On the 3^rd April 2023, AHPRA published advanced copies of documents relating to the Cosmetic Surgery reforms that will come into effect on 1^st July 2023. There were two sets of guidelines that will impact our practice. The first document establishes new guidelines for advertising cosmetic surgery (little impact on our patients) and the other establishes new guidelines for the processes before and after cosmetic surgery (big impact on our patients).

There are several changes that will affect patients.

1. All patients seeking cosmetic surgery must have a GP referral.
2. There must be two pre-operative consultations, with at least one consultation face to face with the medical practitioner who will perform the surgery.
3. Consent cannot be obtained at the first consultation, must be obtained by the medical practitioner who will perform the surgery, and must be obtained at least 7 days prior to the surgery being performed.
4. Deposits cannot be paid until after 7 days after the second consultation.
5. All patients must be screened for Body Dysmorphic Disorder (BDD) with a validated psychological screening tool.

In the past, I have not mandated GP referrals for cosmetic (no item number) procedures, as this puts additional work onto GPs and does not help the paper trail of item numbers for Medicare tracking purposes. Going forwards, all patients will need a GP referral irrespective of which procedure they are considering.

The standard of care in my practice has always been an in-depth initial consult with a 2^nd consult offered to answer any additional questions. An additional consult is provided when marking up patients the day before an operation. The new legislation regarding the consent process will require all patients to have a 2^ndappointment, and those that require pre-operative marking will require a 3^rd appointment.

As far as I am aware, there is no BDD screening tool that is universally accepted. I am searching for a questionnaire that is compatible with online completion. The current plan is to ask patients to complete this questionnaire as part of the process of booking your first appointment. Screening prior to confirming a booking will minimise time lost to patients and staff. Should the online screening tool identify a patient who may have Body Dysmorphic Disorder, we will offer to help them/their GP find a psychiatrist for a formal evaluation preoperatively.

We apologise for the additional steps that are now required for our plastic surgical patients.