Australasian College of Cosmetic Surgery (ACCS) Censor-in Chief Dr John Flynn set the record straight about the training Cosmetic Surgeons and plastic surgeons receive.
Dr Flynn said the College was particularly concerned that misstatements by the Australian Society of Plastic Surgeons are likely to confuse members of the Australian community who may be considering having Cosmetic Surgery.
“It’s important to understand that there’s no recognised specialty of Cosmetic Surgery. Claims that a plastic surgeon has a recognised specialist qualification in Cosmetic Surgery due to their Plastic Surgery qualification are simply untrue,” Dr Flynn said.
Dr Flynn noted that although plastic surgeons learn the necessary competencies to undertake Cosmetic Surgery training and may be introduced to some cosmetic procedures, like any other practitioner they must undertake Cosmetic Surgery training after their Plastic Surgery training to be properly qualified.
Dr Flynn also noted that Cosmetic Surgery is a multidisciplinary practice drawing on a diverse range of doctors. Many of the most significant procedural advances in Cosmetic Surgery have come not from plastic surgeons but from other disciplines. Italian Gynaecologist Giorgio Fischer invented Liposuction, American Dermatologist Jeffrey Klein pioneered Tumescent anaesthetic technique widely used in liposuction today, and the cosmetic properties of Botulinum toxin were discovered by Canadian Dermatologists Alastair and Jean Caruthers.
Cosmetic Surgeons derive from Maxillofacial Surgery, ENT surgery, Plastic Surgery, General Surgery, General Practice, Obstetrics and Gynaecology, Ophthalmology and elsewhere.
“What is common to all of these doctors is that in order to be a Cosmetic Surgeon, they must undertake additional relevant specific training in Cosmetic Surgery,” Dr Flynn said.
The ACCS is the only medical college which provides education and training leading to fellowship specifically in cosmetic medicine and surgery.
Dr Flynn also took aim took aim at misleading statements made by the president of the Australian Society of Plastic Surgeons Hugh Bartholomeusz.
“Professor Bartholomeusz has a history of making misleading statements about the nature and duration of training of both Cosmetic Surgeons and plastic surgeons. He seems even not to know how long plastic surgeons train for,” Dr Flynn said.
Dr Flynn noted that Professor Bartholomeusz has variously asserted post-medical school training by members of the Plastic Surgery society to be:
- “at least a further eight years” (ASPS media release, 14 July 2015)
- “at least 10 years” (Dr Bartholomeuz clinical website)
- “more than 10 years” (Network Seven interview, 3 September 2015)
- “up to 10 years” (Network Seven interview, 5 September 2015)
- “the almost ten years” (The New Daily interview, 30 September 2015)
The actual duration of post-medical school training required to become a plastic surgeon is seven years, (ASPS website), which is the same number of additional years required of Cosmetic Surgeons who train in the ACCS surgical fellowship.
Dr Flynn expressed the view that it is concerning that the head of the Plastic Surgery society appears to be confused over how long the plastics training program is. “Australians considering Cosmetic Surgery are entitled to accurate information in order to make informed decisions about their health care. It’s time to set the record straight,” Dr Flynn said.
“Anyone with a medical degree can perform Plastic Surgery, and doctors from a variety of different disciples perform Plastic Surgery procedures. They just can’t call themselves a Plastic Surgeon unless they have a Plastic Surgery fellowship.
“Theoretically any doctor can perform any procedure. But doctors are expected to work within their level of training and competency. Unfortunately some plastic surgeons without necessary training perform Cosmetic Surgery. Plastic surgeons or anyone for that matter should not be able to claim that they are a Cosmetic Surgeon unless they have trained and been examined in that discipline,” Dr Flynn said.
The ACCS believes national standards of education and training be established so that any medical college or university can have its training program assessed against that standard. Patients will be better protected and better equipped to make informed decisions, because they will able to choose doctors who have undergone appropriate, relevant training, assessment and accreditation specifically in Cosmetic Surgery.
“In the meantime,” Dr Flynn warned, “it is important that consumers do their homework to ensure that their surgeon is properly trained in Cosmetic Surgery. Ask your surgeon to show you their CV and explain their level of training and how often they perform the procedure that you are considering.”
￼￼￼￼￼￼￼Myth: Cosmetic Surgery is a “subspecialty” of Plastic Surgery.
Busted: Neither the Australian Medical Council, which assesses medical specialties and training, nor the Medical Board of Australia which licenses doctors, recognise subspecialties. Cosmetic Surgery is performed by doctors from several different disciplines as are Plastic Surgery procedures.
￼￼￼￼￼￼￼￼￼￼￼￼￼￼￼￼￼￼Myth: Cosmetic Surgery is a recognised part of Plastic Surgery.
Busted: The AMC has never recognised Cosmetic Surgery as uniquely part of Plastic Surgery. The only mention of Cosmetic Surgery in any AMC assessment of the Royal Australasian College of Surgeons (RACS) education and training program was in 2002, when the RACS Board of Plastic and Reconstructive Surgeons was quoted conceding that it was merely trying to expose some of its trainees to Cosmetic Surgery as well as the separate non-RACS surgical specialty of maxillofacial surgery. (“Accreditation Report: Review of the education and training programs of the Royal Australasian College of Surgeons”, AMC, 2002 , p 21). The AMC report made clear that ASPS did not provide Cosmetic Surgery training comprehensively or universally to its Plastic Surgery trainees, and Cosmetic Surgery has not been mentioned in subsequent AMC assessments.
￼￼￼￼￼￼￼￼￼￼￼￼￼￼￼￼￼￼￼￼￼￼￼￼￼￼￼￼￼￼Myth: Plastic surgeons are qualified to perform Cosmetic Surgery and non-plastic surgeons are not qualified.
Busted: There is no government recognised qualification in Cosmetic Surgery. Plastic surgeons, like other medical practitioners, must obtain cosmetic surgical training in the private sector after they complete their Plastic Surgery training. By comparison, to become a Cosmetic Surgeon and ACCS Fellow, doctors must typically complete a minimum of 12 years of medical and surgical education and training, including at least five years of post-medical school experience and training including three years as a surgical registrar BEFORE they begin their Cosmetic Surgery-specific fellowship training. They also may have another specialist qualification.
￼￼￼￼￼￼￼￼￼￼￼￼￼￼￼￼￼￼￼￼￼￼￼￼￼￼￼￼Myth: Anyone with a medical degree can call themselves a Cosmetic Surgeon and perform Cosmetic Surgery procedures.
Busted: Any Plastic Surgeon can call themselves a Cosmetic Surgeon without having undergone sufficient specific Cosmetic Surgery training. As the UK health authorities have also noted, registration as a specialist including in Plastic Surgery “does not give any assurance that a surgeon has received adequate training in Cosmetic Surgery”.
￼￼￼￼￼￼￼￼￼￼￼￼￼￼￼￼￼￼￼￼Myth: The Royal Australasian College of Surgeons (RACS) is the only government recognised specialist surgical training program.
Busted: RACS is not the only government recognised specialist surgical training program. Other medical colleges provide recognised specialist surgical training. Specialists such as Maxillofacial Surgeons, Ophthalmologists, Gynaecologists, receive recognised training in and perform surgical procedures. Some of them also train in and perform Cosmetic Surgery.
Total annual expenditure on cosmetic surgical and medical and related procedures and treatments in Australia is estimated to be $1 billion.
Australians annually consume more than $350 million worth of wrinkle reduction procedures with botulinum toxin.
There are approximately 8,000 breast augmentation surgeries performed each year in Australia and about 30,000 liposuction procedures.