Cosmetic vs plastic surgery

13th Nov 2015

This month, there has been a focus on a cosmetic surgery practice, with reports that ambulances are being called to a popular Sydney breast implant clinic to rush young patients to hospital emergency departments.


What is a cosmetic surgeon? What is a plastic surgeon? Do they differ? If you were considering a breast augmentation or were unhappy about the shape of your nose, who would you want to advise you and potentially operate on you?

Unknown to most, there is a significant difference between cosmetic and plastic surgeons.  The Australian College of Plastic Surgeons warns against ‘unregulated office-based cosmetic surgery and anaesthetic use’.  

Health practitioners in Australia are regulated by the Australian Health Practitioner Regulation Agency (AHRPA). Each health profession that is part of the National Registration and Accreditation Scheme is represented by a National Board. There are 14 National Boards, one of which is the Australian Medical Council, which represents medical practitioners, and also oversees doctor training in hospitals and universities.

The titles of medical specialties are highly regulated by the Australian Medical Council, and it is not permissible for doctors to title themselves as medical specialists in a particular field, if they do not hold appropriate qualifications.

The Medical Board of Australia does not recognise ‘cosmetic surgery’ as a specialty practice of surgery. Fields of speciality practice within surgery that are recognised include plastic surgery, oral and maxillofacial surgery, general surgery, orthopaedic surgery, among others. ‘Cosmetic surgery’ is not included.

The title ‘cosmetic surgeon’ therefore is not indicative of certain qualifications, such as would be expected of a ‘plastic surgeon’. It is important to note that a Bachelor of Medicine/Bachelor of Surgery is the general qualification of a General Practitioner, and does not qualify someone to practice in plastic surgery. The Australian Society of Plastic Surgeons notes that: ‘currently in Australia, it is legal for any doctor with a basic medical degree to perform surgery. Specialist Plastic Surgeons, on the other hand, have extensive surgical education and training including a minimum of 12 years medical and surgical education, with at least 5 years of specialist postgraduate training.’

However, it appears that someone with the same qualifications as a General Practitioner can call themselves a ‘cosmetic surgeon’, potentially after doing a short course.  The Australasian College of Cosmetic Surgery offers training with diplomas available in cosmetic medicine, cosmetic nursing and cosmetic injectables, as well as registrar programs. However, despite submissions by the Australasian College of Cosmetic Surgery to the Australian Medical Council to be recognised as a specialty, this has been refused and the Australian Medical Council does not recognise ‘cosmetic surgeons’ as a medical speciality or accreditation.

By contrast, plastic surgery includes both cosmetic surgery and reconstructive surgery. Plastic surgery has its origins in the treatment of burns injuries. The author has witnessed the horror of these dreadful injuries and subsequent disfigurement. Plastic surgeons have had an important role in the management of burns injuries. However, while some plastic surgeons still treat burns patients, a significant number only work in the domain of aesthetics. To understand various variations and definitions, it is helpful to talk about aesthetic surgery. 

Aesthetics is about appearance; many plastic surgeons predominantly perform aesthetic surgery. This may include rhinoplasty (nose jobs), breast augmentation or reduction, face-lifts, liposuction and more. These plastic surgeons often have glossy websites showing beautiful young women with ‘ideal’ bodies. 

This further adds to the confusion around surgery that is being performed for an aesthetic purpose. To the layperson, surgery performed for an aesthetic purpose may be understood as ‘cosmetic surgery’, and therefore a ‘cosmetic surgeon’ is the best qualified to undertake it. However, this is not the case.

The President of the Australian Society of Plastic Surgeons, Associate Professor Bartholomeusz, has said that:

‘[W]e can only reiterate that cosmetic surgery is not trivial surgery. Anaesthesia and surgery carries risks and it is vitally important that all surgeries, including all cosmetic procedures, are carried out, not just by appropriately qualified surgeons, but also in properly accredited facilities with an anaesthetist present.’

An internet search might reveal a woman can have a breast augmentation costing between $3,900 and $5,500 performed by a cosmetic surgeon.   A plastic surgeon might charge $10,000 for the same surgery. For the most part, patients cannot claim Medicare rebates on this type of surgery.  The decision for an individual may be financially straightforward.  Unfortunately, the patient has no idea what is behind the difference in cost. 

One submission to the Medical Board of Australia’s recent consultation on cosmetic surgery asserted (at 7) that:

‘[I]n our opinion, patients rely on the belief that the industry is properly regulated when they make decisions about which service they choose on the basis of price. Furthermore, advertising regulations for the medical workforce, make it difficult to advertise on the basis of suggesting to the client that one medical practice has better professional standards than another.’

Aesthetic surgery is based on a fantasy. The woman usually has a vision of what she will look like following the surgery. However, she may be disappointed with the outcome. This disappointment is possibly behind the statistical fact that plastic surgeons are amongst the most litigated doctors.* There are no statistics on cosmetic surgeons, but it might be hypothesised that their litigation rates are higher.