Cosmetic surgery industry needs more than a tummy tuck

The exposure by Adele Ferguson and her colleagues at the Herald, The Age and the ABC of the severe shortcomings of a leading cosmetic surgeon – claimed by plastic surgeons to be “the tip of the iceberg” – raises difficult regulatory questions.

Should cosmetic surgery be put on the same highly restricted, highly regulatory footing as plastic surgery? Or should the current seemingly freewheeling regulatory approach be continued with perhaps a tokenistic “tummy tuck” to tighten it up, as seems to be the view of the highly captured Australasian College of Cosmetic Surgery and Medicine.

Cosmetic surgery is under scrutiny. Credit: iStock

In my view, neither is the answer. What is required is much stronger independent regulation and greater industry transparency to prevent the exploitation of consumers, especially vulnerable ones.

The regulation of medical practice has attracted strong opinions over the years. According to George Bernard Shaw, “That any sane nation, having observed that you could provide for the supply of bread by giving bakers a pecuniary interest in baking for you, should go on to give a surgeon a pecuniary interest in cutting off your leg, is enough to make one despair of political humanity.” Shaw conceded that operations are necessary but added “it may be necessary to hang a man or pull down a house. But we take good care not to make the hangman and the house breaker the judges of that. If we did, no neck would be safe and no man’s house stable.”

Obviously, Shaw favoured external regulation of the medical profession.

An equally strong and highly influential opinion was expressed by the doyen of free market economics, the late Milton Friedman. Friedman argued passionately against the system of medical regulation. Liberal principles, he said, did “not justify licensure even in medicine and that in practice the results of state licensure in medicine have been undesirable”. According to Friedman, licensing “almost inevitably becomes a tool in the hands of a special producer group to obtain a monopoly position at the expense of the rest of the public” and can be buttressed by actions to restrict numbers in the chosen profession.

Why is cosmetic surgery treated so differently from other forms of surgery? One reason is the trivialisation of the procedures – the language of “tummy tucks” and “man boobs” distracts attention from the fact that much cosmetic surgery involves significant health, even life-threatening, risks – more so if compounded by inadequately regulated and poor medical practices, such as deficient sterilisation or improper prescription writing, as exposed by Four Corners and this masthead.

Another key reason for the inadequate regulation is that cosmetic surgery is not seen as part of the health system. Rather, it is perceived as being not about sick people but about people who are concerned about their appearance. It is not a recognised field of specialisation in medical schools. It is not a Medicare item nor government-subsidised. It has slipped lightly through the field of strict surgery regulation.

This is not to say that on paper the field is totally unregulated. There exists an array of regulations that could be used to greater effect. There is licensing (by health departments) of day-procedure centres and private hospitals where cosmetic surgery is practised. There are other forms of regulation such as drug and poisons laws and general public health and medical regulation.

The Australian Health Practitioner Regulation Agency (AHPRA) seems to experience difficulty in dealing with rogue practitioners. They typically have deep pockets and there is a degree of loyalty by medical practitioners which makes the gathering of evidence for administrative law tribunals difficult. The key problem, however, is that it lacks relevant powers.

This matter cannot be left to self-regulation by the very commercially driven, self-interested Australasian College of Cosmetic Surgery and Medicine. Its current training, certification and accreditation requirements are a minimal fig leaf intended to ward off serious regulation. Cosmetic surgeons do not have anything remotely resembling the selection, training and certification practices that are required for such invasive surgery. In fact, “cosmetic surgeons” do not even require ACCSM certification to practise.

Independent mandatory medical regulation is required, including arming AHPRA and others with the required powers to enforce substantial training, certification and accreditation requirements.

The diversionary push from the ACCSM to label the matter as a turf war between cosmetic and plastic surgeons needs to be strongly rebutted. It’s not a turf war. The aim is not to kill off cosmetic surgery. It is about ensuring there is proper independent regulation of cosmetic surgery in the interests of the public, and much greater transparency for customers about the risks of cosmetic surgery practices.

This will ensure the right balance between Shaw and Friedman.

Professor Allan Fels is a former chairman of the Australian Competition and Consumer Commission.

Statement of Professor Allan Fels AO

On 28 October 2021 I wrote an opinion piece in The Sydney Morning Herald entitled “Cosmetic surgery industry needs more than a tummy tuck”.

The Australasian College of Cosmetic Surgery and Medicine (the College) and its office holders have complained about the article.

They are concerned that the article suggests that the College is opposed to the independent regulation of cosmetic surgery in favour of a pretence of training and certification, and is a haven for cosmetic cowboys, that is to say doctors who exploit their patients by performing cosmetic surgery with reckless disregard for patient safety.

I acknowledge that the College has stated, including in submissions to the Senate Inquiry, that it supports the independent regulation of cosmetic surgery. My article did not use the words “cosmetic cowboys”, which was an editorial headline inserted at publication. It was not my intention that the article convey this. If, however, the article was taken to say this, I reject that suggestion.