'How the cosmetic surgery industry in Australia is failing patients.'

The recent Four Corners exposé of disgraced cosmetic surgeon Dr Daniel Lanzer and his associates has opened a Pandora’s box of what is happening in the cosmetic industry in Australia. 

Are all cosmetic surgeons bad? No. But it is very difficult for potential patients to make decisions about where to go for cosmetic surgery, because there are many practitioners that offer it, with varying degrees of skill and experience.

What is the difference between plastic and cosmetic surgeons?

Plastic surgeons have gone through accredited training through the Royal Australasian College of Surgeons.

It is a highly selective training program, with rigorous training and assessment processes in place. 

The extensive five-year program for plastic and reconstructive surgery covers a wide breadth of clinical areas including complex reconstruction, microsurgery, hand surgery, skin cancers, burns, and paediatric surgeries such as cleft lip/palate surgery. 

Thus, plastic surgeons are qualified to operate in a broad range of areas. 

Most surgical training takes place in teaching hospitals in the public hospital system.

Listen to Dr. Yumiko Kadota on No Filter. Post continues below. 

Cosmetic surgery is a minor focus of the plastic surgery training program and mainly takes place in private hospitals, which trainees have limited exposure to. 

Typically, plastic surgeons at the end of the program will have completed a six-month rotation in cosmetic surgery. 

Some will go on to do a focussed fellowship to sub-specialise in cosmetic surgery, however it is not a requirement for opening a cosmetic surgery practice. 

In other words, some newly qualified plastic surgeons will start performing cosmetic surgery with as little as six months' experience. 

Some of the best cosmetic surgery I have seen over the past decade have been performed by plastic surgeons who specialise in cosmetic surgery. Having said that, some of the worst complications have also been by plastic surgeons. 

On the other hand, any doctor with a medical degree can call themselves a cosmetic surgeon, and this is something health regulators are looking into very closely. 

Cosmetic surgeons have a variable skill set; some are highly skilled and experienced while others may have just graduated from medical school with limited knowledge and experience. 

Some cosmetic surgeons have completed a two-year training program with the Australasian College of Cosmetic Surgery and Medicine; however, this is not a pre-requisite to practise cosmetic surgery in Australia. 

Others have completed another accredited surgical training program (for example in ophthalmology, otolaryngology, head and neck, oral and maxillofacial, or general surgery), or gained surgical skills through the public hospital system or mentorship under a senior plastic or cosmetic surgeon under an apprenticeship model.

A possible solution to make sure doctors are adequately trained to perform cosmetic surgery would be a specific training program in cosmetic surgery under the auspices of the regulator and the Australian Medical Council.

What red flags should consumers look out for?

A factor that influences patients' decision making when it comes to seeking treatment is the use of marketing tactics to promote a particular practitioner or clinic. 

Often, ‘aspirational’ images and videos of influencers are glamorised and sexualised, luring impressionable people into believing they too can achieve the same stylised and luxurious lifestyle. 

Obtaining informed and educated consent is a legal and ethical requirement before any doctor performs a treatment on a patient. 

Patients must understand what they are signing up for and be aware of what could go wrong.

Another important principle of informed, educated consent is that a patient must freely give their consent without coercion. 

Offering free or heavily discounted cosmetic surgery or injectables is considered financial coercion, as it is incentivising a patient to undergo a treatment or procedure that they may not have otherwise consented to.

Procedures like anti-wrinkle treatments and dermal fillers have become so common, there are a lot of consumers who don't consider the risks. But botulinum toxin and dermal fillers are ‘S4’ prescription drugs under the Poisons Schedule and should be scrutinised as such. Offering free or cheap injectables is just as serious as offering free surgery.

Discounted surgery is one way in which cosmetic surgeons entice patients, according to plastic and reconstructive surgeon Professor Anand Deva. 

Driving surgery prices down undercuts their competition; it is a business model that aims to recruit a large volume of patients rather than focus on quality. 

Some surgeons will waive the cost of their initial consultation fee (and even their surgeon fee) to influencers, essentially providing surgery for cost price. 

Professor Deva lists cheap surgery as one of the red flags to look out for. 

In the same vein, clinics that offer ‘buy now, pay later’ and other pre-approved finance schemes to encourage patients to sign up for surgery that they cannot currently afford should also be a warning sign. Such tactics can expose patients to financial harm. 

Cosmetic clinics also use marketing tools to help increase their reach and exposure. 

It is only in recent times that medical practices and doctors were allowed to advertise, but with increasing competition for work, marketing your practice has become a business in itself. 

PR agencies now actively work with doctors to increase their profile and build their patient base. One sales strategy used by PR companies is influencer marketing. 

Consumers of cosmetic surgery are predominantly young, vulnerable women, many of whom follow influencers. 

Seeing an influencer promote their results on their Instagram or YouTube channel may encourage followers to seek surgery without considering the risks.

Furthermore, patients may believe an influencer to be a genuine supporter of a cosmetic practice or doctor without knowing that they were given free or discounted treatment. 

There are calls for more transparency among influencers, to declare sponsored content. While not labelling products or services as gifted is problematic, doing so with cosmetic treatments can be downright dangerous and a potential breach of the medical regulator’s advertising guidelines.

Similarly, people are often enticed by surgeons or clinics with a large social media following. 

Some surgeons, clinics, and cosmetic injectors buy followers, which can mislead consumers into thinking that they are more popular than they actually are. 

Their low engagement rate, as well as seeing spikes in followers on Social Blade are often clues for accounts with fake followers. 

How do you decide?

So, how can patients decide on which surgeon or cosmetic injector to go to? 

There are three key things to look for: 

1) Recognised clinical experience and qualifications, 

2) Word of mouth from someone you know, and 

3) ‘Before and after’ images of their work. 

Word of mouth is a reliable test, especially if a person you know (and trust) has been treated by a particular surgeon or injector and can vouch for their results. 

You will also be able to see their results in person.  

When perusing ‘before and after’ images on websites and social media, please be cautioned that some photos may have been doctored with editing or filters. 

For ‘before and after’ images of the face, I look at the skin of the patient. 

If blemishes and pores have been blurred for the ‘after’ image, that may be a sign that the photo has been altered. 

Some ‘after’ photos also use make-up, including contouring and highlighting, to make the result look more appealing.

When considering a cosmetic injector, clinical experience is even more important because both nurses and doctors can offer injectables in Australia. 

A cosmetic injector may refer to someone who is a fully qualified doctor, or a nurse with careful and recognised training.

It may equally be someone who has completed a short course online with minimal practical experience. A Bachelor of Nursing degree can be completed in as quick a timeframe as three (or even two) years, and some injecting courses may be completed in a day or two. 

Injectables are not without risk. 

Some patients faint, develop allergic reactions, or develop blockage of blood vessels by filler, resulting in serious complications such as blindness. 

It is also important that an injector has a thorough understanding of the anatomy of the face. 

There are many excellent practitioners who offer injectables. However – just like cosmetic surgeons – there is a wide variation in skill, training and experience. 

As such, when choosing an injector, a patient should find out 

1) if they are a qualified doctor or nurse,

 2) when they graduated from medical or nursing school and how long they have been in practice, and

 3) whether they are accredited by product companies such as Allergan, Galderma, or Teoxane.

The world of cosmetic surgery and injectables is at the most commercial end of medicine.   

While the regulators are working on making it safer for patients, my advice would be to take your time to seek out trusted medical professionals before rushing into a particular treatment or procedure.

Dr Yumiko Kadota is a medical doctor in Sydney, and author of Emotional Female. She was trained in Australia, graduating from UNSW Medicine with Honours. She has been working as a doctor for 11 years. You can follow her work as a cosmetic injector on Instagram  @sydneyfacedoctor 

Feature Image: @sydneyfacedoctor