Health & beauty

Cosmetic procedures

Updated: 07 Oct 2008
Cosmetic-procedures-hero

Introduction

Changing your appearance by cosmetic procedure is a decision that needs to be made carefully.

Whether it's a minor touch-up or a full body makeover, you'll need to work out the best treatment for you - and find the right doctor for the job.

Cosmetic procedures can be expensive, potentially irreversible - and risky. We investigate the options.

Levels of risk

The Medical Council classifies cosmetic procedures according to their level of risk and complexity:

  • Category 1 procedures involve cutting beneath the skin. They include nose surgery, surgical facelifts, breast surgery and liposuction. These more extensive procedures are best carried out in a day-stay clinic or hospital and with an anaesthetist present. They have a higher risk of complications and should be performed by a plastic and reconstructive surgeon or by another specialist surgeon (whose recognised scope of practice includes the specific procedure).

  • Category 2 procedures are non-surgical treatments like laser skin treatments, chemical peels, and injections such as Botox and dermal fillers. They can also be invasive and carry risks. Category 2 procedures are usually carried out in a day-stay clinic or doctor's rooms by a plastic surgeon, GP or dermatologist. Depending on the procedure, an anaesthetist may be present.

Doctors without surgical qualifications may perform certain operations if they're working in a "collegial relationship" with a qualified and registered surgeon. This means GPs performing minor cosmetic surgery must have their training and assessment overseen by a doctor who is registered in an appropriate scope of practice.

According to the Medical Council, there are very few doctors performing Category 1 procedures as part of a collegial relationship - those who do are either dermatologists (who are limited to performing liposuction) or surgeons registered in another specialty. There are many more doctors performing Category 2 procedures as part of a collegial relationship.

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.

Colin Calcinai

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.

Making an informed decision

Choosing a doctor

If you're considering cosmetic surgery and looking for a doctor, your GP is a good place to start. A GP can provide independent advice and help you determine whether you should consult a cosmetic surgeon or another appropriately trained doctor. Your GP may also be aware of doctors practising beyond their skills and expertise.

Check qualifications
The Medical Council of New Zealand register will tell you whether a doctor is registered in New Zealand and what their qualifications are. Any conditions imposed on a doctor's practice will also be listed here.

Finding out more
Visit the websites of the new Health Practitioners Disciplinary Tribunal and its predecessor the Medical Practitioners Disciplinary Tribunal.

The tribunals are responsible for disciplining doctors; details of all the cases they hear are available online. If a doctor has been found guilty of a charge then their name will usually be published.

Deciding on treatment

Before you decide on treatment (surgical or non-surgical), make sure you have real answers to these questions:

  • Is there more than one procedure or treatment option available?
  • How long will the procedure take and how painful will it be?
  • What complications might occur and how common are they?
  • Where will the procedure be performed and will it be under general or local anaesthetic?
  • What's the total cost of treatment?
  • How long will it take to recover and what level of care will I require afterwards?
  • Will there be any bruising, bleeding, swelling or scarring?
  • Does the doctor have a nurse to assist? And is there full resuscitation equipment in the surgery?
  • What can I do if I'm unhappy with the result? Can it be undone or corrected? What will this cost?


Case studies

Maria (not her real name) wanted to look her best on her wedding day so she gave Botox a go. She wisely had a trial run six months before the big day, and a second treatment closer to her wedding day. She was thrilled with the results and would love to have kept it up if it wasn't so expensive - Botox generally lasts 3 to 6 months and costs upwards of $250 per treatment.

Deb's experience wasn't so satisfying. She had an appendix scar revised, abdominal liposuction, and fat implanted into her cheeks - all under local anaesthetic. Deb describes the use of local anaesthetic as completely inadequate. Although happy with her cheek implants, Deb was not satisfied with the scar revision. She also thought her treatment was expensive at $6000, particularly with "theatre" charges when the procedure was carried out in the specialist's rooms and not in an operating theatre.

Cosmetic surgery getaways

Recovering from surgery

As an alternative to having surgery at home, some New Zealanders are choosing to combine cosmetic surgery with an overseas holiday.

"Medical tourism" agencies arrange the entire holiday - air travel, surgery, and hotel and hospital bookings.

If everything goes to plan, surgery overseas can save you money. In New Zealand a full facelift costs $25,000 to $32,000; in Malaysia a similar procedure will set you back about NZ$10,000 (including all treatment and accommodation but not airfares). That's if it all goes to plan - any complications which see you return to hospital will add to your bill.

Agency websites show impressive "before" and "after" photos, along with convincing testimonials. What they don't show you is the ugly in-between stage. Any operation will result in pain, bruising and swelling - which may prevent you from enjoying your holiday. In fact, many typical holiday activities - swimming, sunbathing, and enjoying a drink or two - are ruled out while recovering from surgery.

Before you go

If you're thinking about having surgery overseas, consult a cosmetic surgeon in New Zealand before you go. You need to make sure the operation you choose is appropriate for you and your body, and that your expectations are realistic and achievable.

Colin Calcinai, President of the New Zealand Association of Plastic Surgeons, advises anyone contemplating surgery overseas to check out their surgeon's credentials rather than taking an agent's word.

It's also a good idea to look into the quality of the hospital and its safety record. Choose a hospital that's independently accredited by a healthcare accreditation group such as Joint Commission International (JCI). You can search the JCI website for accredited international hospitals. It provides you with assurance that a hospital meets safety and quality standards.

Surgery usually takes place a day or two after you arrive. This means you may only have a day between meeting your doctor and having surgery. In New Zealand, a cosmetic surgeon should allow at least seven days between the initial consultation and the operation. This allows time to reflect and consider your decision.

Unhappy customers

Looking for wrinkles

If you're unhappy with the outcome of a cosmetic procedure, go back to the doctor who performed the procedure and let them know.

Surgeons (in New Zealand or overseas) generally don't offer a "money back guarantee". But if you're unhappy with the outcome of a cosmetic procedure performed by a Kiwi doctor you have some protection. You can complain to the Health and Disability Commissioner.

If necessary, the Commissioner will refer the complaint to the Medical Council of New Zealand. Making a complaint helps identify where poor practice is occurring and where patient safety may be at risk.

And if you suffer injury as a result of cosmetic surgery performed in New Zealand you're covered by ACC. If you suffer injury overseas you're only covered if your doctor has qualifications equivalent to a surgeon registered here.


More information

The Medical Council of New Zealand's free booklet 'What to expect from your doctor when you have a cosmetic procedure' can be downloaded from www.mcnz.org.nz or obtained by calling 0800 286 801.

More from consumer.org.nz


Report by Libby Manley