Sunshine Coast woman Celia Brady vividly remembers going under the knife for a breast augmentation 13 years ago.
"I remember feeling the incision. I remember wanting to scream and to tell them to stop because I could feel it. But I couldn't," she said.
"I remember coming in and out of consciousness very regularly … once they made their incision ... I felt that, I can remember now so well that feeling of my whole body being ripped off itself."
The 37-year-old mother of four was operated on by a cosmetic surgeon who has since been stripped of his medical license after botching breast and vaginal surgeries of multiple patients.
But Ms Brady said she was not only the victim of a rogue doctor, but also a system that allows anyone with a medical licence to perform cosmetic surgeries without necessarily undertaking specialised training.
"When you are a young person looking to make such a major change to your body, it is vital that you can trust that the health care professionals, and (that) providers are regulated."
Tighter regulation, closer to what Ms Brady assumed was the norm for the industry, has on Thursday been recommended by an independent review into cosmetic surgery in Australia.
It was commissioned by the Australian Health Practitioners Regulation Agency (AHPRA) late last year, after media reports revealed serious problems in the sector, and has made 16 recommendations to crack down on rogue operators.
"The problems the independent review identifies are not new, but they are worse now than ever before,' AHPRA CEO Martin Fletcher said, in accepting the report.
One key recommendation is for separate "endorsed" training for doctors wanting to perform cosmetic surgery, to be accredited by the Australian Medical Council.
AHPRA and the Medical Board of Australia have accepted this and all the other recommendations including:
- the creation of a cosmetic surgery enforcement unit inside AHPRA
- a confidential cosmetic surgery hotline
- the banning of testimonials for cosmetic surgeons
- a complaints committee
But leading plastic surgeons have described the review and its recommendations as "profoundly disappointing", saying it will do little to improve patient safety.
A new working group, made up of surgeons, lawyers, nurses, and private investigators, is calling for the federal government to go further and hold a royal commission into the cosmetic surgery industry.
'We want the public to feel confident'
The review began in December last year, following a joint Four Corners investigation with The Sydney Morning Herald and The Age into the clinics of celebrity cosmetic surgeon Dr Daniel Lanzer, which revealed alleged serious hygiene and safety breaches.
In AHPRA's acceptance of the review, Martin Fletcher acknowledged "the problems in the sector are complex and big money is at stake".
"Exponential growth in the use of social media in recent years has deepened the fault lines in the cosmetic surgery industry — social media has radically increased its power and profitability," he said.
"It has fuelled consumer demand while emphasising benefits and downplaying risks."
Mr Fletcher said AHPRA recognised it needed to do better, as the regulator.
But the president of the Australian Society of Plastic Surgeons said the independent review and its recommendations failed to protect consumers from harm.
"Unfortunately, although the intention may have been good, these recommendations are really inadequate for meeting the needs of the community and really won't achieve what's needed in this area," Associate Professor Nicola Dean said.
Past president Mark Ashton, a member of the new working group advocating for a royal commission, agreed.
“The report was underwhelming and profoundly disappointing,” Professor Ashton said.
“I say that because it will do little, if anything, to clean up and protect the public from under-trained or poorly trained medical practitioners."
What is a cosmetic surgeon?
Under current Australian laws, anyone with a medical license can perform cosmetic surgery, something that many medical professionals say needs to change.
"I think what Australians expect is that only properly trained surgeons are allowed to do surgery and unfortunately at the moment that's not the case," Professor Dean said.
"The Australian Society of Plastic Surgeons was hoping that this report would fix that and it hasn't."
Associate Professor Dean said "endorsed" training for cosmetic surgery, as recommended by the review, would be inadequate for the kind of procedures cosmetic surgeons are doing.
"The only standalone endorsement at the moment that is run by the Australian Medical Council is that for acupuncture ... [which is] a fairly standalone kind of area," she said.
"But cosmetic surgery is surgery … and surgery requires training in anatomy, in peri operative care, in checking for risk factors, for complications, and in really managing the aftercare of patients having serious procedures.
"So to suggest that a little endorsement programme in cosmetic surgery can work as a standalone programme without that core surgical training is nonsensical."
She said doctors could still perform cosmetic surgery without the training and the idea put the onus on consumers to look up whether or not their doctor had been endorsed.
The review acknowledged it received a number of submissions calling for AHPRA to stop allowing anyone with basic medical training to call themselves cosmetic surgeons.
"There have been many submissions to this review advocating for the protection of the term 'surgeon', which would prevent non-specialist surgeons from using it," the review said.
"However, whether the term 'surgeon' alone should be a protected title (and therefore only be permitted to be used by specialist surgeons) is currently under consideration by the Ministerial Council [of state health ministers] and outside the scope of this review."
AHPRA and the Medical Board of Australia said they would welcome any action by state health ministers to protect the title of surgeon under law.
But Associate Professor Dean is frustrated the regulators didn't go further.
"Why are AHPRA not asking for this?" she said.
"They certainly have made efforts to work across the important bodies in Australia, but if it needs a change in the national law, then that's what they should be calling for."
Now, those in the industry will wait to see when the relevant national, state and territory regulators put actions into place.
Celia Brady just hopes the review leads to meaningful changes that provide patients with greater protection.
"As we try to change ourselves with surgery, it is absolutely our choice and we have a right to advocate for that choice, but it needs to be the right choice for every person," she said.
"With better-trained professionals, more regulation, we can ensure that no one is making the wrong decisions."
