Regulation of cosmetic medicine

Associate Professor Stephen Bradshaw AM

3 March 2017

Background to regulation

• 1998 NSW Committee of Inquiry into Cosmetic Surgery

• 2010 AHMAC Inter-jurisdictional Cosmetic Surgery Working Group

Cosmetic Medical and Surgical Procedures – A National Framework

– 2012 Medical Board public consultation - Supplementary guidelines for

Good Medical Practice: A Code of Conduct for Doctors in Australia’

• 2013 Queensland Health Quality and Complaints Commission

Great expectations: A spotlight report on complaints about cosmetic

surgical and medical procedures in Queensland

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2015 Medical Board public consultation

• Registered medical practitioners who provide cosmetic medical

and surgical procedures

• ~ 600 submissions and online petition

• Submissions – government, colleges, associations, clinics, medical

practitioners, nurses, patients

• General support for guidance in cosmetic practice

• Consumer education – potentially useful but disagreement on who

should develop

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Consultation

• Concerns about:

– procedures provided by range of providers in various settings

– procedures for under 18s

– qualifications, training, advertising

• Range of views on need for cooling off periods and psychological

evaluation

• Polarised views on provision of cosmetic injectables

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New guidelines

• Guidelines for registered medical practitioners who perform

cosmetic medical and surgical procedures

• Came into effect 1 October 2016

• Guidelines apply to all medical practitioners who provide cosmetic

procedures regardless of qualifications or specialty

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Definition - Cosmetic medical and surgical procedures

• Operations and other procedures that revise or change

the appearance, colour, texture, structure or position

of normal bodily features with the dominant purpose of

achieving what the patient perceives to be a

more desirable appearance or boosting the patient’s

self-esteem

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• Major cosmetic medical and surgical procedures (‘cosmetic surgery’)

involve cutting beneath the skin. Examples include; breast augmentation,

breast reduction, rhinoplasty, surgical face lifts and liposuction.

• Minor (non-surgical) cosmetic medical procedures do not involve

cutting beneath the skin, but may involve piercing the skin. Examples

include: non-surgical cosmetic varicose vein treatment, laser skin

treatments, use of CO2 lasers to cut the skin, mole removal for purposes

of appearance, laser hair removal, dermabrasion, chemical peels,

injections, microsclerotherapy and hair replacement therapy.

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Guidance on

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• Patient assessment

• Patients under the age of 18

• Consent

• Patient management

• Care by other health practitioners

• Schedule 4 cosmetic injectables

• Training and experience

• Qualifications and titles

• Advertising and marketing

• Facilities

• Financial arrangements

Cooling off periods and psychological evaluation

• Adult patient

– Major procedure – 7 days

– Minor procedure – no cooling off period specified

– Psychological evaluation by psychologist, psychiatrist, or GP if

indicated

• Under 18s

– Major procedure – 3 months, mandatory psychological evaluation

– Minor procedure – 7 days, evaluation if indicated

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Responsibilities of doctor who performs procedure

• responsible for post-operative patient care

• must ensure appropriate staff, facilities and equipment

to deal with emergencies when using sedation,

anaesthesia or analgesia

• facility must be appropriate for the level of risk

• provide detailed written information about costs

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Schedule 4 (prescription only) cosmetic injectables

• Medical practitioner must have consultation with patient

before prescribing cosmetic injectables

- in person or by video

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Safety issues identified outside Board’s scope

• The Board made recommendations to other authorities:

– address inconsistencies in drugs and poisons legislation

across jurisdictions, which can cause confusion for

practitioners and consumers

– review, strengthen and align licensing and regulation of

private health facilities, including the use of sedation and

anaesthesia

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Medical Board of Australia website

www.medicalboard.gov.au

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