Why does facial feminisation need a referral but cis ppl can have extreme facial surgeries regardless?

Hey, I’m having facial feminisation next month with Facial Team in Spain, yay!!

However, I did think it was strange how I needed to provide a letter of referral proving I was receiving gender affirming care.

And looking into this, it seems that many facial feminisation surgeons ask for the same or something similar.

Which got me thinking, ppl can have the most insane non-trans related surgeries on their face without any type of referral or “approval”.

It just feels so deeply unfair that I have to “prove” my fitness for this surgery, when ppl can literally decide they want surgery to look like an animal and that’s fine?

This isn’t me saying other facial surgeries should need referrals too, but simply that trans facial surgeries shouldn’t.

What do y’all think?