The Difference Between a Plastic & Cosmetic Surgeon

There are no rules or regulations in Australia that dictate which doctors can perform which surgeries. Because cosmetic surgery often attracts no funding from Medicare or Private Insurance, the industry remains unregulated and any doctor with little or no training can perform cosmetic surgery.

It is of paramount importance therefore for patients to research and be well informed that their surgeon has the appropriate qualifications to undertake their surgery. Even more important is the safety and environment in which they will perform the procedure, and that they will be able to treat any complication should it so arise.

There are some key differences between Plastic & Cosmetic Surgeons.

1. College and Rigor of Training

Dr Aggarwal is a fully trained Plastic, Reconstructive & Aesthetic Surgeon with the qualification of Fellowship of the Royal Australasian College of Surgeons (FRACS) in Plastic Surgery.

Royal Australasian College of Surgeons is the only body in Australia accredited to train surgeons in this country in any one of the nine surgical specialties. This means that Plastic Surgeons receive the same rigorous training as a cardiac surgeon, neuro surgeon, orthopaedic surgeon, etc. This includes an extremely competitive entry requirement, and once selected for training surgeons train for 5 years in their specialty. Subsequently they have to pass one of the most rigorous fellowship exam in the world, to have the qualification “FRACS”.

There are various colleges of ‘Cosmetic Surgery’ in Australia – unfortunately in Australia there are no parameters around what is required for colleges to be set up. Therefore membership of these colleges does not guarantee a certain level or quality of training. The duration of training from these colleges is often short, and these colleges are not recognised by AHPRA, Medicare, Health Funds or Private hospitals. The only training recognised by the Australian Medical Council and all medical institutions in Australia is that provided by RACS, which provides training to all surgeons in this country.

2. Duration of Training:

• Due to the rigor and competitiveness of Plastic Surgery Training, the total duration of training is often 10 years+ AFTER finishing Medical School.
• Dr Aggarwal’s training to become a plastic surgeon included
  • 2 years as Intern and Resident at Westmead Hospital
  • 1 year as an Accredited General Surgical Registrar at Sydney West Local Area Health Service
  • 5 years as an Accredited Plastic Surgery Registrar
  • 6 months as a Breast Reconstruction Fellow at the University of Toronto
  • 1 year as a Microsurgery Fellow at the University of Pennsylvania
  • TOTAL OF 9.5 years AFTER medical school
• Colleges of Cosmetic Surgery offer ‘training’ that is not standardised or regulated by any recognised body and the duration is much shorter varying from a few days, weeks to 1-2 years where they observe other cosmetic surgeons performing certain procedures.

3. Hospitals

• Private hospitals do not recognise training for cosmetic surgery by any other body than RACS. Therefore doctors who are not RACS trained but call themselves ‘cosmetic surgeons’ are often not granted accreditation to practice at private hospitals
• Cosmetic surgeons will only be able to treat patients in their own procedure rooms, or day surgeries that they have established. These facilities are usually not accredited by Medicare, and therefore cannot administer general anaesthetic on site, and often cannot admit patients overnight
• This can become a problem in the event of complications that require general anaesthesia or require inpatient care. In these situations non-RACS doctors will require you to present to a different hospital and be cared for by a RACS trained plastic surgeon when things go wrong
• As a plastic surgeon, Dr Aggarwal will always look after you. In any unforeseen circumstances you will always be able to have plastic surgery care at a hospital 24 hours a day, 7 days a week. There will never be a scenario in which you will not be able to be looked after by Dr Aggarwal or someone from his team.

4. Anaesthetic

• Cosmetic procedures are often touted as best performed under twilight anaesthetic – while this may be true for some minor procedures many require general anaesthetic.
• However general anaesthesia can only be administered by an accredited anaesthetist in a facility accredited by Medicare. These accredited facilities are Sydney’s private and public hospitals.
• Because these institutions only recognise training from RACS and do not employ cosmetic surgeons, it follows that (usually) only RACS trained plastic surgeons can offer general anaesthesia for cosmetic procedures in a private hospital setting.
• Cosmetic surgeons, unless operating their own accredited facility, therefore cannot administer general anaesthesia, and will usually misrepresent the benefits of twilight anaesthesia as this is the only method of anaesthesia available to them.
• Unfortunately when twilight anaesthesia is inappropriately used, high levels of local anaesthesia can reach toxic levels, and this occurred when some patients had cosmetic surgery at a Sydney institution employing cosmetic surgeons. These stories published in the media can be found here:
  • http://www.abc.net.au/news/2016-04-19/breast-implant-patients-knocked-out-without-consent/7329324
  • https://www.smh.com.au/national/nsw/woman-recovers-after-cardiac-arrest-at-cosmetic-institute-during-breast-implant-surgery-20150131-132n8z.html
  • https://www.smh.com.au/national/nsw/another-patient-rushed-from-the-cosmetic-institute-to-hospital-emergency-unit-20150902-gjde2t.html
  • https://www.smh.com.au/national/nsw/the-cosmetic-institute-lung-punctured-during-routine-cosmetic-surgery-20150929-gjx02h.html

5. Cost

• Plastic Surgeons and Cosmetic Surgeons will generally charge similar amount for their surgical fee
• However the total cost for your procedure is often higher with a Plastic Surgeon than a Cosmetic Surgeon. Why is this so?
• This is because in general a Plastic Surgeon will not compromise the quality of care you receive – if your care requires general anaesthesia, and therefore a private hospital, this is often more expensive than cheaper unaccredited facilities that only offer twilight anaesthesia
• However Dr Aggarwal works at multiple private hospitals and we will always endeavour to find a facility that will be the most affordable for your procedure without compromising the quality and safety of your care.

Furthermore in some cases where a Medicare item number may be applicable, such as for implant revision, Plastic Surgeons like Dr Aggarwal will be able to claim a partial medicare/health fund rebate for your surgery and all hospital costs may indeed be covered making this safer and cheaper than a treatment by a cosmetic surgeon.