The Australian Health Practitioner Regulatory Agency (AHPRA) introduced reforms for the cosmetic surgery sector in July.

The idea is to rein in under-qualified cowboys who are leaving people disfigured, or at the least disappointed.

AHPRA investigations found that doctors were failing to take into proper account patients’ history of mental illness.

Others failed to recognise that their prescribed treatments were potentially dangerous because of a patient’s medical history.

Too many surgeries have been outright botched by practitioners who didn’t know what they were doing. This is a risk patients still face, despite the reforms.

Making money seems to routinely take precedence over patient welfare. There seems to be a widespread failure to obtain proper informed consent from patients.

The reforms were actually announced in May, but practitioners were given three months “to clean up their act”.

What are the reforms?

In essence, doctors performing these surgeries – including breast implants, face lifts and liposuction – are now subject to tougher advertising rules and new safety measures. These include mandatory GP referrals.

The reforms followed a series of gruesome media reports about careless surgeons doing poor work and clowning around in the theatre.

Whether or not the safeguards go far enough remain to be seen. There are instances that practitioners, when under investigation, have altered treatment notes to cover their own backside. In one instance, this led to a caution and education.

As the federal Department of Health continues to advise: “Currently, any registered doctor with a medical degree can call themselves a cosmetic surgeon. They don’t have to undertake any further formal training in surgery beyond their initial medical training.”

People seeking cosmetic surgery are advised to check a practitioner’s qualifications and training. Presumably, many do not.

The burgeoning Botox and laser industry

The reforms also covered doctors who perform non-surgical, cosmetic procedures such as Botox and filler injections, liposuction and thread lifts – also called a barbed suture lift – which is a procedure that lifts and sculpts the face or breasts.

Reforms will focus on prescribed injectables used in derma fillers. Photo: Getty

Not only doctors perform these non-surgical procedures.

They’re also performed by registered nurses (working under supervision), dentists and “other health practitioners”.

AHPRA states it’s now going further to produce “stronger safeguards”    including “new guidelines for registered practitioners performing and advertising aesthetic treatments”.

New guidelines are sorely needed. Australians are spending more than $1 billion a year on non-surgical cosmetic sector procedures. And many patients seem to think that these operations are no more complicated or risky than getting a wax.

Until things go badly wrong

In a statement, AHPRA detailed four investigations where patients had suffered abscesses, burns and had been given advice that ran counter to their medical history.

The practitioner in each case was sanctioned, including a nurse who altered her case notes to cover her backside.

The ages of the patients weren’t revealed (which would have been useful) and they were given pseudonyms.

Case study 1

‘Yasmin’ had a history of mental illness with body image issues, which should have been a red flag.

She told her doctor that she was dissatisfied with the results of 10 previous non-surgical cosmetic procedures. Despite this history, the doctor administered a series of filler injections – as well as further treatments a month later.

Investigators found the doctor failed to manage the patient’s mental health concerns, continued with treatment despite her body image issues and did not properly gain consent.

The doctor now has conditions on their registration restricting practice.

Case study 2

‘Jennifer’ was treated with dermal fillers by a registered nurse, despite having several known skin conditions that made the treatments inappropriate and dangerous.

Following treatment, Jennifer had an adverse reaction which required the fillers to be dissolved and steroid treatment to address the reaction.

Additionally, the nurse inappropriately altered her treatment notes after a complaint was made.

Following an investigation, the board imposed conditions requiring the nurse to undertake formal education and provide a report reflecting on how they will change their practice in the future.

Case study 3

‘Amy’ underwent intense pulsed light treatment with a doctor to improve the appearance of skin on her neck. Instead, she suffered significant burns including large purple blistering.

She claimed the doctor did not obtain correct consent for the treatment, did not first test the treatment on her, and used an incorrect setting that burned her. She also said the doctor did not stop when she complained it was hurting or send her for specialist care to address the burns.

After receiving the notification, as the investigation proceeded, the medical board immediately ordered the doctor to be supervised by another doctor when performing any cosmetic procedures.

Following completion of the investigation, the medical board continued to hold concerns about the doctor’s practice and they continue to require supervision when using intense pulsed light treatments.

Case study 4

‘Carly’ suffered an infection in her cheek following a botched cosmetic thread lift procedure.

The procedure was undertaken as part of a training session for doctors and nurses. Her face became so infected she needed surgery to firstly remove an abscess. And then further surgery to restore her appearance.

The doctor who led the thread lift was cautioned for failing to obtain informed consent, organise appropriate follow-up care, or use adequate infection control techniques.

Another doctor who performed a similar procedure during the same training session was similarly cautioned.

What the regulator says

“Getting these services is not like getting a haircut – these procedures come with risk,” AHPRA CEO Martin Fletcher said.

“We want to ensure the public knows what safe practice looks like, and that practitioners are doing everything necessary to keep the public safe.”

He said the number of reported complaints of serious harm from cosmetic surgery has grown significantly since attention was focused on the sector over the past 18 months.

“The more frequent use of non-surgical cosmetic procedures, and the expanded range of practitioners who provide them, creates the potential to put a larger section of the community at risk of some harm,” he said.

The new safeguards

AHPRA says the planned overhauls “are likely to place a stronger emphasis on informed consent and pre-procedure consultation. Even better patient suitability assessments could be mandatory.

There will also be a focus on prescribing and administering prescription-only cosmetic injectables.

Proposed new advertising guidelines “are likely to focus on the use of ‘before and after’ images, claims about expertise and qualifications of practitioners, and affirm the ban on the use of testimonials”.

There will also be clear rules on the use of influencers and social media figures.

None of this will happen any time soon.

Public consultation on the proposed guidelines will open in coming months. The reforms are expected to be released in the first half of 2024.