The terms “cosmetic surgery” and “plastic surgery” are often used interchangeably. Although both of these disciplines aim to improve a person’s body, the training, qualifications, and outcomes are very different.
So if you are considering a physical improvement for either medical or aesthetic reasons, what is the difference between plastic and cosmetic surgery?
Why are the procedures confused?
There are many misunderstandings about plastic surgeons and cosmetic surgeons and their roles, with many patients mistakenly believing they are equivalent when they are not. Many plastic surgeons choose to focus on cosmetic surgery, which has led to the terms often being used interchangeably, but this is technically incorrect.
There are also medical practitioners in Australia, such as GPs, who legally call themselves cosmetic surgeons. However, many of the procedures they perform should only be done by a certified plastic surgeon. These misperceptions regarding the industry highlight the need for more patient education on the importance of credentials.
What is plastic surgery?
Plastic surgery is a broad speciality field that consists of several sub-specialties. Essentially, this surgical specialty deals with the reconstruction and/or repair of facial and body damage or defects due to injuries, skin cancer, birth disorders, diseases, burns and other physical issues. Plastic surgery may be performed for:
- Hand repairs
- Burn repairs
- Cleft palate or lip repairs
- Mastectomy (breast removal surgery) or scar repairs
- Breast reconstruction or reduction to alleviate chronic back or neck pain
- Scar revision surgery—to minimise scars, so they are less visible and blend in with the surrounding skin tone and texture
- Reconstruction of the lower limbs—the legs, thighs, toes or feet
- Trauma surgery
What is cosmetic surgery?
Also known as “aesthetic surgery”, cosmetic surgery is dedicated to enhancing an individual’s appearance through various medical and surgical techniques. It can be performed anywhere on the body, including the neck, face, chest and abdomen, and the area to be treated is not typically dysfunctional. Instead, it may need to be aesthetically enhanced according to the patient. Cosmetic procedures include:
- Meloplasty (facelift)
- Breast reduction or augmentation
- Abdominoplasty (tummy tuck)
- Rhinoplasty (nose surgery)
- Blepharoplasty (eyelid surgery)
- Otoplasty (external ear surgery)
- Cheek or chin replacement
- Facial implants
- Cheek fillers
- Neck lift
- Brow lift
- Hair transplant
- Lip augmentation
- Chemical peel
- Wrinkle reduction
Are procedures emergency or elective?
Plastic surgery can be done as either an elective or emergency surgery. Emergency surgery usually means there is an urgent threat to an individual’s life, limb, organ or another part of their body. Examples include nasal injuries, facial lacerations and deep scalp wounds.
Cosmetic surgery is always an elective procedure as the area to be treated is not dysfunctional and needs to be treated aesthetically according to the patient.
What training and certifications are required?
Surgical procedures always come with the risk of complications. You can reduce this risk by selecting a surgeon who is appropriately qualified, trained and accredited to perform the highest level of procedures and surgeries.
A cosmetic surgeon differs significantly from a plastic surgeon. However, although health groups and government health departments are lobbying to change the rules, currently, it is not illegal for anyone in Australia with a basic medical degree to perform a cosmetic procedure. This is despite them having minimal to no surgical training and no formal qualifications.
They could be a GP, general surgeon, or dermatologist who has decided they want to perform cosmetic procedures. The training they have undertaken could be as basic as short weekend courses or a cosmetic surgery training in topics ranging from using injectables, placing breast implants or performing liposuction.
Cosmetic surgeons who claim to be board-certified may have received their certificate from the Australasian College of Cosmetic Surgery (ACCS), however, this qualification is not recognised by the Medical Board of Australia. Cosmetic surgeons claiming to be board-certified can be misleading, so it is vital you ask for proof of qualifications and certifications before undertaking any cosmetic or surgical procedure.
Many surgeons who offer cosmetic surgery also don’t have the appropriate:
- Medical training
- Surgical qualifications and recognition by medical boards
- Surgery specialities (skills, expertise and surgical study)
- Technical expertise (ongoing education and advanced surgical technique conferences with leading plastic surgery experts)
- Significant experience
Essentially, a cosmetic surgeon without the proper qualifications or registrations is not authorised to call themselves a plastic surgeon.
Plastic surgeons have earned a specialist degree through extensive training and surgical education. This includes a minimum of 12 years of additional surgical training in cosmetic and reconstructive plastic surgery procedures. Specialist training in Australia is undertaken as a Fellow of the Royal Australasian College of Surgeons — a FRACS (Plas). Plastic surgeons should also:
- Be registered with the Australian Health Practitioner Regulation Agency (AHPRA) for a specific surgical ability.
- Be certified by the Royal Australasian College of Surgeons (RACS), which is recognised by the Medical Board of Australia. This includes undertaking RACS testing and extensive examinations.
- Be a member of the Australian Society of Plastic Surgeons (ASPS).
- Specialist plastic surgeons are typically also members of peer societies, including the Australasian Society of Aesthetic Plastic Surgeons (ASAPS) and the International Society of Aesthetic Plastic Surgery (ISAPS). Membership is only available to qualified plastic surgeons.
- Be allowed to operate in larger hospitals—only accredited surgeons can do so.
- Tend to work alongside very experienced general anaesthetists and use “fully-asleep” forms of anaesthesia versus “twilight” anaesthesia only (most back-room clinics are restricted to using what’s known as “awake” surgery).
What types of doctors are qualified to do cosmetic surgery?
There are many different types of doctors who are qualified to perform cosmetic surgery and do cosmetic treatments. These include:
- Specialist Plastic Surgeons
- Ear, Nose and Throat Surgeons (ENT Surgeons) or “Facial Plastic Surgeons”, primarily for nose surgery
- Oral and Maxillofacial Surgeons primary operate within the head, neck, face, and oral regions
- Cardiothoracic Surgeons
- Bariatric Surgeons, Obesity Surgeons or Gastro Intestinal GI Surgeons
- Breast Surgeons or “OncoPlastic Surgeons”, primarily for Breast Cancer Surgery and Reconstruction
- General Surgeons who are trained as RACS surgeons
- Oculoplastic Surgeons or Ophthalmologists
However, again, it’s vital you choose an experienced specialist who has the training and qualifications listed above.
What are the risks of choosing an unqualified surgeon?
Any form of invasive surgery involves an element of risk. This is significantly increased if your surgeon — particularly your cosmetic surgeon — doesn’t have the necessary training and qualifications. Risks and side effects include:
- Minor side effects such as redness, swelling, bruising through to severe infections or scarring.
- Complications related to anaesthetics, including nausea, post-surgery vomiting, blood clots and pneumonia.
- Bleeding, infections, scarring, fluid collection, skin breakdown and numbness from nerve damage.
- With breast procedures, a loss of nipple sensation, asymmetry and difficulty breastfeeding.
- With body lifts and tummy tucks, wound breakdown and delayed healing.
- With non-surgical procedures like fillers and Botox, drooping eyelids and skin necrosis (“skin death”).
What questions should I ask before considering cosmetic surgery?
After speaking with your GP, you should consider asking your surgeon some general questions about what’s involved and the risks, both of the surgery and the anaesthetic. These can include:
- What are your qualifications?
- How many times have you performed this procedure, and how often do you do it?
- What are the risks of this procedure?
- How many people have experienced complications when you have performed this procedure, and what were they?
- Are there any alternative options to this procedure?
- What kind of anaesthetic will I be given, and who will provide it? What qualifications do they have?
- What care will I need after the procedure, and who will provide it?
- What will it cost, and what do those costs cover?
Does health insurance cover the procedures?
Plastic or reconstructive surgery is often considered medically necessary and, as such, may be covered by private health insurance. Some procedures like abdominoplasty, breast reductions, post weight loss surgery and blepharoplasty (eyelid surgery) may cover the areas of both plastic and cosmetic surgery. In these instances, Medicare and/or private health cover may be available dependent on your individual policy.
Because cosmetic surgery deals with aesthetic enhancement in the absence of medical indications, it is typically not covered by Medicare or private health insurance.
- Michelle Staughton, 2020, Plastic surgeon vs cosmetic surgeon and other types of doctors, Cocoruby Plastic Surgery
- 2021, Plastic surgeon vs. cosmetic surgeon: What’s the difference? Dean White Plastic & Reconstructive Surgeon
- Shaziya Allarakha, What is the difference between plastic surgery and cosmetic surgery? MedicineNet
- Libby Hakim, 2019, From botox to breast implants: The dangers of cosmetic surgery, HCF
- 2021, General risks and complications of cosmetic surgery, Cocoruby Plastic Surgery
- 2019, Guide to cosmetic surgery, Health Direct