A surfboard destroyed Graham’s face. Finding a surgeon wasn’t so easy

Graham Kittle was surfing in heavy swell at Manly when a surfboard escaped its owner’s leg rope and smashed across his face,breaking his skull and scything a hole from his left ear to his jawline.

Nine hours of surgery later,he woke to discover facial nerves on his left side had been severed,and it would take many more surgeries from a specialist to put them back together.

But withstrict rules around what doctors who perform facial plastic surgery can call themselves,it wasn’t immediately obvious from his own research who had the expertise to do it. Eventually,his brother-in-law Richard Harvey,a professor of otolaryngology at the University of NSW and Macquarie University,put him in touch with Dr Catherine Meller,who specialised in facial nerve and reconstructive surgery.

“Because she’s listed,like Richard is,as an ENT[ear,nose and throat specialist] ... I couldn’t find her,” he said.

Otolaryngologists – more commonly known as ENT doctors – are trained in facial plastic surgery techniques,but some have been warned by the Australian Health Practitioner Regulation Agency (AHPRA) that referring to themselves as a “facial plastic surgeon” could be against the law.

The Australian Society of Head and Neck Surgeons (ASOHNS),the body representing ENT doctors,launched Federal Court action in 2022,effectively seeking immunity from regulatory action for qualified members wanting to use the title “facial plastic surgeon” alongside the term “otolaryngologist”.

In the final two days of the case,heard by Justice Melissa Perry last week,lawyers for ASOHNS argued its members trained in surgical techniques should be able to call themselves facial plastic surgeons because it is “a very accurate description of what they’re trained to do”.

“[My clients] want to describe accurately the services they provide – one of those is facial plastic surgery,” the applicant’s barrister,Stephen Lloyd,SC,told the court. “The normal English way to express that is to use the noun ‘surgeon’.”

Lloyd told the court that highly qualified ENT specialists were entirely different to doctors “passing themselves off as cosmetic surgeons and misleading the public as to skills they might not have”.

The action predatesthe federal government’s recent changes restricting the title “surgeon” for use only by those accredited in the fields of surgery,obstetrics and gynaecology,or ophthalmology,which came after aninvestigation by this masthead into harmful practices in the cosmetic surgery industry.

In an affidavit filed to the Federal Court last year,Melbourne-based ENT specialist Dr Zenia Chow said she had received a letter from AHPRA giving her 30 days to remove any reference to “facial plastic surgeon” from her advertising because it included “inappropriate reference to a specialist title or endorsement that is false,misleading or deceptive”.

She said she disagreed with the orders but complied with them to avoid regulatory action. This had led to some confusion among her patients,she said.

“My patients often ask me whether I am qualified as a Facial Plastic Surgeon,or whether I simply have an interest in,and occasionally perform,facial plastic surgery without having trained in the field,” she wrote.

The barrister representing AHPRA,Saul Holt,KC,said Dr Chow was “an obviously competent person who can do facial plastic surgery”,but it was not the job of the court to assess individual competency,and couldn’t guarantee that other less-qualified ENT doctors wouldn’t be breaking the law if they claimed to be facial plastic surgeons.

“People may well go away and think this is binding …[but] any such comfort would be a false comfort,” he told the court.

The judge said that there could be cases where using the term would be misleading or deceptive,but her decision would be useful for specialists in a similar position to Chow’s.

“It[my decision] would be taken into account in the provision of advice to others,and it would be presumably respected by the medical board[AHPRA],” she said.

She reserved her decision to be delivered at a later date.

Start the day with a summary of the day’s most important and interesting stories,analysis and insights.Sign up for our Morning Edition newsletter.