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Risk warnings for cosmetic medical patients

Disclaimer: The following is for educational purposes only and general public awareness. It is based on common accessible knowledge and client experience. It is not necessarily the opinion of the author.

Treatments between clinics are NOT the same. Advertising is often misleading and patients regularly leave disappointed. The industry is not regulated and whilst rules exist for how practitioners (doctors and nurses) must work, they are not always policed. A patients’ only protection is to be well educated about potential treatments, clinics and options. Always ask questions and never, ever treat if you feel uncomfortable or unsure, even if you are already in the chair!


Safety and Efficiency - The TGA (Therapeutic Goods Administration) is the Government body that determines which medical products and devices can be used in Australia. Our TGA is the strictest in the world in an attempt to protect its citizens from injury or death. A doctor must only use medical products deemed effective by the TGA. Nurses can operate them only under doctor instruction and never on their own. It is very expensive for companies to have their products and devices passed by TGA standards due to the extensive research needed to prove safety and efficiency. This adds to the cost of treatments at the consumer end. However, it is illegal to use a non-registered medical product or device. Yet, copies of registered machines are being made in Asia and sold onto the Australian market. Be warned these machines are either often dangerous or do not deliver the results of the genuine devices, which can lead to patients either being disfigured or wasting their money. The counterfeit treatments often sound ridiculously cheap compared to their genuine counterparts and also offer quick results with no risk or side effects. Before deciding on a treatment always check that the machine is genuine by referring back to the company who makes it. 

Training and Experience– In Australia there is no requirement for training to perform cosmetic medicine other than being a doctor, or a supervised nurse. This means that any doctor or nurse can simply do a 3-hour course and start treating patients. Now would you trust your open-heart surgery to anyone other than a fully trained cardio-thoracic surgeon? Of course not! So why would you trust your appearance when you must present yourself to people every day?

Fortunately, there are full training programs available but they are at the doctors’ expense. They are very costly and not a prerequisite, so most doctors would not choose to undertake this training. This, of course, puts patients at risk. It is also why seeing a fully trained and experienced aesthetic doctor is more expensive than one who is not. However, patients often save by not having unnecessary procedures and also have the knowledge, that they are receiving the best treatments currently available, at the safest of levels. The most advanced training a doctor can do is a Fellowship with a College. At present this could be with the Australian College of Cosmetic Medicine (ACCS), Cosmetic Physicians College of Australasia (CPCA), or in the Royal Australian College of Surgeons in Plastics or the Australian College of Dermatology. Please note that a Fellowship is a full training experience that takes years to complete. It involves being tested for theoretical knowledge and technical skills by peers of higher standing, ongoing education and years of actual experience. It is NOT the same as an association or affiliation with a College, so do not be tricked!

There is no Fellowship for aesthetics in dentistry or nursing. Training here consists of short courses.

Just a quick note on injecting. Good injecting is an “art form” that takes years to master. It’s about learning facial aesthetics, balance and harmony. Anybody can push a product into the skin, which is why we see so many terrible looking lips. Patients should discuss with their chosen injector what they wish to achieve and see if it is realistic. An experienced injector will be honest and upfront. Listen to their advice if you are serious about looking your best.

Advertising – Advertising medical products in Australia is restricted, but again not always policed, so many clinics are actually breaking the law, whether they realize it or not. A classic example of this is the “group-on” which in itself seems tacky when discussing a medical procedure but in addition is illegal as it offers publically, a time-limited discount on that treatment.

Advertising is a way to bring people in the door and doesn’t always reflect the true nature of the treatment or its value. For example, there are three TGA registered wrinkle relaxer products. Two have the same unit dosage ratio and the other needs 2.5 times the dose to get the same effect. So when advertised per unit it seems cheap but you need to multiply the cost by 2.5. The recommended dose per area of the first products is 20units, which equates to 50units of the other product. In most patients, this gives a full block. A full block means maximal longevity, which usually increases over time with regular use. Inadequate doses mean it wears off faster and as such you return more frequently and spend more! Advertising softer results mean you just get less product per treatment. Patients need to check the dosages they are getting. A full block does not mean an unnatural look either. Some clinics offer free top-ups to full block. These clinics offer the best value as any additional product is at their cost. All you have to worry about is getting the maximal result. In the case of wrinkle fillers, some clinics treatments may seem cheap as they have cross-linking technology that allows an effect but doesn’t last as long as other companies. 

In general the saying, “you get what you pay for” is very true in aesthetic medicine. Remember if it sounds too good to be true against similar treatments, then there will be a reason for that. That reason often relates to poor quality products or devices - especially ones that might not be TGA approved and may be illegally imported, poor doses or even limited training and experience by the nurse or doctor. You may be trading price for safety.

Unwanted Advice - Beware the clinic that attracts patients with ridiculously cheap sounding treatments and then plays on the patients’ insecurities! For example, a patient presents for their cheap wrinkle relaxer and are told they need multiple other treatments, as their imperfections are pointed out. Patients often believe what they are being told and leave having spent far more than intended. Often the treatment is not very good either. It is not ethical to point faults out to a patient unless they specifically ask for advice and even then it should be tempered with accurate information that can be explained as to why the treatment would benefit the defect. Patients should leave a clinic feeling better about themselves and their choices, whether they treat or not!

Ranking Systems - Patients should also be aware that there is no recognized ranking system for doctors and nurses. In fact, it is against AHPRA’s professional “code of conduct” for medical professionals to make public statements that they are “the best” at a procedure over their colleagues. Generalized statements that can be proven if questioned are allowed, such as being very experienced in a procedure or having specialized training in an area. In actuality, other doctors see such statements as insulting especially our International colleagues who are recognized leaders in their field. Beware also the clinic that claims they won some industry reward. These are in fact popularity contests where clinics have encouraged their patients to vote for them. Truth is, happy patients just get on with their life after their treatments and come back again when they want another one! They do not look for websites to vote and hence the reason why the better clinics are rarely included in the competition.

Informed Consent – It is a legal requirement that a patient undergoing a treatment be fully informed about the risks and side effects of the procedure before consenting to it. In addition, costs and realistic expectations should also be discussed, along with alternative options. A good doctor will take into account the patients desires for their treatment. All treatments that are TGA scheduled must have a prior consultation with a doctor, not a nurse. In addition, Skype consults were designed for rural medicine when a doctor was not able to attend a medical problem. Since they do not allow a true assessment of skin, they are not ideal for cosmetic consultations. What is concerning about Skype consultations with doctors is that many doctors are not even in the State. In which case, if something goes wrong with the treatment how can they review you and provide care. Nurses cannot prescribe or treat and as such a patient is left afraid and in the dark about their negative outcome or side effect. Even the simplest procedures carry risks, which can range from simple bruising to possible blindness. Cosmetic medical treatments are medical procedures, NOT simply beauty treatments that can be carried out in beauty salons that are not equipped for emergency situations or have medical sterility to prevent cross infections. Always ensure you have had a full consultation where all your questions have been answered before you undergo a treatment. It is often best to go away and think about treatments, especially expensive or invasive ones before you agree to the procedure. 

Testimonials/Reviews – It is actually illegal for doctors/nurses to promote themselves with testimonials or reviews in Australia. Since Google is foreign run you will still see them here. Potential patients must always consider that when reading reviews who wrote them and what was their motivation. Reviews against businesses can be written by their competition or disgruntled clients who may be psychologically disturbed. Positive reviews can be written by friends of business owners, or for personal gain. Either way, reviews are not a good way to make a decision about a business. In the case of medicine, potential patients would always consider their health first and look for experience, qualifications, quality of the facility and “value” over costs. They should have a consultation and then make their own judgment as to whether they would like to treat at that clinic.

The Health Department - Think all clinics where a doctor or nurse work is under the control of the Health Department. Think again! In WA only 3 of the clinics offering cosmetic medicine are in fact checked. They are known as licensed facilities (day hospitals) and have met the highest standards in safety, medical hygiene, daily running and facilities that are possible in the medical industry. It is so difficult, and expensive, to reach these requirements that most clinics do not bother with the process. In fact, they may be offering certain treatments (surgical such as liposuction) illegally and dangerously. Non-surgical procedures are still medical ones and should be done in a medical facility rather than a beauty salon or hairdresser, who are not designed for the hygiene and safety requirements for medical treatments. Patients should not think that getting a cosmetic medical treatment is like a beauty treatment, or put it in the category of shopping for groceries despite many clinics now being in shopping centres. Medical treatments can have side effects and risks that regularly occur, even in the best hands. Be sure that the experience and facilities to treat such negative outcomes are present in the clinic of your choice. Finally, if you are considering surgical options then please check with the Health Department of WA to ask if the facility you wish to use is licensed for such procedures. It’s not worth your health.


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