There was a recent excellent piece on Mamamia by Erin Docherty on the rise of cosmetic injectables and reversal of treatments, often for poorly done work, and reflection by two doctors on why this might be increasingly the case.

A common reason cited, which is well known among those of us who’ve been around a while, is the explosion of aesthetics and injectables in the beauty space, which has led to the proliferation of chain clinics and corporates that pull in relatively junior and inexperienced nurses and doctors, with minimal medical training post graduation, into this industry.

They can be trained in injecting after as little as a weekend or a week long boot camp and then set up in salons and chain clinics to inject with minimal oversight and supervision.

With the large numbers recruited by these chains, prices drop and potential consumers, who know no different, and may choose based primarily or only on price, may go to these places. Most will be fine, even if they don’t always get the results they want, and some will be injured.

When I see patients in my clinic who’ve had something go awry elsewhere, or because they are coming to me as new patients and I go over consent, some express anxiety and surprise at the potential issues and concerns I discuss with them to sign on the consent, including risk of bruising and bleeding, risk of injury to a blood vessel with dermal filler causing blockage which, if not caught in time, can cause skin death as well as the rarest complication of them all, blindness in one or both eyes.  

Yet others I see who’ve been going elsewhere routinely cannot tell me if they’ve had anti wrinkle or filler to areas of concern, or what brand or how much was used.

All this points, disturbingly to a lack of regulation and oversight of often very junior and inexperienced nurses and doctors, who may lack the necessary skills to educate and choose patients appropriately and manage unrealistic expectations, much less unexpected complications such as vascular occlusion and the rarest of them all, blindness.

In the absence of education, most people will assume that it is similar to shopping at ALDI vs shopping at Coles or Woolworths, rather than recognising that qualifications matter, experience matters, as does the ability to effectively consent a potential patient on risk, manage expectation and say no if there are problems within those. Medical procedures are not the same as non invasive hair and beauty procedures but they’re being heavily advertised and sold as such through marketing. 

In an ideal world, we’d like our desired objects/ goals/ treatments to be fast, good and cheap. Alas, the truth is that at best, you may get 2 of the 3, leaving the third which you actually pay for.

Most experienced clinicians will not be cheap. If they are, you really need to ask yourself why.

Most experienced clinicians will usually be fast, but that is because we’ve done the years of work that goes into learning, and honing our skills, such that it may take us a fraction of time to do what a newer clinician will take twice as long on, and usually with fewer mistakes.

Lastly, most experienced clinicians, outside of Covid times, tend to be booked out and can’t fit you in on the day barring emergencies post treatment and will hold you accountable to your treatment goals as it’s in your best interest to do so. 

Most experienced clinicians are more interested in educating you, and helping you choose what’s best for you in the bewildering array of cosmetic procedures, including skin improvement, rather than simply selling you a preplanned, generic package or a deal that may or may not suit.

The current marketing push from big chains and corporates may be one of the contributing reasons for why we see vending machine style aesthetics and so many weird faces walking around among us, who frequently use these services, in which the patient largely designs their own treatment and the person injecting simply says yes.

Doing cosmetic enhancements on the face especially, where millimetres of change are apparent, is complex, delicate work, and it takes a combination of science and art to bring it all together and years of experience and practice. You cannot learn that in a 5-day boot camp or a weekend course and certainly not without some foundational years in the basics of medicine, during which you learn the art of medicine - consultation, assessment, correct diagnosis as well as recognising complications when they occur and how to manage them. Junior staff are heavily supervised in hospitals and other settings for this very reason and not left to their own devices for years, until deemed safe to the public and competent. 

As with the cosmetic cowboys expose not that long ago, many people are being harmed by non invasive medical aesthetics, we just don’t see it as much of a problem because to some degree, we’ve become so desensitised to it since we all know (of) someone who’s walking around among us with frozen faces, overinflated lips, exaggerated cheeks and hollow temples and a face that does not match the neck/ décolleté and hands.

It is not what aesthetic medicine, at its core, was even intended to be, and I hope we are taking back the reigns and as doctors and nurses, returning to the core of what we undertook in training for this in the first place - to first do no harm.