Academic shines spotlight on unregulated plastic surgery industry


When Amy Rickhuss was wheeled out of a cosmetic surgery clinic and into an ambulance to Westmead hospital, it set off a chain of responses pitting a high-profile academic against a booming cosmetic surgery business.

The 21-year-old’s heartbeat became irregular after what was believed to have been an adverse reaction to local anaesthetic used during a breast enlargement procedure.

The dramatic incident came to the attention of Merrilyn Walton from the University of Sydney who reported it to the Health Care Complaints Commission, sparking a war of words with a cosmetic surgery clinic, the hiring of crisis management consultants and a spotlight being shone on the largely unregulated world of cosmetic surgery.

Walton, a professor of medical education (patient safety) has lodged a complaint about the Rickhuss incident and two others that occurred at different cosmetic surgery facilities, to the NSW Health Care Complaints Commission.

As the former head of that Commission, Professor Walton presented a report on the cosmetic surgery industry to the NSW Health Minister of the day, Craig Knowles in 1999.

She is now concerned proposed guidelines from the Medical Board of Australia do not go far enough to regulate private doctor clinics.

“The clinics can do what they do. I just think it needs to be regulated,” she said.

“The [proposed] guidelines go into experience and credentialling​, but it doesn’t deal with the environment under which these procedures are now occurring and they are occurring in rooms because of improvements in sedation.

“I think everywhere that invasive procedures take place need to be treated the same and they need the minimum standards to keep patients safe.”

Professor Walton has written critically in the media about the billion-dollar cosmetic surgery being allowed to grow with “scant regulation”.

“Cosmetic surgery is not a recognised branch of medicine, so operators are only required to have a general medical degree,” she says in The Conversation. “These doctors are able to operate in an environment with few minimum standards and no inspection system to ensure patients are not at increased risk of harm.”

In response to Professor Walton’s criticism and complaint to the HCCC, The Cosmetic Institute has hit back accusing her of a conflict of interest because her son-in-law is a plastic surgeon who works in a private practice in Bondi.

David Segal who manages the The Cosmetic Institute in Parramatta and Bondi said Professor Walton should have declared her son-in-law, Alex Phoon​, is a plastic surgeon when she made her complaint to the Health Care Complaints Commission.

“You need to declare your hand. You need to say my son-in-law is a competitor,” Mr Segal said.

“I think what’s happening is they are trying to …take any action they can to stop us doing what we are doing and using the guise of medical safety when it’s about the fact our business has been successful and we are taking market share.”

Mr Segal said he had employed crisis management communications firm Cato Counsel to help deal with the issue to protect his business.

“It’s wearing a bit thin for us because we are trying to do the right thing and give consumers another option. I’m more than happy to compete on an even playing field where we have to be offering a great service,” he said.

Professor Walton completely rejected Mr Segal’s claims, saying she has had a longstanding interest in the need for regulating the cosmetic surgery industry that predates her son-in-law’s entry into the plastic surgery profession. She had also declared her his profession to the Australian Health Practitioner Regulation Agency when she sought its advice on the three incidents.

AHPRA advised her to refer the three incidents to the HCCC, saying her family relationship was irrelevant to the issue of patient safety which the HCCC would assess independently.

Mr Segal was also critical of postings on the Park Clinic Plastic Surgery Facebook site where Dr Phoon works, saying they were inflammatory. One posting says “Park Clinic Surgeons do not and will never perform twilight anaesthetic for breast augmentation surgery!”.


This is a reference to the type of local anaesthetic and sedation which is used for cosmetic surgery procedures at Dr Segal’s clinic.

Dr Phoon said his clinic published the Facebook post in response to interest and questions about the procedure from patients.

“Our patients wanted to know more about the safety of twighlight anaesthetics in the setting of breast augmentation surgery,” Dr Phoon said. “We felt it was important to inform our patients why we personally choose general anaesthesia over twighlight techniques, so they could help make their own decisions.”

Mr Segal said his practice aimed to provide women with a safe alternative to travelling to Thailand, Malaysia and Mexico for surgery.

“The reason that TCI exists is to offer people affordable options for cosmetic surgery here in Australia under Australian healthcare standards by Australian surgeons where there is recourse if things don’t go right they can have access to their surgeons for follow up and complication management,” he said.

“The reality is, irrespective of whether you are a plastic surgeon or whether you are a neurosurgeon, you are always going to have complications … [like] the issue we had when the patient had the unusual reaction to the local anaesthetic.

“We transferred her to a tertiary hospital which is the standard process.”

Mr Segal said the anaesthetist who treated Ms Rickhuss is a senior consultant from St Vincent’s hospital.

“We have about 40 anaesthetists who rotate through both of our facilities and they all work across Sydney’s most prestigious hospitals,” he said.

Mr Segal said his practice has done 11,500 procedures since August 2012 when it was established.



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