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Cosmetic Surgery Industry

The cosmetic medical and surgical industry has become a multi-million dollar entrepreneurial industry.  Rapid and  ad hoc growth has opened the way for unregulated practices and some questionable  methods of promotion, posing ethical dilemmas for some members of the medical  profession, consumers and legislators. Advertising and promotion of cosmetic medical and surgical procedures focus on the benefits for the consumer, downplaying or not always mentioning the risks.  Different “boundaries” are tolerated for  promotion of these procedures (which  are not driven by medical need and where there is significant  opportunity for financial gain by those promoting them) than is  the case for “mainstream” medical procedures. Factual, easily understood information for  consumers contemplating cosmetic medical or surgical procedures from a source that is independent  of practitioners and promoters is  not always readily available. While cosmetic medical and surgical procedures are undertaken by some medical practitioners who have completed advanced specialist surgical or medical training, current regulatory provisions allow any registered medical practitioner to set up in practice and call themselves a cosmetic surgeon or physician, conveying the impression that they are  specifically qualified or  specialise in the area. In other areas of medicine, the general practitioner (GP) is the ‘gatekeeper’ for referral to surgeons.  Where the cosmetic surgery industry  sells procedures directly to the public, a GP referral is  not required.  This means the GP is not able to offer an independent view on the procedure unless specifically sought by the patient.  The GP is also potentially uninvolved in post-procedural care. Unregistered practitioners in the industry  are largely able to operate independently, without a common code of conduct or a common  set of core practice standards.

Use of Schedule 4 substances (eg Botox) in their work raises issues related to access to what are prescription-only substances and the qualifications training and oversight of those who administer them.  Use of devices  such as lasers and intense pulsed light sources in their work is not regulated in  all jurisdictions and training is variable. It is difficult to assess the  extent to which the current  regulatory framework provides or maintains consumer safeguards because  there are few sources of information.  Medical insurance claims data suggests that medical practitioners working in the area of cosmetic practice have a higher claims frequency, which has increased at a much higher rate over the last ten years,  than the average for all insured doctors.   The most common reason for claims was dissatisfaction with the results.

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