In the wake of the TGA regulations around cosmetic medicine, there continues to be a lot of fear around what this will mean. Most injectors to date have relied heavily on being able to show before/ after photos, often of a single treatment area, “before” and “after” treatment with an S4 (prescription) medication. For example? A before photo of someone frowning hard and an after photo of that person no longer able to frown. No guesses as to which class of drug is responsible for this; there is only one. 🤫 A before photo of someone with thin lips at rest (ie not smiling) and an after photo of that person with plump, juicy swollen lips. Again, no guesses as to which class of drug is responsible for this. 🫤 Many pages on social media are full of these images, and these injectors’ selling point, is that they treat with the drug in question for those who want similar results. The problem with this from the TGA’s point of view? it’s seen as incentivising it’s advertising a prescription medication stating prices, specials and packages often gets people to act on impulse and walk in to “buy” the treatment on sale as if it is an order for a burger. these advertisements often trivialise the fact that these are medical procedures, risks may be low but not zero and not everyone is suitable for it. these adverts may lure vulnerable people in who may have body dysmorphic disorder, unrealistic expectations and encourage injector hopping. advertising typically acts on people’s emotions and desire to act now to avoid missing out, and advertisers will typically put forward their best results, rather than average results and minimise poor results. So what is the solution now Before/ After photos are no longer permitted? With this easy means to generate revenue curtailed the TGA is likely hoping to return to a more medical model for medical procedures, often by very inexperienced people. More and more people are studying nursing who have no interest in nursing except to inject. Similarly many doctors post the mandatory year of internship, are opting to bypass speciality training to set up as aesthetic injectors. These people have the bare minimum knowledge of what it means to be a doctor or a nurse, much less to begin to know the ethics of medicine, and thus are at risk of falling into the retail model of providing medical services which goes against every code of medical conduct. In the absence of photos, how are you  to choose a provider? When we put the medicine back into medical aesthetics, we go back to basics, which should have been in place already. How do you choose a plastic surgeon, most of whom don’t advertise their work online through before/ after photos? How do you choose an orthodontist, most of whom don’t advertise their results? Or any type of doctor, dentist or provider? We do it through some means: word of mouth referral by friends and family who’ve seen that provider understanding someone who’s right for them may not be right for you. reviews on third party sites such as Google (though may providers incentivise these eg “leave us a 5 ⭐️ review and go into the draw for X worth $300”) stalk their social media pages for a while (usually months) ; observe how they work; observe their ethos, and their own face to get an idea of whether their outlook aligns with your own aesthetics and goals. Then….make an appointment. Go in with an open mind. Spend the time in consultation deciding: do you feel comfortable with them? do you feel safe with them? do you feel they get you, understand your concerns? do you feel confident they can help you? do you feel you can develop a longterm relationship with them? are you a fit for what they need from you, in terms of the timeframe, cost and appointments needed? we are still able to show before/ after photos of results in consultation with you; do the results appeal to you, and is each result optimised to the person being treated? Ie do they still look like themselves, or does everyone look the same after treatment? If you’re an ethnic person, it’s important to look also for representation of your ethnicity, or other ethnic types in the work, so you can see that the person who’ll be treating you, understands how to treat different faces and isn’t simply following trends and fads. Ok…I’ve attended the consultation and am ready to start. Now what? At Skin Essentials, our Full Face Aesthetics appointments are moving to an “expression of interest” form format for those who are keen to explore this. Why is this? it’s a significant investment of time and money. we have limited appointment slots for those who are ready to begin so spots are prioritised for those who are ready to begin on the day if appropriate. having an EOI form is an extra step for those who are ready and serious; Dr Joshi vets them prior to taking payment for the consultation. We don’t want to waste your money or our time together if you’re not ready. once we have your filled out EOI form, we’ll be in touch to advise on next steps including the ballpark time and monetary commitment and to offer you an appointment and take payment so we can begin the process. Still keen? Get in touch with us to get the ball rolling! We look forward to meeting you soon!  

As of March 7th 2024, the Therapeutic Goods Administration (TGA) of Australia implemented widespread changes that will limit most discussion about medical aesthetics on social media and most settings outside of a consultation with your doctor or healthcare professional (HCP). The ability to simply order treatment with prescription medications on demand over the last few years, often via barely qualified HCPs is resulting in the commoditisation of medicine and prescription medications, which carry far more side effects than over-the-counter (OTC) medications, with higher risks. This has led to increased risk and poor outcomes on occasion, in untrained hands. As such, long after it was due, the TGA is aiming to return this aspect of medical care back where it belongs, between a patient and their HCP, but I anticipate we will get a lot of pushback. So why is a consultation necessary for medical aesthetics, if you know what you want? Like any other concern, all consultations begin with a comprehensive consultation between you and your doctor to determine what your concern is. Even if you’ve googled the issue and believe you know what is wrong, your doctor has an obligation to exclude any other possibilities that may be the cause of your condition and to satisfy themselves that the treatment you request is not only the best option for you, but also something they can safely provide for you. Equally, they need to be certain that there are no reasons you should NOT have that particular drug/ medication. All this takes time and is far more than the cursory 30 second consultations often taking place up until now, whereby we exclude pregnancy, ensure you are 18 and make sure you have no significant medical illness. It’s also more than the 20 second video call with a doctor you’ll never see again, who nods and signs off on the drugs another HCP administers if you choose that model of care. By law, what is required, as stated above, is a list: your concerns if your doctor can help you with those how much they bother you and whether you’ve had any treatment for them to date any vulnerability you may have if you have any reason you may not be a suitable candidate for medical aesthetics eg a history of being underage, pregnant but also having anxiety, or a history of going from injector to injector and still being dissatisfied with the results or being overfilled. If you and your doctor determine you are a good candidate, there is still more to cover: what is possible given your concerns, your genetics, age and budget the timeframe if it is a time sensitive concern eg aging whether you have the budget for it without too much hardship whether you are able to stick to the treatment plan as agreed to between you and your doctor if you feel safe and comfortable with your doctor All the steps above take time, well above a half hour, and cannot be rushed. At Skin Essentials, if we cannot tick all of those boxes, I tend to suggest a patient goes away to think, and mull her options and to return if/ when that changes and she feels ready to proceed. Medical aesthetics is entirely optional and a want, even if it can feel like a need. It is still medical procedures that are entirely optional and as such, the stakes are much higher to get the results you want, or to wait until you are ready and able to commit. All of this requires clear, upfront communication about costs, timeframe and expectations - for you of your doctor and for your doctor of you. This is what the TGA is hoping for to limit the tide of poor work and vulnerable people being taken advantage of at present. In no other area of medicine would you be able to simply show up to an appointment and order a treatment with a bare minimum of consult or relationship with your doctor. So it is with medical aesthetics, a specialty in its own right with rare but real risks.  

In January this year, the Therapeutic Goods Administration of Australia, aka the TGA, surprised the non surgical cosmetic industry with the news that we are no longer allowed to use common terms to describe some of the services we provide, using the drugs used in those services. Medical aesthetics can no longer use certain terms and those terms will be going away? What Kind of Terms are Changing in Medical Aesthetics? Terms that you commonly associate with the services you receive from a medical aesthetics practitioner are no longer able to be used in advertising, information on websites, and other key places. Anti wrinkle treatment Dermal filler Biostimulatory filler Fat dissolving injections You get the idea. What Do the New TGA Guidelines Say? It sent the industry into a panic and the TGA took its guidance offline to await confirmation. As of 7th March 2024 it had finalised its guidelines, and the new changes will go through, effective immediately. What do they say in essence? Historically, the TGA has allowed indirect references to prescription medicines to be referenced in advertisements related to cosmetic health services. This was allowed only in the context of promoting the service and only by using generic non-product specific terms such as ‘wrinkle reducing injections.’ Express references to products or ingredients themselves, such as ‘Botox’ or ‘botulinum toxin’, were not permitted. The TGA considered this a pragmatic approach which would allow cosmetic clinics who offered these services to differentiate themselves from those that did not. It goes into further details, the gist of which is essentially: we are no longer allowed to refer to those terms as they allude to the use of prescription drugs we are no longer allowed to use before/ after photos that suggest the use of prescription drugs eg before photo with someone frowning, and after photo without the frown; or a before photo of someone with thin lips and after photo with plumper lips etc Why is the TGA doing this? Recently, the TGA has observed that clinics and health services in other industry areas are advertising the availability of prescription medicines, usually by referring to a class of goods (for example ‘weight loss injections’, ‘medicinal cannabis’ or ‘nicotine vaping products’). The TGA has interpreted that promoting a health service in this way is also an advertisement for a therapeutic good that refers to prescription medicines, which is unlawful. The update aligns with the focus of other regulators on health professionals performing non-surgical cosmetic procedures and acknowledges the increasing vulnerability of Australians influenced by advertising in the cosmetic space. Prescription only medications carry higher risks than goods available for self-selection. Decisions about treatments that involve the use of prescription medicines should only be made by a health professional in consultation with each individual patient. In brief, as with all other means of prescription medications, a face to face consultation is the first step to addressing a concern in collaboration with your medical professional/ doctor to then determine next steps, treatment and whatever drugs that might involve. As you can imagine, this has the industry in a tizzy all over again. Do the TGA Guidelines Change the Medical Aesthetics Approach at Skin Essentials? At Skin Essentials, we’ve never advertised drugs by prices, nor by before/ after pictures such as above. We take a holistic full face approach to the face in front of us at a paid-for, non redeemable consultation designed with one thing in mind : understanding and addressing your aesthetic concerns determining if they can be helped or if you need another expert eg a plastic surgeon determining if we are likely to work well together ie a good fit determining if you have any vulnerabilities that make you unsuitable for cosmetic work or have unrealistic expectations determining the timeframe to get you results determining the cost of those results, which is significant determining if you are in a position, psychologically as well as financially to commit to the process as outlined If we tick all those boxes above, then we start. If you or I cannot tick any of the list above, then we don’t start, but you’ve had some idea as to what the cause of your concerns is, what is needed to correct them if/ when you are ready to begin. So from our point of view, not much will change to our processes at Skin Essentials. What *will* change is the ban on educating the general public on social media and the stern limitation of terms I can use to do this. Media from the USA and UK and other parts of the world continue to flood our feeds, with drug names and explicit videos of procedures. I used to use this for educational purposes but I will no longer be able to do this as this would be a violation of the TGA rules. While the goal and aim of the TGA is to stop unscrupulous operators from enticing and luring vulnerable people into medical aesthetics, often from a very young age, the reality is that since these changes were announced, the rogue operators, who continued to operate during Covid lockdowns, continue to post and use the terms “anti wrinkle”, “dermal filler” “nose filler” “biostimulatory filler” and more. As I’ve said before, I suspect they see pesky fines and disciplinary action as the price of doing business. As a small business, I can’t afford to do this nor do I want to. One of my strongest stances at Skin Essentials is our ethics and our values based approach to patient care. That won’t change in coming weeks and months as we pivot to find a new way to educate people without using terminology illegally. In the meantime, we ask our current patients to help others find us by leaving us honest feedback of their experiences with us in clinic given social media is being heavily censored going forward to help us stay in business. Thank you for your ongoing support and we hope to see you