New cosmetic surgery regulations

Here’s what you need to know about Australia’s cosmetic surgery reforms.

As of 1 July 2023, significant changes have been made to Australia’s cosmetic surgery industry. These are part of a sweeping reform package issued by the Medical Board of Australia (MBA) and Australian Health Practitioner Regulation Agency (Ahpra) after an independent review found unsafe practices, misleading advertising and a need for minimum standards on qualifications.

The review was necessitated after alarming media reports of unsafe practices and medical misconduct of certain ‘cosmetic cowboys’ in the sector. As such, the new regulations are designed to protect patients and improve the standard of care for cosmetic procedures.

What’s new?

The new reforms mandate that all cosmetic surgery patients must have a GP referral, be screened for underlying psychological disorders such as body dysmorphic disorder, have at least two pre- operative consultations (at least one in-person with the practitioner performing the surgery), and a mandatory cooling-off period before booking or paying a deposit for the surgical procedure.

In addition, there is a ban on influencer testimonials and deceptive or misleading social media posts, as well as advertising that offers discounts without terms and conditions or creates unreasonable expectations of treatment or encourages indiscriminate use.

Cosmetic surgery advertising must now be identified as adult content. Videos and images must be used responsibly and not for entertainment and must not be sexualised or include gratuitous nudity. The use of negative body language is banned, such as ‘mummy makeover’, ‘problem area’, ‘unsightly bulges’ and ‘thigh gap’ and the use language that promotes ‘ideal’ body shapes is also banned, such as ‘bikini body’, ‘happier, healthier you’, ‘look as young as you feel’, ‘art’ and ‘sculpt’.

Medical practitioners must include clear information about their registration type and their registration number, and provide easily accessible information about risks and recovery.

COSMETIC SURGERY PATIENTS MUST HAVE A GP REFERRAL, PSYCHOLOGICAL SCREENING, TWO PRE-OP CONSULTATIONS, AND A COOLING-OFF PERIOD.

GP referral

All patients seeking cosmetic surgery must have a referral, preferably from their usual GP – if that is not possible, from another GP or other specialist medical practitioner. The referring practitioner must work independently of the practitioner who will perform the surgery and must not perform cosmetic surgery or non- surgical cosmetic procedures themselves.

Only cosmetic surgery, such as breast augmentation, liposuction, abdominoplasty, facelifts, rhinoplasty and cosmetic genital surgery, requires a GP referral.

Non-surgical cosmetic procedures, such as anti-wrinkle injections, fillers, laser and energy-based treatments and thread lifts, do not require a GP referral.

The referral should indicate the nature of the patient’s request, but the decision about which surgery/procedure is provided will be made by the patient and the practitioner performing the surgery. Just like other areas of medicine, the patient can use the referral to see a practitioner of their choice.

Psychological screening

The practitioner who will perform the surgery must discuss and assess the patient’s reasons and motivation for requesting the surgery, including external reasons (for example, a perceived need to please others) and internal reasons (for example, strong feelings about appearance). The patient’s expectations of the surgery must be discussed to ensure they are realistic.

The practitioner who will perform the surgery must assess the patient for underlying psychological conditions such as body dysmorphic disorder (BDD), which may make them an unsuitable candidate for the surgery.

If screening indicates significant underlying psychological issues, they must be referred for evaluation to a psychologist, psychiatrist or GP, who works independently of the cosmetic practitioner.

A practitioner must decline to perform the surgery if they believe it is not in the best interests of the patient.

Before any cosmetic surgery, all patients under 18 must be referred to, and be evaluated by, a psychologist, psychiatrist or GP, who works independently of the practitioner who will perform the surgery, to identify if there are any significant underlying psychological problems which may make them an unsuitable candidate for surgery.

Two consultations required

A patient seeking cosmetic surgery must have at least two pre-operative consultations. The patient’s first consultation must be with the practitioner who will perform the surgery or another registered health practitioner who works with the practitioner who will perform the surgery (not a patient advisor or an agent).

At least one of the two consultations must be in-person with the practitioner who will perform the surgery.

Patient consent

When consent can be given, the patient must not be requested to sign consent forms at their first consultation. Additionally, the patient cannot consent to cosmetic surgery until they have had an in-person consultation with the practitioner who will perform the surgery.

The decision to have the surgery (provision of informed consent) must be made at a consultation with the practitioner who will perform the procedure (in person or by video).

The medical practitioner who will perform the cosmetic procedure or prescribe the cosmetic injectable must provide the patient with enough information for them to make an informed decision about whether to have the procedure. The practitioner must have a verbal consent discussion with the patient as well as provide written information in plain language.

Practitioners should take all practical steps to provide information in a language understood by the patient and in a way that does not glamorise cosmetic procedures, minimise the complexity of the procedure or overstate likely results. It must include details about the procedure (including risks and possible complications, range of possible outcomes, recovery and aftercare requirements), the medical practitioner’s registration type, qualifications, training and experience.

Mandatory cooling-off period

There must be a cooling- off period of at least seven days after the patient has had two consultations and given informed consent (signed consent forms), before the surgery can be booked or a deposit paid.

For patients under 18, there must be a cooling-off period of at least three months between the provision of informed consent and surgery being performed. The patient should be encouraged to discuss why they want to have the surgery with their GP during the cooling- off period.

There is no cooling-off period with non- surgical cosmetic procedures (which may pierce the skin but don’t cut beneath it, such as injectables, thread lifts and laser treatments), unless the patient is under the age of 18.

More changes on the way

The title of ‘cosmetic surgeon’, and who can use it, is a hotly contested issue, with differing opinions on what qualifications guarantee safe care. As cosmetic surgery is not recognised as a speciality in Australia, any medical practitioner, whether or not trained and competent in cosmetic surgery, may legally call themselves a ‘cosmetic surgeon’.

The independent review commissioned by the MBA and Ahpra recommended an ‘endorsement model’ for cosmetic surgeons to establish expectations about minimum qualifications, and a public education campaign to assist the public to understand an endorsement, both of which have been accepted by the MBA and Ahpra.

An endorsement would recognise that a person has an extended scope of practice in a particular area because they have obtained a specific qualification approved by the Medical Board. The training programs leading to the qualification also must be accredited by an independent accreditation authority. Once established, the report says it ‘will be easy for consumers to identify whether a practitioner is qualified to perform cosmetic surgery’ (as the endorsement will be listed on the Ahpra public register).

‘We want everyone who chooses to have cosmetic surgery to be better informed and protected. We want doctors who undertake cosmetic surgery to be trained to a safe standard. We want the public to feel confident they are going to be well looked after and, if things go wrong, that they will be supported and that their concerns will be acted on,’ said Ahpra chief executive Martin Fletcher.

‘We will use our legal powers in full to better protect consumers who choose cosmetic surgery. Registered practitioners in the industry can expect a relentless focus.’ [A]A