Blepharoplasty or eyelid lift surgery or double eyelid surgery is a cosmetic surgical procedure. It carries certain risks and benefits. It is important that you understand who will be operating on you and how to choose your operator.

What is the difference between a cosmetic surgeon and a plastic surgeon?

In a word, it is the training.

Currently, any medical practitioner can call themselves a cosmetic surgeon. There are five types who do: medical graduates, general practitioners, specialist plastic surgeons, non-plastic surgeons, and Fellows of the Australasian College of Cosmetic Surgery and Medicine (FACCSM). Some have received cosmetic surgery training, others have not. This is confusing to both patients and regulators.

The Australasian College of Cosmetic Surgery & Medicine is calling for regulation and accreditation for all doctors who perform cosmetic surgery, just like any other specialised field of practice. This is not about self-regulation or a turf war among doctors from various medical backgrounds. It’s about patient safety and an independent overhaul of the system is required, putting patients first, not surgeons.

Nevertheless, plastic surgeons are opposing an independently mandated accreditation standard for all doctors. They want exclusive use of the title cosmetic surgeon or specialist cosmetic surgeon or specialist plastic & cosmetic surgeon. They want patients to go solely to them and claim only they are safe to perform cosmetic surgical procedures. Apart from facilitating plastic surgeons getting a monopoly of the cosmetic industry, would this measure raise the standards and protect the patients?

The Australian Medical Council, the independent national standards body which audits training of plastic surgeons, reported that plastic surgeons have a “deficit” in their experience of cosmetic surgery and qualify with a “gap in this area of practice”.

This has always been the case because cosmetic surgery falls outside of the plastic and reconstructive surgery in public hospitals, where reconstructive plastic surgeons are trained and cosmetic surgical procedures are not performed. Plastic surgeons are simply not trained in cosmetic surgical procedures. So we have plastic surgeons who profess to be a specialist and expert in cosmetic surgical procedures but was never exposed to cosmetic surgery during their training.

Dr Tansley, the President of Australasian College of Cosmetic Surgery & Medicine, says “This has always been the case because cosmetic surgery falls outside of plastic and reconstructive surgery in public hospitals, where reconstructive plastic surgeons are trained and cosmetic surgical procedures are not performed.” After he qualified as a plastic surgeon, he had to join the Australasian College of Cosmetic Surgery & Medicine to receive cosmetic surgical training.

The consequences for patients can be fatal. The only death of a cosmetic surgery patient in Australia from inadequate surgical training occurred at the hands of a specialist plastic surgeon whose liposuction patient believed he was competent because he was a specialist plastic surgeon. The Victorian coroner who investigated her death said “irrespective of a practitioner’s provenance or primary qualifications, there was a need for specific training and experience in performing liposuction surgery”.

Dr Tansley further adds, “other complications resulting from inappropriate training can cause patients years of misery and financial distress. One distraught woman consulted me after cosmetic breast surgeries at the hands of two plastic surgeons. Her woeful story of breast augmentation using PIP breast implants (now banned), was followed by asymmetry, pain, “uniboob” deformity and failed revisional surgery, all consistent with inadequate cosmetic surgical training and experience.”

The Council of Australian Governments’ health committee is considering the regulation of cosmetic surgery. A Senate committee is also considering it as part of its inquiry into the registration of medical practitioners. Almost everyone in government recognises the lack of regulation is concerning. The Australasian College of Cosmetic Surgery & Medicine has been calling for regulation of the cosmetic industry and accreditation of cosmetic practitioners practising cosmetic surgical procedures. Nobody listened. But everyone is responding to the Four corner’s investigation report.

The solution is simple. As the Australasian College of Cosmetic Surgery has always been advocating, all doctors performing cosmetic surgery should have to meet a national accreditation standard and be on a register of cosmetic surgeons. The standard would require essential training, qualifications, competency and recertification specific to cosmetic surgery. By restricting the title of cosmetic surgeon only to those doctors on the register, patients will be protected by allowing the easy identification of practitioners who are trained, competent and safe.

No plastic surgeon or cosmetic surgeon who is trained, competent and safe in cosmetic surgery should object to patients being protected in this way. The government and regulators need to put an end to this confusion and unsafe practices. All medical doctors professing to be cosmetic surgeons should be adequately trained and examined for their competency.

Patients must come first: regulate cosmetic surgeons like any other doctor.