Plastic Surgeon or Cosmetic Surgeon? And what does FRACS mean?

Note: this article is not written to discredit or devalue other specialists or medical practitioners. It is written to inform you, the prospective patient and be an adjunct to your informed decision making process on the different types of medical practitioners who may be equipped to perform the operation you are after. It is ultimately up to you to be happy with the skills, experience and qualifications of your chosen surgeon and this is written with the intention to help you achieve that.

At present, many trade professionals have the ability to cross over into other areas of work. However despite a trades person’s skills, government licensing regulations require only legally licensed professionals actually perform particular specialised work. Despite the fact that your plumber could, in theory, have the technical knowledge to fix your electrical socket, unless they were legally licensed, they’d be prevented to do so (and also breaking the law).

Similarly many medical professionals have been interested in and able to develop their skills in performing a wide variety of surgical operations, outside their initial medical training. From simple outpatient, in-room surgeries (ie a skin cancer removal) to more complex cosmetic procedures such as breast augmentations.  The allure of performing aesthetic type surgeries has become an interest to many doctors for a variety of reasons.

You might then assume that in a similar way many trade professionals are required to be licensed for that specific skill that all medical professionals performing surgical procedures, and specifically aesthetic and cosmetic surgery, are similar qualified.

Well that isn’t quite exactly how it works when we are talking about cosmetic surgery.


Who can call themselves a surgeon?

In Australia the titles of medical specialties are highly regulated by the Australian Medical Council, and it is not permissible for doctors to title themselves as medical specialists in a particular field, if they do not hold appropriate qualifications. Rightly so.

Fields of specialty practice within surgery that are recognised by the Medical Board of Australia include plastic surgery (not to be confused with the term cosmetic surgery), oral and maxillofacial surgery, general surgery and orthopaedic surgery, among others. However, the Medical Board of Australia does not recognise ‘cosmetic surgery’ as a specialty practice of surgery. (see this article on Lawyers Alliance for more information).

This means that while a Bachelor of Medicine/Bachelor of Surgery is the general qualification of a GP (General Practitioner), within Australia, it is also legal for a qualified doctor with a basic medical degree, to perform surgery provided informed consent is obtained from the patient.

Since Cosmetic Surgery is not a recognised speciality practice, any registered medical professional/doctor is legally allowed to refer to themselves as a cosmetic surgeon, however only qualified doctors, with the appropriate qualifications, may refer to themselves as plastic surgeons.

Hence the reason you’ll see (or have already seen) some surgeons using the term cosmetic surgeon and some using the term plastic surgeon, or specialist plastic surgeon along with the FRACS acronym (these have completed further medical training in a specialty field of Plastic Surgery through the Royal Australasian College of Surgeons).1


What makes a ‘qualified plastic surgeon’?

Plastic and reconstructive surgeons are fully qualified fellows of the Royal Australasian College of Surgeons (this is why FRACS is included after many surgeons names).  After obtaining a basic medical degree (Bachelor of Medicine/Bachelor of Surgery), followed by internship, residency and registrar posts (post study intern/experience), a tiny proportion of doctors in Australia receive acceptance into the plastic surgery training program (SET).

The SET program is usually completed in no less than five years.  Any other specialty surgeon (eg. vascular, general, urology, cardiac surgery etc) who claims to be fully qualified and practising in Australia and New Zealand will be a respective fellow of the same Royal Australasian College of Surgeons (RACS).  They would have been selected to complete their own specialty arm SET program, each with their own core regulations, requirements and period of training. Trainee surgeons who do not make it through their specialty specific rigorous training process will be made probational, and those who ultimately fail the process will not be granted a fellowship by RACS (and not be allowed to call themselves plastic surgeons, nor use the FRACS acronym).


What does this mean for you when considering cosmetic surgery?

A Cosmetic Surgeon is a term applied to describe anybody who performs cosmetic surgery.
Because cosmetic surgery isn’t a specialty practice of surgery it means that you don’t have to be a qualified surgeon (ie complete the training mentioned above) to perform cosmetic surgeries as long as you have the consent of your patient.

For you, this means that some cosmetic surgeons are general practitioners or emergency or medical physicians who have not had any formal training through RACS.  Some may be general doctors who have started but never completed the surgical training program (SET). A new college, called the Australasian College of Cosmetic Surgeons has been established more recently to help train these medical professionals in appropriate surgical practices specific to cosmetic surgery.


Qualified plastic surgeons (FRACS) undergo specialist surgical training at the RACS.

To give you an idea of the rigorous training that us qualified surgeons go through, here’s a brief synopsis of the Royal Australasian College of Surgeons (RACS).

Within each specialty RACS training scheme, the college closely monitors the quality of each program to ensure that stringent accreditation and regulations are met every step of the way.

Each specialty arm has been involved with surgical training for decades, and the ability for trainees to learn from their more experienced clinicians and seniors has been present and maintained over a high standard across a huge historical period of time.

The Royal Australasian College of Surgeons advocate 9 core competencies. As a fully qualified Plastic and Reconstructive surgeon, my everyday practice strongly encompasses all of these important values:

  1. Medical Expertise
  2. Judgement – Clinical Decision making
  3. Technical expertise
  4. Professionalism and Ethics
  5. Health Advocacy
  6. Communication
  7. Collaboration and Teamwork
  8. Management and Leadership
  9. Scholarship and Teaching

It is important to note that the ability to use our hands and operate well (our technical expertise) forms only a small part of what we do as surgeons.

All these core competencies are learnt and practised from years of treating patients from both medical and surgical areas, and are assessed heavily during our surgical training and continually developed from decades of clinical and in-hospital training.

From a breast surgery perspective, fully qualified plastic surgeons are armed with the knowledge and skill to treat many conditions from cosmetic to reconstructive breast surgery (including congenital asymmetries).  These problems are often very complex to solve and require a mixture of techniques for every unique patient. The mere ability to insert an implant is a great skill to have, but addressing spare loose skin, shape and proportion is another matter altogether – and why our plastic surgery training is especially important.

From a wider community healthcare perspective, fully qualified plastic surgeons in Australia are commonly involved in both private and public practice, which then generates the ability to discuss complex cases in multidisciplinary forums with many different specialties in times of need. This helps to ensure that each patient has the care they require for each relevant pathology.  For example, a specialist plastic surgeon would routinely reconstruct a breast cancer patient in conjunction with a cancer resecting specialist breast and endocrine surgeon (they remove the actual cancer), with the accompanying guidance of a large team of medical and radiation oncologists to recommend appropriate adjunct therapy.  Moreover, joint resources with occupational health services and specialist nursing care are accessed with ease.

Our work within the public sector regularly requires involvement in routine clinical audits, continuing medical education and professional research activities to maintain up to date with evidence based medicine in order to provide the best patient care possible at all times.  Many of us are also involved in training junior doctors to further the knowledge of our next generation.

Final thoughts for you when choosing your surgeon

Despite all the above, it is of course true that a qualification itself does not guarantee that a surgeon is going to be the best surgeon for you.  A surgeon’s skill and efficiency can vary significantly between different individuals, and the values, ethics, and ability for a medical practitioner to develop rapport with a patient is not dependent on certain qualifications.

Any surgery – cosmetic or not – is a decision which affects the rest of your life.  It is very important to note that a cosmetic operation (in most cases) is done with the purpose of enhancement, and not as a life or limb saving or disease curing manoeuvre.  In a way, the stakes are even higher to ensure that you are well informed in your decision making process in regards to cosmetic surgery. As a fully qualified plastic surgeon I hold that in extremely high regard.  Your safety, outcome and quality of life is my utmost concern. I will always ensure that I provide the best and safest quality of care as possible at all times, to every patient I meet.

If you would like to have a consultation to discuss your surgical journey, have your questions or concerns answered, or to gain a second opinion, feel free to complete the booking consultation request form. I’d love to help and support you through this journey of yours.

Portions of this article have been written based on information within the Lawyers Alliance article “Cosmetic Vs Plastic Surgery”. The original article can be read and seen here. For more information regarding this topic, we highly encourage you to read the referenced article.



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