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Putting cosmetic surgery under the microscope

Putting cosmetic surgery under the microscope

Published on September 25, 2017 by Bill Madden and Justine AndersonBill Madden and Justine Anderson

Despite the seemingly increased popularity of cosmetic procedures, it might surprise many Australians that the industry here is far less regulated than other areas of medicine.

It’s no question that the cosmetic surgery industry is continuing to grow rapidly, perhaps as a consequence of the image-obsessed world in which we live in.

It is estimated that 15,000 Australians spend $300 million a year travelling overseas for cosmetic procedures, let alone the numbers who undergo cosmetic surgery here in Australia.[1]

Yet as thousands flock to have cosmetic surgery, many people may not know that a cosmetic surgeon does not need to hold the same level of specialised training as a plastic surgeon or that a cosmetic surgeon can undertake procedures in facilities other than hospitals and which may not be properly equipped if something goes wrong.

So, who are cosmetic surgeons and how can they operate?

Plastic surgeons vs. cosmetic surgeons  – Is the training the same?

One of the most significant differences between plastic surgeons and cosmetic surgeons is the level of training.

In Australia, in addition to holding a Bachelor of Medicine & Bachelor of Surgery (‘MBBS’) plastic surgeons must complete a specialisation by way of a fellowship (FRACS (PLAS)) and thereby completing an additional 5-10 years in education and training.

On the other hand, any registered practitioner with an MBBS can call themselves a cosmetic surgeon without any specialty training or surgical qualifications from FRACS. 

Plastic surgeons vs. cosmetic surgeons  – Where they can operate?

Cosmetic surgery procedures can be performed in both licensed facilities such as hospitals as well as in unlicensed facilities such as private operating rooms.

The only restriction placed on cosmetic surgery procedures in unlicensed facilities is the level of anaesthesia that surgeons are permitted to use. For example, general anaesthetics can only be administered in licensed facilities. 

However, a cosmetic surgery practitioner may use what is known as “twilight/conscious sedation” where patients are given doses of anaesthetics but essentially remain awake.

This means that medical practitioners can legally perform for example, a breast augmentation in an unlicensed facility if they are not using a general anaesthetic.

Unlicensed facilities do not have to adhere to the same strict hospital protocols or safety standards and there are very few, if any, rules governing equipment, staffing or hospital back-up in case of an emergency.

So what could possibly go wrong?

When using twilight/conscious sedation an anaesthetist may not necessarily be present and in these situations the surgeon undertaking the procedure is also administering the anaesthetics.

This poses a number of issues to the patient.

Amongst other things, anaesthetists’ sole responsibility is to monitor the vital signs of a patient and keep them alive during the procedure. The anaesthetist is trained to understand the subtleties and nuances of the transition from consciousness through to sedation and can respond to any emergencies. Some of the risks an anaesthetist is trained to recognise and respond to include overdoses, cardiac arrests, toxicities, infections, seizures and oxygen deficiencies.

Additionally unlicensed facilities may lack requisite machinery and equipment needed to manage an emergency, and may also not be in close proximity to hospitals. 

The law and what you need to know

The law requires certain information be provided to a patient, such information includes a description of the procedure including its inherent risks and side effects in an easily comprehensible way; also, what particular form of pain relief will be provided (e.g. local anaesthetic, sedation or general anaesthetic) – such information forms the basis of informed consent.[2]

In addition a patient would be wise to ask questions such as:  

  • Who will be performing the procedure?
  • Who will be monitoring me during the procedure (e.g. anesthetist or another person who will be monitoring my pain relief and breathing)?[3]
  • Where the procedure is going to take place; and
  • What facilities are available in the event of an emergency?

As with any negligence claim, a patient who alleges that a medical practitioner is liable for failing to warn of a procedure’s material risk must establish that the duty owed was breached, i.e. a material risk was not disclosed, and that the harm sustained was caused by that breach.

Regulatory Measures

In 2016 the Medical Board of Australia issued a set of mandatory guidelines for all medical practitioners performing cosmetic medical and surgical procedures. The guidelines apply to all medical practitioners including specialist plastic surgeons and cosmetic surgeons, regardless of their qualifications.

The guidelines require:

  • A seven-day cooling off period for adult patients and a three-month period for under 18s,
  • The treating practitioner to take explicit responsibility for post-operative patient care and for making sure there are emergency facilities when using sedation and anaesthesia, and
  • The medical practitioner to provide clear information to consumers about their credentials and experience, risks and possible complications and detailed written information about costs.

Things to know if your are considering a cosmetic procedure:

  • Not all surgeons are the same when it comes to training
  • Plastic surgeons undertake 5 to 10 years on top of a basic medical degree
  • Anyone with a medical degree can practise as a cosmetic surgeon
  • Ask about where it will be undertaken and facilities available if an emergency occurs
  • Ask if the facility is licensed or unlicensed
  • Ask what kind of anaesthetic will be used and if a specialised anaesthetist will be present

If something goes wrong?

  • Seek immediate medical advice and treatment – do not delay
  • There are legal remedies available – seek independent legal advice as soon as you can

[2] See ‘Guidelines for registered medical practitioners who perform cosmetic and surgical procedures’, published 1 October 2016, guideline 4. <>

[3] Ibid, guideline 5, 6 & 8.

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