Key Takeaways
- Since 1 July 2023, anyone having cosmetic surgery in Australia needs a referral, at least two consultations before surgery (one in person with the surgeon who will operate), screening for body dysmorphic disorder, and a cooling-off period of at least seven days before surgery is booked or a deposit is paid.
- Under-18s must be assessed by an independent psychologist, psychiatrist or GP, and there’s a cooling-off period of at least three months between consent and surgery.
- Since late 2023 in most of Australia, and nationwide since May 2024, only doctors with specialist registration in surgery, obstetrics and gynaecology, or ophthalmology can call themselves a “surgeon”, including a “cosmetic surgeon”.
- Cosmetic surgery must be done in a facility suited to the risk of the operation, and the rules restrict payment, finance offers, testimonials and before-and-after images.
- You can check any doctor’s registration and specialty yourself on the public register kept by the Australian Health Practitioner Regulation Agency (Ahpra).
“Do I really need a GP referral?” and “Why can’t I just book a date?” are questions I hear often. The short answer is that the rules changed in 2023, and those steps now sit between your first enquiry and the day of surgery, whoever you see.
In this article I explain what the Medical Board of Australia and Ahpra require before, during and after cosmetic surgery, who can call themselves a surgeon, what’s happening with the cosmetic surgery endorsement, and how to check a doctor yourself.
I’m Dr Scott J Turner, a Specialist Plastic Surgeon and Fellow of the Royal Australasian College of Surgeons (FRACS). This is general information about the rules, not legal advice.
Why the rules changed
An independent review, commissioned by Ahpra and the Medical Board in late 2021 after serious patient safety problems came to light, looked at how doctors who perform cosmetic surgery are regulated. Its report, published in September 2022, made 16 recommendations, and Ahpra and the Medical Board accepted all of them.
The result was a set of new guidelines for doctors who perform and advertise cosmetic surgery, which took effect on 1 July 2023, and work on a cosmetic surgery endorsement. Alongside the review, health ministers changed the national law on who can use the title “surgeon”. The common thread is treating cosmetic surgery as medical care rather than a purchase.
These rules apply to surgery done mainly to change appearance, and to any doctor who performs it, whether or not they can use the title surgeon. They don’t apply to reconstructive surgery, gender affirmation surgery, or surgery that’s medically justified, for example to restore function or repair the effects of injury or disease.
The steps before cosmetic surgery
| Step | What the rules require |
|---|---|
| Referral | A referral, preferably from your usual GP, otherwise from another GP or a specialist. The referring doctor must be independent of the surgeon and must not do cosmetic procedures themselves. |
| Two consultations | At least two consultations before surgery. The first must be with the surgeon or a registered health practitioner who works with them, not a patient adviser or agent. At least one must be in person with the surgeon who will operate. |
| Psychological screening | The surgeon must assess your reasons and expectations and screen for body dysmorphic disorder using a validated tool, with referral for independent assessment if needed. |
| Consent | You can’t be asked to sign consent forms at your first consultation, or consent before an in-person consultation with the surgeon. Consent is obtained by the surgeon at least seven days before surgery and reconfirmed on the day. |
| Cooling-off period | At least seven days after your two consultations and signed consent, before surgery can be booked or a deposit paid. |
| Written information | Plain-language information on the operation, risks and recovery; the doctor’s registration, training and experience; and costs, including the total, fees or estimates for the anaesthetist and hospital, implants, follow-up, possible revision and deposit refund terms. |
The referral
The referral isn’t a formality. Ideally it’s a doctor who knows you, and in every case one who has nothing to gain from your surgery, who has thought about your general health and your reasons before you see a surgeon. If you don’t have a regular GP, another GP or a specialist can refer you, as long as they don’t do cosmetic procedures themselves.
Two consultations
In my practice, both consultations are with me. You can have the first by video and the second in person, or the first in person and the second by video. The first covers what’s bothering you, your medical history, the options (including non-surgical options and not having surgery at all), the risks, and what recovery involves. You leave with written information and time to think. I explain what both consultations involve in your first consultation.
Screening for body dysmorphic disorder
Body dysmorphic disorder is a recognised mental health condition in which someone becomes intensely preoccupied with a perceived flaw that others barely notice. Research suggests surgery rarely helps, and it can make the distress worse. Screening isn’t about judging anyone. It’s about making sure surgery is the right answer to what you’re bringing to me. I use a validated screening questionnaire for everyone and record the result. If the screening raises a flag, the next step is an assessment with an independent psychologist, psychiatrist or GP before any decision is made, and a surgeon must decline to operate if surgery isn’t in your best interests.
Consent, cooling-off and costs
My written quote sets out the total cost, what’s included, the deposit and payment dates and the refund terms, and confirms that cosmetic surgery isn’t covered by Medicare. Once you’ve had both consultations and signed consent, at least seven days must pass before surgery is booked or a deposit is paid. That week gives you time to change your mind before you’ve paid anything beyond consultation fees. You can see my fees on the plastic surgery prices page.
If your surgery involves an implant
For any cosmetic surgery that places an implant, such as breast implants, you must be given the manufacturer’s patient information leaflet approved by the Therapeutic Goods Administration (TGA) before surgery, and a patient implant card afterwards. Keep both. If you ever need follow-up or see another surgeon, they tell that surgeon exactly what was used.
Extra protections for under-18s
The rules are stricter for anyone under 18:
- They must be referred to and assessed by a psychologist, psychiatrist or GP who works independently of the surgeon, before any cosmetic surgery.
- There must be a cooling-off period of at least three months between consent and surgery.
- The surgeon must be satisfied that the young person can consent, and should take the views of a parent or guardian into account.
- State or territory law can add further restrictions for under-18s.
Non-surgical cosmetic procedures, such as cosmetic injectables, have their own rules. For under-18s these include a cooling-off period of at least seven days between consent and the procedure, and regulators consider that the common prescription-only cosmetic injectables shouldn’t be prescribed to under-18s for cosmetic purposes. These rules have applied to doctors since July 2023. Since September 2025 similar rules apply to nurses and other registered health practitioners, and advertising of higher-risk non-surgical procedures can’t be aimed at under-18s.
Money and payment rules
The guidelines are specific about money, because financial pressure is one way people get pushed into surgery:
- No money is payable until after the cooling-off period, apart from consultation fees.
- Surgeons must not offer, promote or recommend loans or commercial payment plans, or encourage you to take on debt or access your superannuation for cosmetic surgery. They can tell you which payment methods they accept.
- Surgeons must not offer extras that act as an incentive, such as free or discounted flights or accommodation, or free or discounted surgery to influencers in exchange for promotion.
- Surgeons must disclose any financial interest that could be seen to influence their advice.
Where surgery is done, and care afterwards
The Medical Board’s guidelines require cosmetic surgery to be done in a facility that suits the risk of the operation and your health, is staffed and equipped to manage complications and emergencies, and meets state or territory licensing laws. The guidelines also include a requirement for facilities accredited to national standards, but the Medical Board deferred it in June 2023 and it hasn’t started. Separately, in 2023 health ministers agreed a national licensing framework for cosmetic surgery facilities, which the states and territories have committed to implementing, and national cosmetic surgery standards for facilities have applied since December 2023. Most of my surgery is done in accredited private hospitals under general anaesthesia, with a specialist anaesthetist.
After surgery, the doctor who operated is responsible for your care. If they aren’t available, they need a named, suitably qualified doctor to cover them, arranged in advance, and you must be told who that doctor is. You must get written instructions on discharge, including who to contact and when. A doctor who flies in to operate away from their main practice must remain available in that location for at least 24 hours after your surgery.
Who can call themselves a surgeon
Since 20 September 2023 in most of Australia, and in every state and territory since May 2024, only doctors with specialist registration in surgery, obstetrics and gynaecology, or ophthalmology can use the title “surgeon”. That includes “cosmetic surgeon”. A doctor with general registration can’t call themselves a surgeon, however much cosmetic work they do. Misusing the title is a criminal offence, with a maximum penalty of a $60,000 fine, three years’ imprisonment, or both.
“Cosmetic surgeon” isn’t a specialty in its own right. A specialist plastic surgeon has specialist registration in surgery in the field of plastic surgery, and is a Fellow of the Royal Australasian College of Surgeons. That training includes managing complications as well as doing the operation. I hold specialist registration in surgery (plastic surgery) and have been a Fellow since 2013. I explain the main qualifications and what they mean in choosing your surgeon, and the voluntary Australian and New Zealand Board of Cosmetic Plastic Surgery (ANZBCPS) certification, which is separate from registration.
The cosmetic surgery endorsement
The endorsement is designed to show on the public register whether a doctor has met cosmetic surgery training standards set by the Australian Medical Council and the Medical Board. The standards are approved, and education providers can apply to have their training programs accredited. Once a program is accredited and approved, its graduates will be able to apply for the endorsement.
The Medical Board’s endorsement page still lists no approved programs of study, so no doctor holds the endorsement yet. Two things are worth knowing:
- The endorsement won’t let a doctor call themselves a surgeon. That still needs specialist surgical registration.
- Any registered doctor with an approved qualification will be able to apply, whether or not they’re a specialist surgeon. Specialist registration in surgery already reflects surgical training accredited by the Australian Medical Council, and it shows on the public register.
Advertising rules
Cosmetic surgery advertising, including websites and social media, now has its own guidelines:
- No testimonials. Patient stories and positive reviews about clinical care can’t be used in advertising, and I don’t use them.
- Real, unedited images. Before-and-after photos must be of the doctor’s own patients, taken in matching conditions, without filters or retouching, and must carry a prominent warning that results vary. Single “result” images with mood lighting, filters or models aren’t allowed, and images of under-18s can’t be used. Patients must give separate consent before their images are used, and can withdraw it at any time.
- No trivialising. Advertising can’t glamorise surgery, play down the risks or recovery, or use language that suggests a normal body is a problem to be fixed.
- No influencer arrangements that get around these rules.
Since September 2025, advertising of higher-risk non-surgical procedures has tighter rules too, including real images and a warning that results may vary. Under therapeutic goods law, prescription-only medicines, including most cosmetic injectables, can’t be advertised to the public. A clinic can promote its consultations, but not the medicine, by name or by implication.
How to check a doctor yourself
- Search the Ahpra public register. It shows whether a doctor has general or specialist registration, and in which specialty and field.
- Ask directly. Ask about their registration, their training and experience in your operation, where they operate, and who looks after you if something goes wrong.
- Notice how the practice treats the steps above. A practice that respects the referral, the two consultations and the cooling-off period is telling you something. So is one that treats them as obstacles to rush past.
- Know where to report a problem. Ahpra runs a Cosmetic Surgery Hotline on 1300 361 041. You can also complain to the practice, to the health complaints body in your state or territory, or to Ahpra, and a non-disclosure agreement can’t stop you complaining to a regulator.
All surgery carries risks, and I explain them, and how they’re managed, in risks and complications of cosmetic surgery. If you’d like to talk through your own situation, you can contact the practice.
Frequently asked questions
Do I need a referral to see a plastic surgeon?
For cosmetic surgery, yes. Since 1 July 2023, you need a referral, preferably from your usual GP, before your consultation, and the referring doctor must be independent of the surgeon and not do cosmetic procedures themselves. For surgery with a medical reason, you need a valid referral to claim the Medicare rebate at the specialist rate for the consultation.
What is the cooling-off period for cosmetic surgery?
For adults, at least seven days must pass after your two consultations and signed consent before surgery can be booked or a deposit paid. For under-18s, there must be at least three months between consent and surgery. No money is payable during the cooling-off period apart from consultation fees.
Can you have cosmetic surgery under 18 in Australia?
It’s possible, but the rules are much stricter. A young person must be assessed by an independent psychologist, psychiatrist or GP first, the surgeon must be satisfied they can consent, and there’s a cooling-off period of at least three months. State or territory law can add further restrictions, and major cosmetic surgery is rarely appropriate at that age.
What’s the difference between a plastic surgeon and a cosmetic surgeon?
“Cosmetic surgeon” isn’t a recognised specialty. Since late 2023 in most of Australia, and nationwide since May 2024, only doctors with specialist registration in surgery, obstetrics and gynaecology, or ophthalmology can call themselves any kind of surgeon. A specialist plastic surgeon holds specialist registration in surgery in the field of plastic surgery and is a Fellow of the Royal Australasian College of Surgeons. You can check any doctor’s registration on the Ahpra public register.
Can I book surgery or pay a deposit at my first consultation?
No. You can’t be asked to sign consent forms at your first consultation, and you need at least two consultations, one in person with the surgeon. After you’ve signed consent, at least seven days must pass before surgery is booked or a deposit is paid.
