy defect, or head and neck cancer.
This argument could be easily, and naively, dismissed as just another turf war between two groups, one trained and the other untrained to standards set by the Australian Medical Council was it not for the fact that patients are being unnecessarily injured, regularly maimed and, in some cases, even died.
Cosmetic surgery is not risk-free. Any surgery, even cosmetic surgery, has a risk of complication and, in rare circumstances, of death. To mitigate, but not eliminate this risk, a prospective patient has to be able to ensure that the person performing the surgery is properly trained, and that their training can be held up to an objective independent national body’s standard that is recognised and can be assessed as being the best in surgical care internationally. The public and the community deserve no less.
The skills necessary to safely perform cosmetic surgery are no different from those required to perform any surgery, and practitioners are required to have the same ethical and moral framework around which they perform surgery. These practitioners need to have specific credentialed skill in the scope of surgery they are performing, be able to manage patient expectation, care for their patient and manage complications should they arise.
Further, their surgical training needs to be objectively and independently held against a known national standard, in the same way we independently rate those training skills applicable to all other surgery. The results of this assessment, and those surgeons who have attained it, have to be freely and readily available to the public and, in the case of cosmetic surgery, ubiquitously available on social media as well.
Australia is not alone – similar regrettable instances of compromised patient care have occurred in Britain and America. The forthcoming Australian Health Practitioner Regulation Agency inquiry provides an opportunity for Australia to reject the arguments of the cosmetic cowboys and institute safeguards necessary to yet again lead the way in public safety and international plastic surgical care.
Professor Mark Ashton is professor of surgery and anatomy at the University of Melbourne and past president of the Australian Society of Plastic Surgeons.