AWhen I walked into the emergency room where Kate was sitting, the first thing I noticed was the smell. A faint, disturbingly sweet smell of bacteria mixed with a musky scent. In tears, Kate unbuttoned her shirt, revealing one of the worst post-operative infections I had ever seen. She was painted in a kaleidoscope of colors, with bruises that completely covered her breasts. She had a breast augmentation two weeks ago. The cut on the bottom of her left breast was red, puffy, and festering. The implant in the right breast appeared to have migrated laterally and there was an asymmetry between the pair. Kate was upset and aptly stated: “It’s a botch job, not a bosom job.”
At first, Kate told me, she was delighted with her choice of cosmetic surgeons. She found her page on social media. She even had a colleague who went to the same doctor about botox and was thrilled with the results. Kate was an educated, highly intelligent woman. She felt she had done her duty of care before going to the operation. She had extensively researched the risks of breast augmentation and read the doctor’s rave reviews. Your advisory office was clean and modern, and the reception staff was friendly. She had had friends who made bad decisions and sought the same surgery in third world countries for a fraction of the price. She could afford the operation in Australia and was confident that she was making a responsible choice.
A GP would be reprimanded for performing appendicectomy in their practice, but for some reason a nose job or liposuction is acceptable
On average, breast augmentation surgery in Australia can cost anywhere from $ 6,000 to $ 20,000 and is usually not covered by Medicare. A “cheaper” procedure can often be performed when a patient is willing to see a less qualified surgeon, e.g. B. A cosmetic surgeon without approval from the Royal Australasian College of Surgeons (RACS). Cheaper brands of implants can be used and the operation can be performed in a clinic rather than a hospital with an experienced anesthesiologist team under general anesthesia. Terrifyingly, many of these cheaper cosmetic surgeons also have no hospital admission rights, and if the operation doesn’t go according to plan, they’ll have to call an ambulance to take the patient to an emergency room in the middle of the operation.
Despite her research, Kate didn’t understand the inherent difference between a cosmetic surgeon and a plastic surgeon. Anyone could be forgiven to think, as Kate did, that the two were the same thing and could be used interchangeably. Little did she know that the slightly lower cost of the procedure was a discount for a lack of training, expertise, multidisciplinary staff, and adequate anesthesia support.
For those seeking surgical aesthetic enhancement, there is an implicit belief that the doctors performing the invasive surgical procedures are actually trained surgeons. However, this is not always the case. Under current regulations in Australia, any physician with general registration with the Australian Health Practitioner Regulation Agency (Ahpra) can market themselves as a cosmetic surgeon without additional training. A pediatrician could do liposuction, an ophthalmologist could do your tummy tuck (tummy tuck), a pathologist could offer you a nose job (rhinoplasty), and a psychiatrist could do your Brazilian post-tightening.
Kate’s cosmetic surgeon had no formal surgical training as a Fellow of the Royal Australasian College of Surgeons; was not a plastic surgeon with over a decade of rigorous, supervised surgical training; and had not developed the ability to deal with complex and unexpected complications with finesse, or to understand the subtle nuances of anatomical variation. Her operations were all performed in a specialized clinic, not a hospital with intensive care access and advanced emergency life support. Before that, Kate’s surgeon worked in a completely different, non-surgical specialty. One day they decided to become a cosmetic surgeon. And then it was them.
The cosmetics industry is booming. Australians spend over $ 1 billion each year on cosmetic procedures. In 2017, more than 20,000 breast augmentations and 30,000 liposuctions were performed in Australia. Roughly speaking, the cosmetic field can be divided into cosmetic medicine and cosmetic surgery, with cosmetic medicine encompassing all non-invasive procedures and cosmetic surgery encompassing all invasive surgical procedures designed for aesthetic enhancement, including rhinoplasty, blepharoplasty, breast augmentation, and neck lift .
In 1998 the Cosmetic Physicians College of Australasia was founded to regulate the field of cosmetic medicine (as opposed to cosmetic surgery). So far there is no official Australian college for cosmetic surgeons. Cosmetic medicine only involves practicing non-invasive medical treatments, including dermal fillers, anti-wrinkle injections, laser and IPL machines, and treating scars, vascular defects and rosacea. Many consumers will see their family doctor, dermatologist, dermatologist, or registered nurse to perform these procedures. In contrast, plastic surgeons are arguably the only surgical specialty uniquely qualified to perform the risky and technically demanding invasive cosmetic surgeries such as tummy tuck and breast augmentation.
The Australian Society of Plastic Surgeons (ASPS) has been calling for uniform national regulations for cosmetic surgery in practice for years, arguing that the current lack of supervision poses a critical risk to patient safety. There are currently no regulations and no licensing requirements for a doctor who performs cosmetic surgery in the practice. Professor Hugh Bartholomeusz, former ASPS president, argued that “we are aware that consumers are ill-equipped to see whether the doctor they choose for their cosmetic surgery is adequately trained to perform their procedure.” A GP would be reprimanded for performing appendicectomy in their practice, but for some reason a nose job or liposuction is acceptable.
As this topic is gaining traction and publicity, we have taken steps in the right direction. In 2018, the governments of Victoria, Queensland, and New South Wales passed laws restricting the types of facilities where cosmetic surgery can be performed. In 2019, Federal Health Secretary Greg Hunt urged state and territorial health ministers to restrict the use of the title “surgeon”. However, these steps are not enough to adequately safeguard the interests of the hundreds of thousands of Australians who seek plastic surgery every year and face this potentially dangerous ambiguity.
It’s a tragedy. But not one that is completely inevitable. Kate wondered: “If I had known the difference between a plastic surgeon and a plastic surgeon back then, I would never have chosen them to operate on me. It is completely misleading. “
Consumers spend a lot of time researching a particular surgeon’s price. However, they often remain unaware of the potential non-monetary costs.
* Pseudonym used to maintain confidentiality
Dr. Yael Lefkovits is a doctor at the Royal Melbourne Hospital