Published on 2 July, 2023AHPRA Cosmetic Surgery Changes: What Do They Mean For Patients?Update: July 2023AHPRA and the Medical Board’s new guidelines for registered medical practitioners who perform cosmetic surgery and procedures came into effect on the 1st of July 2023. These guidelines aim to ensure that cosmetic surgery is administered in a professional, safe and clinically appropriate manner. If you are having skin cancer surgery with Dr Sharp or an item numbered procedure – such as post partum or post weightloss abdominoplasty, breast reduction, medical blepharoplasty or skin removal procedures such as brachioplasty – these changes do not apply to your procedure.If your procedure is deemed cosmetic, the new guidelines do apply.Procedures that have a primary aesthetic purpose and do not carry an MBS item number are considered cosmetic. This applies even if the procedure has both aesthetic and functional benefits, but still does not meet the MBS criteria.How do I know if my procedure is cosmetic or item numbered?This is determined at the time of consultation with your specialist plastic surgeon. A nurse or other healthcare provider cannot assign item numbers to a procedure on the surgeon’s behalf, so you really need a consult with the operating surgeon to determine what applies to you. This is the reason why your first consult in our clinic is always with Dr Sharp – and also why we ask all patients to have a GP referral, just in case their procedure is unexpectedly cosmetic. Having a GP referral means you are covered for either eventuality.What if I have already had my first consult before 1st July?The new rules discussed in this article do not apply. The guidelines discussed in this article only apply to patients who have their initial consult after the 1st of July 2023.Do I need a GP referral?Yes. A referral from your general practitioner is required in order for you to consult any registered medical practitioner regarding cosmetic surgery. Patients and GPs have asked us what the GP letter needs to say; this can be confusing for both GP and patient if they are not certain which specific procedure the surgeon is going to recommend upon consultation. We therefore recommend that you ask your GP to refer you to Dr Sharp to discuss surgical options for your specific “area/s of concern” eg “abdominal skin laxity”. Please ask your GP to include current medications, BMI and your surgical/medical history. If your GP has any questions or confusion regarding the surgery you are considering, please invite them to email or call us; we frequently take calls from GPs and are more than happy to help.Psychology questionnaireMost of our patients have very understandable motivations, reasonable expectations, healthy lifestyles and positive perceptions of their bodies; so this aspect of the new guidelines does not imply an assumption that seeking cosmetic surgery indicates body image issues. In fact, our patients have already been completing a body image questionnaire before embarking upon plastic or cosmetic surgery for many years. This has helped us understand their motivations, expectations and whether they are at a point in their lives where surgery might be appropriate. This tool has now been updated to include questions that ensure we comply with AHPRA’s requirements for body image screening. Such questions are a blunt tool – and are not the only way in which a specialist surgeon determines whether a patient is a suitable candidate for cosmetic surgery.Cosmetic surgery consultation processDr Sharp has always conducted at least two consults with patients before their cosmetic surgery and has always required a 7 day cooling off period after a patient decides they wish to proceed with surgery, so this process will not change significantly from the best practice process we have always undertaken.The only change will be to the timing of the consults and cooling off period. Your consent form will be signed in consultation with Dr Sharp at your second consult, after which you will need to observe a 7 day cooling off period before being able to confirm a surgery date by paying your booking deposit ($500). Again, this will only apply if your procedure doesn’t carry an MBS item number.Most importantly, we will not be delegating your consults to our nurses or another healthcare professional in our team, in order to expedite the surgical consent process. From your first consult to your last, we believe the operating surgeon is the best person to create your surgical plan, explain your surgery and discuss risks, complications and benefits – as they are ultimately the person responsible for your care. That takes time, trust and a relationship that cannot be built in a single discussion.Patients only pay for their initial consult with Dr Sharp and provided their subsequent consults are all within 12 months from their initial consult, these are unlimited and free of charge. We want to encourage patients to have as many consults as they need with their surgeon before making a big decision!Travelling patientsOur clinics are located in Queensland and so we see many regional and rural patients from our state’s vast reaches. Most cannot access specialist plastic surgery locally. Some travel so they can be cared for by family who live in closer to major Brisbane hospitals, during the post op period.Patients travelling to Brisbane for cosmetic surgery will now have to:have at least two consults – one of which must be face to face – before/at the time of signing their consent formwait a 7 day ‘cooling off’ period, and then;surgery booking can be madeIn our clinic, the recommended ‘traveling patient’ consultation process is:Travel to Brisbane for your initial consult with Dr Sharp, in our clinicsYour second consult can then be conducted via video if you wish. If you feel well informed and ready to proceed with surgery at this point, you will sign your clinical consent forms.After 7 days, you can secure a surgery date.Most patients will still have another consultation with Dr Sharp, closer to their surgery date, to refresh their consent information and postoperative recovery guidance. This can be virtual or face to face, depending on the amount of time that has lapsed since the initial consult.We understand this process won’t work for all patients, and so for those who are unable to come to Brisbane for their initial consult, a face to face consult will need to occur for the second consult instead, 7 days after which a surgery date can be booked.After surgery, most travelling patients stay in Brisbane for at least 7 days so our clinic can provide postoperative care and oversight during this period.Please remember this only applies to patients travelling to Brisbane for a cosmetic procedure. Read more about travelling to Brisbane to have surgery with Dr Sharp here, including postoperative timing and commitments. Social media and advertising changesThe intent of these changes is to ensure cosmetic surgery is not trivialised, and to avoid people feeling pressured into undergoing procedures. You’ll notice social media content is a little more dry and clinical. For example:If before and after images are shown, the ‘before’ image must be given equal or more prominence as the ‘after’. The post can not disproportionately focus on the result.We can’t use certain terms that may have previously been used to commonly or colloquially refer to certain procedures or parts of the body Medical practitioners must list their credentials / qualifications and Medical Board registration number, which is why you might see ‘MED…’ in your surgeon’s social media posts.Surgeons cannot post patient selfies or single images of patients to show results; clinical before and after images must lead the imagery in a post.Emojis cannot be used to cover body parts – or react to an image that advertises cosmetic surgery.The tone of social media posts should be informative and educational, not sexual or flippant.Photos of patients in swimwear, lingerie or in styled lifestyle shots cannot be shared by the clinic.Stock photos cannot be used to advertise cosmetic surgery.Patients cannot comment positively about their own surgery – or another patient’s results – on our social media accounts. They can comment on their own social media accounts, provided the surgeon isn’t tagged.The surgeon cannot make a subjective claim or viewpoint about their expertise – for example they can’t say they are a leading cosmetic surgeon in Brisbane or renowned cosmetic surgeon in Brisbane. They can factually advise that they are experienced or frequently perform the surgery, provided this is of course true and could be substantiated by independent hospital audits etc.All advertising must come with warnings about results, risks and recovery. Underpinning these rules is a concern that content might encourage vulnerable people to have surgery that they may not otherwise want or need. We know most people do not see a social media post and decide to undergo major body-altering surgery. Most of our patients are mature women who undergo cosmetic procedures after a long period of consideration, research and multiple consults with multiple plastic surgeons.We apologise to the patients whose comments and tags had to be removed on our social media, along with our replies, in order to be compliant. We’re also prohibited from acknowledging or replying to positive comments publicly – so we are sorry if we appear to be ignoring these!We still love interacting with patients who are researching cosmetic surgery online – as well as receiving feedback from our existing patients – so please keep in touch through direct message, phone call or email!What the code changes don’t meanDoctors can still operate on patients without having specialist qualifications.AHPRA has adopted an ‘endorsement’ model which means eligible doctors will be able to perform cosmetic surgery with the Medical Board’s endorsement – without undergoing the Royal Australasian College of Surgeons’ Specialist Training Program (FRACS). The FRACS training program involves many years of education, supervision, mentorship and advanced surgical skills practice – including the trainee surgeon treating thousands of patients in major tertiary hospitals.In contrast, the ‘endorsement’ will not involve the FRACS training standard – and yet endorsed doctors will have the Medical Board’s permission to advertise and perform cosmetic surgery.All surgery carries risks, and complications occur for all surgeons, from time to time. Complications can require rehospitalisation, or even reconstructive surgery.Doctors usually require specialist qualifications in order to have admitting rights to most major private hospitals in Australia. So what happens if a patient undergoes surgery with a someone that doesn’t have a FRACS qualification, and then experiences a complication requiring re-admission to hospital? Currently based on the information provided, the ‘endorsed’ doctor must refer the patient to a taxpayer-funded public hospital for care – or arrange for a qualified specialist surgeon to admit their patient to a private hospital, and take over their care.The Medical Board’s changes still permit this practice; allowing doctors to perform cosmetic surgery on patients provided they have an arrangement in place with another surgeon to admit their patient and take over care if needed.Continuity of care and the patient-surgeon relationship has always been a pillar of undergoing private surgery in Australia. Under the new guidelines, it is possible for a doctor to operate on a patient despite knowing they’d be unable to continue their care or provide revision surgery or complication management themselves, should they arise.May 2023: AHPRA announces draft cosmetic surgery codeChanges to AHPRA’s cosmetic surgery guidelines and regulations will come into effect on the 1st of July, impact patients in a number of ways. The Medical Board of Australia has published advance copies of three important documents relating to its cosmetic surgery reforms.Guidelines for registered medical practitioners who advertise cosmetic surgeryGuidelines for registered medical practitioners who perform cosmetic surgery and proceduresRegistration standard: Endorsement of registration of registered medical practitioners for the approved area of cosmetic surgery In response to panic caused by recent media coverage of the draft changes, Sharp Clinic director Liz Washington explains how the proposed code may impact patient access to specialist consultations and surgery.Is my procedure impacted?The new laws only apply to patients who are having a cosmetic procedure. It does not apply to patients who are having item numbered procedures, for example breast reduction, post pregnancy or post weightloss abdominoplasty. If your procedure has no functional or medical benefits, and is only being undertaken for aesthetic improvement, it will be considered cosmetic and the new code will apply to how your surgeon can treat you. Some of the changes include:• All patients seeking cosmetic surgery must have a GP referral• Surgeons must screen patient for body image disorders before cosmetic surgery can be considered• There must be two pre-operative consultations, at least one face to face with the surgeon and the clinical consent form cannot be signed until the second appointment. This must be done with the surgeon. After the consent form is signed, a 7 day cooling off period must be observed before patients can pay a deposit to book a surgery date.Registration Standards: who can call themselves a ‘cosmetic surgeon’?This is a proposal to allow doctors who do not hold a Fellowship of the Royal Australasian College of Surgeons to obtain an ‘endorsement’ by AHPRA to promote themselves as ‘surgeons’ who can perform cosmetic surgery. This delegitimises cosmetic surgery as somehow less serious than every other surgical discipline, and cosmetic surgery patients as less deserving of specialist care.Despite representation from a wide range of eminent bodies including RACS, GSA, ASPS, ASAPS, BreastSurgANZ, the Urological Society of ANZ and the ANZ OHNS telling AHPRA that the endorsement model is flawed, and will place patients at risk, it appears to be proceeding. There are concerns that this will lead to more confusion for patients – and therefore it will be more important than ever to check your surgeon is an actual specialist plastic surgeons before undergoing surgery.AdvertisingThese new guidelines also have a strong focus on online and social media advertising and have been designed to provide greater clarity about what is not acceptable.Our practice is supportive of these changes to ensure patients are not misled or pressured into having aesthetic surgery.They will mean that we are no longer allowed to enable positive comments on our social media posts about patient results. So please don’t think we are ignoring you – we are just abiding by the new regulations! Patients are, however, permitted to make a positive comment about the staff or patient experience in our clinics.