Cautions over cosmetic injectables

By Kirsty Frame of RNZ

What was once only found in Hollywood reality TV shows is now something you can get down the road for as little as $70.

Cosmetic injectables have become increasingly more accessible, affordable and popular, but there are concerns New Zealand’s regulations are too lax.

Derma filler, which is injected under the skin to add fullness to areas of the face, ranges anywhere from $400 to more than $1200.

One common area is the lips, which is more affordable than other areas, but a more temporary “lip flip” injection can start at $70.

Bella went to one store to get her lips done, something she had wanted for a while. She only needed 1ml of the product at about $480.

But it did not work out as she had hoped.

“[The nurse] vaguely explained to me what [the filler] was, and then she just did it for me, she didn’t really explain any risks,” Bella said.

“I came out with the most sausage-looking lips, it was awful ... I was like, ‘oh my god what have I done?”

It was not until seeing a new practitioner a year later that Bella learnt her filler was not put into the right parts of her lips the first time.

A clinic needs to have a doctor to administer a standing order, similar to a prescription, to approve the injectables and have responsibility over the nurse administrating them.

But there are no ratio standards - meaning big chain stores can have a small number of doctors approving huge numbers and responsible for more nurses.

The New Zealand Society of Cosmetic Medicine (NZSCM) is recognised by the Medical Council as a regulator to train doctors in cosmetic medicine.

Dr Sarah Hart of the New Zealand Society of Cosmetic Medicine.

Dr Sarah Hart is part of the society, and a cosmetic doctor for almost 20 years. She said there is inconsistent experience behind the people holding the needle.

“Our doctors have typically had 15 years of medical training under their belt, two years of which have been specifically cosmetic medicine, and yet there’s other providers out there who have done a weekend course and are delivering treatments.”

Too often she gets clients coming in with ‘botched’ procedures.

“I’ve had loads of people coming in going ‘oh, I don’t like this, I went here and they botched it, can you please help me fix it up?’

“Then I have to charge them the cost of dissolving the filler and then there’s the cost of maybe redoing it if they want.”

It is hard to measure, but about 5 per cent of the population have had some kind of procedure - and it is growing as more shops open up.

Dr Hart said a number of Australian chains are now setting up shop over here.

Big franchises are able to buy more injectables in bulk to sell at cheaper prices, which Dr Hart said combined with the lax regulations in New Zealand are creating a “buyer beware” market.

“A person going in for treatment needs to ask questions about the training that the practitioner has had, how many procedures they’ve performed, their relationship with the doctor that provides the standing orders.

“And also, if they’re getting pressured sales tactics, if they’re getting pushed towards something, then I think that’s a real red flag.”

The Clinical Aesthetic Network (CANNZ) is a society representing aesthetic practitioners - nurses, doctors, dentists and other medical professionals who work with cosmetic products.

CANNZ-endorsed practitioners and clinics undergo an audit process for its membership clinics and offer mentorship for people in the industry.

Brandy Wehinger, president of the Clinical Aesthetic Network NZ.

Its president, Brandy Wehinger, thinks she has trained almost 200 nurses “from the ground up” with Caci Clinics, where she is national clinical educator.

“Usually when they come in, for example from a franchise, they have minimum requirements for experience usually and they come in for pretty in-depth training to get them prepared for a limited scope of practice.”

Wehinger said there is good faith that nurses are getting the right training, even if it is not a written requirement.

“The prescribing doctor has to make sure that the nurse or whoever is suitably trained in order to issue that standing order.

“If you were a district nurse, you wouldn’t receive a standing order to go around administrating medications unless you were trained on how to assess the patient and to administer it, so it’s not voluntary at all.”

There are several training academies across the country which a clinic can fund if it doesn’t offer training in house.

Wehinger said a big part of the problem practitioners have is managing expectations of a procedure with clients.

After years of concerns over Australia’s cosmetic industry standards, it has just tightened up its regulations significantly.

Patients will have to undergo a psychological assessment by the practitioner - checking for any signs of ill mental health or body dysmorphia.

Words such as “perfect”, “hot” or “younger” will be banned from advertising for cosmetic procedures.

There will also be a cool-down period between consultation and procedure - something that did not happen for Bella.

“It’s kind of dangerous how easy it is to just go and get your lips or your cheeks or your jaw done,” she said.

“I just walked in and went ‘can I get my lips done’ and they went ‘yup here you go’ straight on the day ... I was kinda like ‘oop, gotta do it now.’”

The Medical Council has a statement which outlines the standards it expects of doctors who perform cosmetic procedures - both surgical and non-surgical.

The statement “is designed to ensure that doctors have the necessary competence (knowledge, skills and experience) to undertake cosmetic procedures, with the primary goal of public safety.”

It says practitioners “should be very cautious” before agreeing to perform a procedure on someone experiencing an episode of mental illness or long-standing persistent body dysmorphia, as well as someone who appeals indecisive or not carefully considering the implications.

The statement does not include requirements of training staff under the standing order issuing.

But a spokesperson for the council said in light of the developments in Australia, it is taking the opportunity to review its 2017 statement and approach.