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

I recently did a  live on Instagram with Clinical Psychologist Dr Toni Pikoos, in which we discussed the intersection of medical aesthetics and psychology as I have been reflecting on the type of patients who are less likely to have success with aesthetic treatments. As a doctor, I cannot overestimate the importance of the initial consultation in assessing patient concerns, their understanding of what is possible as well as their expectations of how aesthetic treatments will help them, whether they are willing to stick to the suggested timeframe and budget for the best possible outcomes. As such we simply will not engage with anyone who refuses to begin with an initial consultation or believes they can simply order a treatment as there is a chance they may be wrong, and feel they’ve wasted their time in attending the appointment. Perhaps especially because non-surgical treatments are largely elective from a medical point of view, I believe that practitioners have an ethical responsibility to select patients carefully, including screening for certain red flags and having protocols in place before treatment even begins. Related to this, it is imperative to look out for signs of body dysmorphic disorder (BDD) during the initial consultation and early stages of treatment as this is a contraindication to aesthetic treatment. The mental health of patients and the responsibility to protect the vulnerable ultimately lies with us so we have a duty of care to assess this before we inject or to press pause if we recognise it after starting if we can’t educate our patients.  Social media contributes to the disconnect between what is physically possible and what is best left to photoshop and filters, and marketing by big companies further encourages this by disguising medical treatments as just beauty - “lunchtime procedures” etc only serves to perpetuate this myth, so at Skin Essentials we go to some lengths to screen all new patients for potential red flags, but read on to see why this is harder than it seems. 3 key examples we encounter regularly enough: 1. Unrealistic expectations Often as early as during the consultation, but more commonly during the early treatment stages, it may begin to become apparent that the patient has expectations of aesthetic treatments that are unrealistic - for example, they may expect to be frozen with anti wrinkle treatments and to stay that way for the whole 3 months. or they may expect that 1ml of filler will replace typical volume loss in a 40 year old face, which might need on average, 4-6mls. others may come in with stories of having had treatment elsewhere with impossibly low doses which lasted unreasonably long periods of time.  At this stage, if it becomes apparent, I try and explore this expectation with them, how likely it is, and whether I can reasonably help them, including suggesting I may not be the right person for them if I am unlikely to be able to meet their expectations with respect to price, dose (and related to this, cost) or timeframe.  2. Budget vs true cost mismatch By the time we see people at Skin Essentials, most people have been dissatisfied with the ageing process for some time, usually months to years, and are keen to begin to do something about it. Unfortunately due to social media, as well as well meaning friends and a general sense of secrecy around the true cost of aesthetic treatments  they may severely underestimate the cost in terms of timeframe, frequency of treatments initially and the budget realistically needed to effect significant change in the areas that trouble them, which are usually also multi-factorial: skin lines, wrinkles and sundamage volume loss with hollowing of the face and sagging around the lower face  sun damage  pigmentation  redness/sensitivity etc  There is no one treatment that will treat all these various concerns; treatment options are usually best combined, and undertaken over multiple sessions over months to begin to see changes. For this reason, I commonly tell patients it is like orthodontic treatment - if it’s going to cost $10,000 and they only have a budget of $2500, they may be better off not beginning as they won’t achieve desired results. Equally, it is better to start and keep going than to wait because the ageing process will not.  3. Requesting to look like celebrities Rarely, patients will present with pictures of celebrities they wish to look like eg JLo, one of the Kardashians or specific attributes - big juicy lips, a non surgical butt lift for example - and it is then up to the practitioner to explain why it may not be a reasonable goal even if they have the money for it, due to limitations of anatomy.  So when this occurs, how do we deal with it at Skin Essentials?  1. Consultation  The fact is, there is never such a thing as “just some anti wrinkle treatment for X or Y” or “just some lip filler”. It does not matter how simple the prospective patient thinks the issue is, as a medical practitioner it is my responsibility and duty of care to assess each person, including a detailed medical history, assessment if appropriate and their expectations before we proceed to treatment, if it is appropriate to do so. We don’t do treatments made to order.  At Skin Essentials, you are emailed an intake form as soon as you have booked an appointment and it is in your best interests to fill this out as soon as feasible so we have a clear idea of your concerns as well as what is likely to be the problem. In truth, the consultation begins well before you walk through the door and we have a fairly good idea of what we will see and suggest when we finally meet you.  2. Education  We aim to maximise our time in clinic addressing your concerns, educating you on what they mean, and what, if any, the options to help improve them are; additionally, we discuss