There is a difference between cosmetic and plastic surgery. Photo / 123RF
News.com.au reporter Rebecca Sullivan reveals why anyone with a standard medical degree is legally allowed to perform cosmetic surgical procedures in Australia.
It was a Facebook ad for a $5990 breast augmentation in Brisbane that first caught Australian Samantha Humm's attention.
After having four children, the 30-year-old Gold Coast mum wanted to feel more confident about her body by changing the look of her breasts.
Samantha contacted the Australian company online and travelled to Brisbane for a consultation with a male doctor who called himself a cosmetic surgeon.
She was nervous to bare her chest to a stranger. Her fiance was the only other man who had ever seen her breasts. But three weeks after the initial consult, Samantha was booked in for a breast augmentation.
When she woke up from surgery, she felt fine and was pain-free. But a week later, her left breast felt hot and hard.
"I was having a shower and all of a sudden I felt this massive gush of liquid come out of my breast; all this fluid was leaking out of a hole in my scar," Samantha said.
"I made a follow-up appointment with the surgeon but he said: 'It's fine, these things can happen'. He put me on antibiotics but about a week later the wound reopened again. It just went on and on," she said.
Each time she returned to the clinic she was told everything was "fine" and her breast would heal eventually.
Instead, the wound opened up completely and the implant began to stick out.
"I could feel the silicon inside me and I was tugging on the actual implant," Samantha said.
"I went to the local hospital and it was like a freak show. All these nurses were coming in to look because they'd never seen anything like it. The plastics team there were so shocked.
"They said: 'He's butchered you'. The only thing that could be done was to have [the implant] taken out. I've still got the right implant in and I've been waiting for months with just one implant.
"And then the doctors told me the difference between cosmetic and plastic surgery. I didn't have a clue about either."
The most shocking thing about Samantha's story is that the doctor who performed her surgery didn't break any laws.
This week news.com.au is running a series of stories exploring why anyone with a standard medical degree is legally allowed to perform cosmetic surgical procedures in Australia.
These should be performed by a plastic surgeon or a medical practitioner who has undergone proper cosmetic surgery training, the industry's top bodies told news.com.au.
But a lack of industry regulation and confusion about the term "cosmetic surgeon" means patients are handing over their bodies and cash to dodgy doctors, with devastating and often lethal consequences.
In NSW, the Health Care Complaints Commission (HCCC) is conducting an inquiry into cosmetic health service complaints throughout the state. Public submissions close on April 8.
The inquiry comes after a public health warning was issued last September, when the owner of a Sydney beauty clinic died days after a botched procedure on her breasts caused her to go into cardiac arrest.
The woman who performed the procedure was a Chinese tourist not qualified to carry out cosmetic work in Australia and was charged with manslaughter.
She was allegedly assisted by Yueqiong Fu, a graduate nurse and salon worker, who has also been charged with manslaughter.
In a separate case, a group of Australian women have launched a class action against Australia's largest cosmetic surgery clinic, The Cosmetic Institute (TCI), claiming botched breast augmentations left them with serious health consequences.
One woman went into cardiac arrest after being given a high dose of local anaesthetic. Another said she now suffers seizures, while a third woman was forced to undergo emergency surgery.
The case was back in court last month and TCI insists it has done nothing wrong. Its legal team told a Sydney court they want several parts of the class action "thrown out" completely.
Australian Society of Plastic Surgeons president Professor Mark Ashton says clear industry regulations are needed to prevent this sort of tragedy.
"We're concerned about the lack of clarity and transparency around the term 'cosmetic surgery'," Professor Ashton said.
"Many people are advertising themselves as cosmetic surgeons when they have undergone little or no formal training in surgery.
"There are a lot of people promoting themselves beyond their level of expertise and the community as a whole is very confused about what the term 'cosmetic surgeon' actually means."
"Strictly speaking, nobody should use the term cosmetic surgeon at all. It's not a title that's recognised by the Medical Board of Australia," said the Cosmetic Physicians College of Australasia spokeswoman Dr Mary Dingley.
You're either a plastic surgeon or a cosmetic medicine practitioner.
"You can say that you perform cosmetic surgery, but you can't actually use the title 'cosmetic surgeon'. I'm not a surgeon, I only perform non-surgical procedures so I call myself a cosmetic medicine practitioner," Dr Dingley said.
But the temptation to capitalise on the booming popularity of cosmetic procedures means doctors with different qualifications are rebranding themselves as cosmetic experts.
News.com.au has heard of cases where cardiovascular surgeons or gastroenterologists deem themselves qualified to perform breast augmentations.
"Any doctor, any person with an MBBS [a Bachelor of Medicine and a Bachelor of Surgery] is entitled to perform surgery that they feel competent and trained to do," Dr Dingley said.
"No GP is going to perform brain surgery, because they don't have access to the hospital equipment. But the skin is far more accessible and people feel as it's more superficial, it's not so dangerous.
"We have people who don't have any kind of qualifications at all who feel they are capable of making cuts in people's skin. Often they're doing these in a beauty salon or even in their own homes, without access to proper, approved products, sterile equipment and proper facilities.
"They could be using a product that's labelled as Botox but it's salt water. It could be non-sterile. We just don't know, because it hasn't been tested and approved."
Any type of plastic or cosmetic surgical procedure is not cheap. Botox costs a few hundred dollars a pop, while a breast augmentation can be $10,000 or more.
One big concern among industry experts is the use of attractive 'payment plan' options that prey on vulnerable clients and encourages them to go into debt to pay for their procedures.
Nicole Montgomery is asurgical nurse and founder of Trusted Surgeons, an online platform that helps patients choose a qualified, well-recommended plastic surgeon.
Ms Montgomery, who worked at a popular Sydney clinic for a number of years, said the majority of the clinic's customers paid for their procedures using a high interest payment plan.
"The client demographic was people from a lower socio economic background and their marketing really preyed on single parents and divorcees," Ms Montgomery said.
"Most plastic surgeons don't advertise their costs. You go in for a consult and then they discuss price. But they were advertising $20-a-week breast augmentations that actually cost $5990. If you were a single mum on a pension you could pay off $20 a week for your boob job," she said.
Ms Montgomery's organisation fields constant queries from women in a huge amount of debt to clinics and unable to pay for reparative surgery.
"Patients left with botched jobs can't afford to fix the problem, because they were already in a huge amount of debt," she said.
"Most people who called through did not have $6000 in the bank and when something went wrong they were already in debt. It's unlikely any patient who came through could afford revision surgery by a plastic surgeon.
"People had complications post-surgery and patients were left backed into a corner. They couldn't afford to have reconstructive surgery. They've gone into debt to get their life changing surgery and give them the confidence they desire.
"I did all the post-operative care and I had women crying on the phone just devastated. Being a nurse and a woman, you feel empathy for these women, especially those who didn't tell their parents or who are single mums and can't afford reconstructive surgery."
New York Times: Tapping originated from a technique called Thought Field Therapy.