It’s never been more important to allay the fears of the patient and reiterate that their safety is always the number-one priority.

In the wake of the recent flurry of media headlines after a patient from The Cosmetic Institute (TCI) was reported to have a cardiac arrest on the operating table, a storm of controversy over the state of the cosmetic industry as a whole has been unleashed.

But how do consumers view these stories? Is it so enthralling because it is so rare, or is there a darker element at play that perhaps these patients have brought it upon themselves by giving in to their vanity? After all, they weren’t having a necessary and life-saving intervention. Cosmetic surgery is totally elective surgery.

If you Google ‘patient safety’, you will be presented with 111,000,000 results in 0.33 seconds. Patient safety has been the cornerstone of the medical profession since the Hippocratic Oath was written in the late fifth century BCE. Patient safety is, or should be, at the core of every doctor’s practice and every medical facility.

On Realself.com (March 28, 2015), a plastic surgeon posted this response to a patient who was concerned after reading a newspaper report of a cheerleader dying after having breast augmentation surgery:

“One question that plastic surgeons are asked is: ‘What are my chances of dying from cosmetic surgery?’

In our day-to day practice as plastic surgeons, it is extremely rare to even hear about such a terrible complication either in the surrounding community or even in the nation as a whole. To put a number on the odds is difficult, but the numbers I have seen range from 1:57,000 to 1:200,000 surgeries. Lets take the highest odds of 1:57,000. Even that number seems quite high to me. However, using that number as a starting point, the risk of dying from pregnancy, that is, from the moment of conception to the moment that the child is delivered, also happens to be around 1 in 57,000. You are 510 times more likely to die from being involved in an automobile accident, and 78 times more likely to die as a pedestrian struck by a moving vehicle than dying after cosmetic surgery.

What activities carry lower risk of dying than from elective cosmetic surgery? You are two times less likely to die from being bitten by a dog, and three times less likely to die from a lightening strike than from cosmetic surgery.

The bottom line is that cosmetic surgery is always offered to those in the lowest risk categories or the healthiest patients, that is the people who have no significant risk factors. This selection makes the chances of a patient having a life threatening complication after plastic surgery extremely rare.

I hope that puts the odds in better perspective for you and many other people that may potentially read this because they have the same concern as you. (SOURCE: National Safety Council: Injury Facts 2014)”

Yes, there is no doubt the cosmetic surgery industry needs regulation. In what shape or form is still a matter for heated debate and probably government intervention. The review of the Private Health Facilities regulation act will be released in September, 2016.
However, fear mongering and sensationalist headlines don’t further the cause of patient safety. A collegiate approach to regulating the industry as a whole will be more effective and pertinent.

We have approached key stakeholders for their comment and all agree to some extent that consumer education is essential to patient safety.

Statement from ASAPS

To create a balanced article, we have also published comment from TCI.

The Australasian Society of Aesthetic Plastic Surgery (ASAPS) strives to make sure that cosmetic surgery patients feel safe and confident in the hands of their medical practitioner. Our approach has always been that there is a framework to protect patients and enable consumers to choose.

The cosmetic interventions sector is growing rapidly. Our concern is that the existing regulatory framework has not kept pace with changes and it does not provide enough protection against many of the potential risks and complications from cosmetic procedures.

ASAPS exists to advance surgical standards and improve patient care in cosmetic treatments. Ensuring plastic surgeons provide high-quality patient care is at the heart of what we do. One of the ways we protect patients is by setting standards for plastic surgeons to ensure and promote best practice. Another is by providing world-class educational meetings for plastic surgeons regarding surgery and all cosmetic medical practitioners for cosmetic medical treatments.

ASAPS wants to improve the quality of care provided to people who have cosmetic interventions by setting out a range of actions to ensure medical practitioners have the right skills, the products used are safe, providers are responsible, people get accurate information and support is available if things go wrong.

ASAPS has outlined a range of issues and recommendations already underway which we are working with healthcare regulators and patient safety organisations to improve the quality of training and care provided by the industry to medical practitioners and patients.

Many of these are about tightening controls already in place or putting in new systems of control. This is the beginning of a process in which we shall ensure proportionate and appropriate improvements in the industry to better protect the consumers and patients of tomorrow.

Some of the issues we would like to highlight are:

1. Medical practitioners: Setting standards for training and practice.
a. At present, any medical practitioner can undertake cosmetic surgery independently in the private sector. We want to ensure that any medical practitioner calling themselves a “cosmetic surgeon” has the appropriate qualification of the Fellow of the Royal Australasian College of Surgeons (FRACS) ie, the term surgeon should be protected and defined by qualification and training.
b. The Royal Australasian College of Surgeons (RACS) is one of three colleges recognised by the Australian Medical Council (AMC) to train surgeons in Australia. The other two are the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) and Royal Australian and New Zealand College of Ophthalmologists (RANZCO).
c. There needs to be an investigation into providers that employ medical practitioners under the guise of “cosmetic surgeons” who are not fully competent in the procedures that they are authorised to perform.

2. Medical practitioners only perform cosmetic surgical procedures where they have the technical skills and experience to do so.
a. In the interests of patient safety, ASAPS recommends that surgeons performing cosmetic surgical procedures practice within their field of specialty training. Surgeons will be able to apply for certification of expertise in one or more of a number of associated groups of operations, as long as they work within the scope of their specialty training.
b. For a variety of reasons, cosmetic surgery is not a defined surgical specialty in its own right. The training within certain defined specialties, such as plastic surgery, ENT surgery, ophthalmology, breast surgery and gynaecology includes an aspect of cosmetic training but there is no common qualification available for those performing cosmetic surgery.
c. Cosmetic surgery may be performed by a medical practitioner having completed a full training program in a recognised surgical specialty that has cosmetic and reconstructive elements in its curriculum such as plastic surgery. Surgeons qualified in other specialties may carry out cosmetic surgery but only if it is related to their anatomical area of expertise eg, ENT surgeons may carry out cosmetic surgery on the ears and the nose.
d. Accreditation to operate at private hospitals is tightly regulated according to training and individual skills. Cosmetic surgical procedures should only be able to be performed by an individual that he/she is accredited to perform in an accredited private hospital. This would then apply to procedures performed outside the private hospital system such as in private clinics as well.

3. Historically, governance of standards of practice in cosmetic surgery has been limited to the private hospital sector. These hospitals were responsible in ensuring they are employing surgeons who are fully competent in the procedures they will be expected to perform.
a. There is a clear need for accredited training standards to be set for cosmetic procedures so that patients can be assured that the person carrying out an intervention has the appropriate training.
b. ASAPS wants to see an end to the possibility of an unscrupulous medical practitioner being able to mislead the public as to their skills and experience, and of training providers (including surgeons) offering poor quality training courses for practitioners.

Statement from The Cosmetic Institute

At the Cosmetic Institute, the safety of our patients is our highest priority. That is why we only employ highly experienced medical professionals as surgeons, anaesthetists and nursing staff.

It is important to understand that any type of surgery carries some risk.

The Institute has performed more than 16,000 procedures and the vast majority of these have been completed without incident and to the satisfaction of our patients.

We ensure that each patient fully understands the risks and benefits, what procedure is suitable for them and most importantly we try to address any misunderstandings about what cosmetic surgery can achieve.

We are continually monitoring feedback from our patients and improving our post-operative care to ensure outcomes are in line with patient expectations.

There have been several recent examples of complications occurring during surgery which have attracted publicity. Of the patients that have been admitted to a tertiary hospital, all complications bar one have been anaesthetic/ allergy related.

The reality is that adverse reactions to anaesthetic are not uncommon in relation to any type of surgery.

In the case of one patient, a rare but recognised anaesthetic complication occurred. Following subsequent medical testing and clearance, she later returned to the Institute and had her procedure completed without incident.

The Institute uses only fully qualified anaesthetists, and when these events occurred they reacted promptly and professionally and had the patients transferred to a tertiary hospital, which is best medical practice when emergency situations occur.

While the Institute’s two operating facilities in Sydney are fully ISO9001 accredited and boast state of the art operating theatres, we wanted to ensure our patients have the highest levels of confidence in the treatment they are receiving. For that reason all our procedures are now performed in licensed private hospitals in Sydney and at our new facility on the Gold Coast.

We have a highly experienced surgical team, who work under the supervision and direction of two of Australia’s leading plastic surgeons who have trained surgeons in the public health system. Our surgeons all have significant, formal surgical training from a number of surgical disciplines within the public health system.

Cosmetic surgery is a rapidly expanding area, with total annual expenditure on related procedures estimated to be $1 billion. That is why the Institute was very pleased to see a recent media report that State and Federal Health Ministers are looking at nationally consistent guidelines for cosmetic procedures. The Institute supports the position of the Australian College Of Cosmetic Surgery (ACCS) that national standards of education and training be established to underpin the public’s confidence in these procedures.

Statement from the ACCS

The Australasian College of Cosmetic Surgery has been working with key stakeholders to review and consider how facilities regulation and procedures within the practice area may be improved to better protect patient safety.

Some of the concerns expressed within the industry underline the College’s longstanding case that cosmetic surgery should be recognised as a specialty in its own right, and that a recognised set of national standards of education and training be established. Any medical college could then have its training program accredited against those standards to remove all doubt.

For its part, the College has continued to develop and strengthen its cosmetic surgical and medicine training fellowship programs as well as offering new stand-alone modules such as its popular injectable training program.

The College has also put considerable focus on patient education and, for example, as part of its Code of Practice, provides a patient information brochure about risks and training.

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