These guidelines have been developed by the Medical Board of Australia (the Board) under section 39 of the Health Practitioner Regulation National Law as in force in each state and territory (the National Law).
The guidelines aim to inform registered medical practitioners and the community about the Board’s expectations of medical practitioners who perform cosmetic medical and surgical procedures in Australia. These guidelines complement Good medical practice: A code of conduct for doctors in Australia (Good medical practice) and provide specific guidance for medical practitioners who perform cosmetic medical and surgical procedures. They should be read in conjunction with Good medical practice.
The new guidelines will apply to all medical practitioners, including specialist plastic surgeons, cosmetic surgeons, and cosmetic physicians, regardless of their qualifications.
These guidelines do not apply to nurses and beauty therapists who provide cosmetic procedures.
These guidelines take effect on the 1st of October 2016.
Definitions
Cosmetic medical and surgical procedures are operations and other procedures that revise or change the appearance, colour, texture, structure or position of normal bodily features with the dominant purpose of achieving what the patient perceives to be a more desirable appearance or boosting the patient’s self-esteem.
Major cosmetic medical and surgical procedures (‘cosmetic surgery’) involve cutting beneath the skin. Examples include; breast augmentation, breast reduction, rhinoplasty, surgical face lifts and liposuction.
Minor (non-surgical) cosmetic medical procedures do not involve cutting beneath the skin, but may involve piercing the skin. Examples include: non-surgical cosmetic varicose vein treatment, laser skin treatments, use of CO2 lasers to cut the skin, mole removal for purposes of appearance, laser hair removal, dermabrasion, chemical peels, injections, microsclerotherapy and hair replacement therapy.
Surgery or a procedure may be medically justified if it involves the restoration, correction or improvement in the shape and appearance of body structures that are defective or damaged at birth or by injury, disease, growth or development for either functional or psychological reasons. Surgery and procedures that have a medical justification and which may also lead to improvement in appearance are excluded from the definition.
The medical specialty of plastic surgery includes both cosmetic surgery and reconstructive surgery. Reconstructive surgery differs from cosmetic surgery as, while it incorporates aesthetic techniques, it restores form and function as well as normality of appearance. These guidelines apply to plastic surgery when it is performed only for cosmetic reasons. They do not apply to reconstructive surgery.
Section 2 – Patient Assessment
The patient should be referred for evaluation to a psychologist, psychiatrist or general practitioner, who works independently of the medical practitioner who will perform the procedure, if there are indications that the patient has significant underlying psychological problems which may make them an unsuitable candidate for the procedure.
Other than for minor procedures that do not involve cutting beneath the skin, there should be a cooling off period of at least seven days between the patient giving informed consent and the procedure. The duration of the cooling off period should take into consideration the nature of the procedure and the associated risks.
A medical practitioner should decline to perform a cosmetic procedure if they believe that it is not in the best interests of the patient.
Section 3 – Additional responsibilities when providing cosmetic medical and surgical procedures for patients under the age of 18
The medical practitioner must assess and be satisfied by the patient’s capacity to consent to the procedure.
The medical practitioner should, to the extent that it is practicable, have regard for the views of a parent of the patient under 18, including whether the parent supports the procedure being performed.
Before any major procedure, all patients under the age of 18 must be referred for evaluation to a psychologist, psychiatrist or general practitioner, who works independently of the medical practitioner who will perform the procedure, to identify any significant underlying psychological problems which may make them an unsuitable candidate for the procedure.
For minor procedures, referral for evaluation by a psychologist, psychiatrist or general practitioner, who works independently of the medical practitioner providing the procedure, is not required for patients under the age of 18, unless there are indications that the patient has significant underlying psychological problems which may make them an unsuitable candidate for the procedure.
For the patient under the age of 18, there must be a cooling off period between the informed consent and the procedure being performed:
- for minor procedures, the cooling off period must be a minimum of seven days
- for major procedures, the cooling off period must be a minimum of three months.
The patient should be encouraged to discuss why they want to have the procedure with their general practitioner during the cooling off period.
Section 4 – Consent
The medical practitioner who will perform the procedure must provide the patient with enough information for them to make an informed decision about whether to have the procedure. The practitioner should also provide written information in plain language. The information must include:
- what the procedure involves;
- whether the procedure is new or experimental;
- the range of possible outcomes of the procedure;
- the risks and possible complications associated with the procedure;
- the possibility of the need for revision surgery or further treatment in the short term (e.g. rejection of implants) or the long term (e.g. replacement of implants after expiry date);
- recovery times and specific requirements during the recovery period;
- the medical practitioner’s qualifications and experience;
- total cost including details of deposits required and payment dates, refund of deposits, payments for follow-up care and possible further costs for revision surgery or additional treatment, and;
- the complaints process and how to access it.
Informed consent must be obtained by the medical practitioner who will perform the procedure.
Other than for minor procedures, informed consent should be obtained in a pre-procedure consultation at least seven days before the day of the procedure and reconfirmed on the day of the procedure and documented appropriately.
Section 5 – Patient Management
The medical practitioner who will perform the procedure is responsible for the management of the patient, including ensuring the patient receives appropriate post-procedure care.
If the medical practitioner who performed the procedure is not personally available to provide post-procedure care, they must have formal alternative arrangements in place. These arrangements should be made in advance where possible, and made known to the patient, other treating practitioners and the relevant facility or hospital.
There should be protocols in place for managing complications and emergencies that may arise during the procedure or in the immediate post-procedure phase.
Written instructions must be given to the patient on discharge including:
- the contact details for the medical practitioner who performed the procedure;
- alternative contact details in case the medical practitioner is not available;
- the usual range of post-procedure symptoms;
- instructions for the patient if they experience unusual pain or symptoms;
- instructions for medication and self-care, and;
- dates and details of follow-up visits.
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