Who does the work?

Specialist cosmetic surgeons

Any doctor can call themselves a cosmetic surgeon but they are only recognised as a specialist cosmetic surgeon by the Medical Council of New Zealand if they have trained through the Royal Australasian College of Surgeons (or an overseas equivalent).

If your doctor is a specialist cosmetic surgeon their vocational scope of practice will be registered as "plastic and reconstructive surgery" on the Medical Council of New Zealand online register.

Cosmetic surgery is a branch of plastic and reconstructive surgery: it has the sole purpose of improving appearance or self-esteem. Other plastic and reconstructive surgery can be medically necessary - for example, to correct a cleft lip or palate. Most plastic and reconstructive surgeons here perform both cosmetic and medically necessary procedures.

GPs with special interests

Advances in techniques and the development of new cosmetic procedures has seen an expansion in the range of procedures that fall into Category 2 (see Levels of risk). The number of general practitioners offering these services has also grown and many procedures can now be safely carried out in day-stay clinics or doctors' rooms. Without private-hospital theatre costs and the expense of a specialist anaesthetist, these procedures have become more affordable.

"Appearance-medicine" clinics established by GPs occupy a space between beauty therapists and specialist cosmetic surgeons. Some clinics that have specialist surgeons, GPs and nurses offer different levels of cosmetic procedures, with the specialist surgeons doing the most complex procedures.

Appearance-medicine GPs may be very experienced at performing some cosmetic procedures - and even minor surgery such as eyelid lifts and scar revision. But they don't have the recognised specialist qualifications that a cosmetic or plastic surgeon holds and they must be working in a collegial relationship with a doctor who is registered to perform such procedures.

Appearance medicine isn't part of any formal medical training college. This means there's no independent organisation overseeing training and accreditation of appearance-medicine doctors.

This may change - the Royal New Zealand College of General Practitioners is working with appearance medicine doctors on the standards for training and assessment for doctors performing Category 2 procedures.

Colin Calcinai (pictured), President of the New Zealand Association of Plastic Surgeons, warns that although most Category 2 procedures aren't surgical this doesn't mean they're not invasive.

He'd like to see surgery performed only by registered surgeons.