Cosmetic surgery ‘blunders’ – will the new guidelines assist?

We have all seen the tabloid media headlines and Facebook pictures of cosmetic surgery disasters. Most frequently it seems to be fillers gone wrong or over zealous sculpting with the scalpel. However, there have also, tragically, been instances when patients have gone into cardiac arrest, developed life threatening infections or have died following a cosmetic procedure. Whilst there is a distinction between cosmetic medical procedures and cosmetic surgical procedures, to the purpose of this post I will refer to them collectively as “cosmetic procedures”.

Often the public reaction is that the adverse event arose because the procedure was performed by an inexperienced practitioner in substandard conditions. As cosmetic surgery is not a recognised specialty, and can be performed by a wide range of medical, and allied health, practitioners, there is an element of truth to that impression. However that is not the only reason for what appears to be a disproportionate amount of complaints about cosmetic procedures.

In 2013, Queenslands Health Quality and Complaints Commission (as it was then known) analysed complaints received about cosmetic procedures provided by Queensland health and allied health practitioners between 2006 and 2012. The report found that there were “fewer patient safeguards and  less regulation in place for cosmetic procedures than for other areas of medicine”. In part that arises by virtue of the nature of cosmetic surgery, particularly considering that:

  • Cosmetic procedures are entirely elective and is usually requested by the patient. Often that patient, motivated by a desire to improve appearance and not a medical need, has preconceived ideas of the risks and likely outcome as a result of independent google searches and discussions with family and friends.  Therefore there is a tendency for the patient not to take on board, or critically analyse, information provided to them by the practitioner during the initial consultation.
  • The procedures are performed outside the public health system in private hospitals, day procedure centres, practitioners rooms and beauty salons. Such locations are often less regulated and may have less direct after care available.
  • Due to the elective nature the consultations and procedures are usually paid for directly by the patient and at a considerable cost. Therefore the temptation to the patient is to minimise pre and post consultations and time spent in hospital. This can lead to less than optimal post operative care.
  • The safety of some devices, such as lasers and IPLs, used for cosmetic surgery are regulated on a a state by state basis. Not all states regulate such devices.

In May 2016, the Medical Board of Australia issued guidelines for registered medical practitioners who perform cosmetic medical and surgical procedures. The guidelines come into effect on 1 October 2016. The guidelines include:

  • guidance on the manner in which the first consultation should be conducted, including the recommendation that it be conducted by a registered health practitioner, discussions as to the reason and motivation for the procedure, alternative treatment options and the expected outcome of the procedure;
  • a seven-day cooling off period for all adults before major procedures (ie. anything that involves cutting of the skin);
  • a three-month cooling off period before major procedures for all under 18s and a mandatory evaluation by a registered psychologist, general practitioner or psychiatrist;
  • a seven day cooling off period before minor procedures for all under 18s, and where required, evaluation by a registered psychologist, general practitioner or psychiatrist;
  • the provision of detailed written information, in plain English, about, amongst other things, the nature of the procedure, the practitioner’s qualifications and experience, and the risks and complications of the procedure;
  • the treating medical practitioner taking explicit responsibility for post-operative patient care and for making sure there are emergency facilities when they are using sedation, anaesthesia or analgesia;
  • a mandatory consultation before a medical practitioner prescribes schedule 4 (prescription only) cosmetic injectables, either in person or by video consultation; and
  • the provision patients with detailed written information about costs.

While many medical practitioners providing cosmetic procedures will already practice in a manner that is consistent with the guidelines, all should ensure that their practices are reviewed, and adapted if necessary. Certainly, pursuant to Section 41 of the National Law these guidelines will be admissible in disciplinary and civil proceedings as evidence of what constitutes appropriate professional conduct or practice and therefore medical practitioners who do not comply with them are likely to face disciplinary and civil exposure.

However, cosmetic procedures are also conducted by  health practitioners, such as cosmetic nurses and podiatric surgeons, who are not be subject to the guidelines as they are not “registered medical practitioners”. Perhaps we will see the adoption of the Medical Board Guidelines by the professional bodies of other allied health practitioners?

Further, the guidelines do not go so far as to require any specialist training prior to a registered medical practitioner using the title “cosmetic surgeon”. The guideline to advise the patient of one’s experience and qualifications may provide sufficient information to some patients, however there are many that will not understand the details and significance of a practitioner’s qualifications, or lack there of.

So while the new guidelines can only be seen as a positive step, there is still further room for improvement and increased regulation in this booming industry.

If you have any questions in relation to the application of the guidelines please contact Julie Somerville, Principal.

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