• Every few weeks of late, it seems, we are seeing posts on social media of young women with rare complications due to injectables, namely, dermal filler.
• Not that long ago, it was a young woman who posted of her experience on TikTok.
• Shortly after, well known influencer Lily Ghalichi posted of her own experience with a blocked blood vessel, ie a vascular occlusion, a well known, if rare side effect of dermal fillers, to her Instagram and how it was treated when caught (early).

Yesterday another young woman from the USA posted and what stood out to me this time, was the way she presented her story and the red flags present within it, to anyone who knew what to look for. It got me thinking, why are more people not aware of what red flags to look out for and by the same token, what green flags to indicate you are in safe hands? 

So I posted on my own IG, to try and educate those who choose to have dermal fillers.

What are some safety features, or GREEN flags you should be looking out for in your aesthetic practitioner?

• their qualifications - in Australia currently, injecting S4 drugs (anti wrinkle treatments, dermal fillers and other related drugs) are limited only to AHPRA registered medical practitioners - nurses, doctors, dentists. Is your practitioner registered and of good standing with AHPRA?
• their experience? How many years post graduate are they? Injectables flooded the market two decades or more ago, and it is becoming more and more common to see people taking up the briefest of training simply to be able to go into aesthetics, often without much if any, post graduate experience. "Would a reputable clinic or clinician take someone with no experience on?" and if not, where are these people likely to find work and at what prices? 
• do they take their time with you in the consultation or is it designed to convert you? Do you feel pressured to proceed with the treatment on the day? Do they cover complications in a way that is designed to be realistic or simply to get you to proceed?
• when, not if, when, something does go wrong, do they have a safety net in place to help you until the concern is resolved, or a way to refer you to someone else who can help? Do they have the necessary drugs stocked and ready to go? Do they practice in a location whereby if you had an emergency at 11pm, they can open the clinic or salon to see you if needed?
• do they have a clear aftercare plan and system to check all is well and a means for you to contact them if you have concerns?

When and if there are complications, can you rely on them to be there with you and to refer you appropriately if it is out of their skillset, until the issue is resolved?

Beauty and Aesthetics especially, is a multi-billion dollar industry and it feels some days like everyone wants in because the demand is so huge. Unfortunately even though we are not like the UK, where literally anyone can inject and buy drugs off eBay, we are still a largely unregulated industry and people are frequently sold the illusion that it is “just beauty” and the “customer is always right”. 

Many practitioners seem to undersell the gravity of rare but serious complications when talking to and consenting patients. It is often sold as “fun”, “sexy” and with minimal complications for patients, and simply, great revenue for practitioners. 

In my clinic, patients are often shocked when they’re told about the rare but serious risk of vascular occlusion or even blindness, even though they have had filler elsewhere before, prior to proceeding. 

They are similarly surprised when I turn some of them away and refuse to do anything because of :

• unrealistic expectations
• they bounce from injector to injector and remain unhappy with results 
• they do not know what was done where, or by whom, or what product was used
• they are unprepared for any downtime or the time taken to build results, which may involve several sessions on a tight timeframe
• they've left it too long and done the bare minimum and then woken up, often in their 40s, 50s or later, and hate what they see but do not want the cost or downtime of surgery so go from practitioner to practitioner who give disparate advice, none of which is appropriate or right. 

Others report feeling pressured into it on the day due to hefty consultation fees redeemable only with treatment on the day and then have regret around proceeding. 

It is worth remembering that as AHPRA registered practitioners, doctors, nurses and dentists have a duty of care, which includes “first do no harm”, to act always in the patient’s best interests, to not be seen to be inducing vulnerable people (incentives, specials, posting testimonials and even using drug names are all prohibited in Australia) even and especially if that means saying no and not placing undue pressure on the day to “convert” regardless of whether that is what the patient wants or expects and the loss of revenue that may entail. 

I admit it, as a small business owner who has limped along due to Covid, I'm the first to feel my heart sink when I see a new patient who has done nothing to date, and now feels desperate for a quick, low budget fix; or a patient who's been to several practitioners and been dissatisfied with all of them, or someone who wants to "look younger" but is opposed to everything suggested...I know I am going to spend the time they have booked to educate them and then wish them well and generally refuse to touch them if it'll not make them happy. 

I tend to tell patients not to rush, that aesthetic treatments, by their very nature, are entirely non essential, and to take the time; I tell them they should not feel or be rushed especially if doing so will lead to regret.

• at best these patients may report feeling rushed, pressured or unhappy.
• at worst, they may end up with an avoidable complication (which can occur in the best, most experienced hands) that is missed due to rushing or inexperience. 
• eyes and lips are delicate areas and repeatedly puncturing the skin in these areas with sharp objects by multiple practitioners cannot possibly be good in the longterm vis-a-vis side effects. 

It is time we begin to reassess our relationship with medical aesthetics - they aren’t usually a one-size-fits-all, they aren’t without risks including severe complications, especially when missed and they are not something that should ever be taken up on impulse. Unlike other aspects of beauty such as hair, nails and makeup, breaking the skin barrier carrier risk every single time and your skin and your face deserve the necessary diligence before you proceed. 

So my advice, if asked, and I do get asked: 

• spend the money on a consultation, more than once if needed, till you are satisfied. 
• get a feel for your clinician and if you don't feel right, run
• look at their own face, and if you don't like what you see, run
• ask about their qualifications - how long have they been qualified? how many years in hospital? how long have they been injecting? do they have supervision and if so, is it via someone more experienced in clinic next door or via a Skype call elsewhere? 
• if something was to go wrong, can they recognise it? seek help in a timely manner? obtain the relevant consent to manage it? 
• when, if ever, was their last complication? I tell all my patients when my last complication was by way of transparency and honesty 

Lastly, if you like someone that you feel is personable, whom you click with, even if they are far away, or interstate, or even overseas (but you have family you visit here), consider seeing them instead of asking if they can recommend someone local to you. 

Medicine is as much a science as it is an art. While we may know each other as colleagues, none of us usually watches each other enough to know if it will be a good fit, or if we practice alike. Personality is what ultimately determines fit, and like sunscreen, like brands of skincare and so much more, you have to try a few before you find one that fits, so do the work, so when you allow someone to touch your face if it involves heat, skin breakage or injecting drugs into it, you choose someone you have peace of mind is not only qualified, but also has your concerns in mind and that if something goes wrong, you will be in good hands and not turfed.