Patient safety is a pet peeve of ours here at Skin Essentials. In as much as is possible, we pride ourselves on doing everything we can, from the time you book a consultation to the day of your planned treatment to aftercare and followup, to work in a way that is ethical and safe while keeping you informed every step of the way. So it is surprising to regularly see media articles about cosmetic cowboys as well as the sleight of hand that frequently shows up on social media feeds as medical aesthetics but which is largely clever marketing and gimmmickry to lure unsuspecting patients into procedures. So how is a patient to know and what are some red flags to watch out for to help yourself stay safe? Read on to find out our thoughts! 1. Your provider should state their credentials and qualifications clearly.  In Australia, only AHPRA registered healthcare workers (HCWs) are cleared with appropriate training, to inject for medical aesthetics - medical doctors, nurses and dentists. Dermal technicians can additionally, undertake some skin therapies that are within the scope of their practice. As doctor is not a protected term, you will find some people including naturopaths among others using the term “doctor” in their title, while not being a medical practitioner, which is a protected title. Equally, not all doctors are of equal standing - a dermatologist (FAAD) is not the same as a plastic surgeon (FRACS, Plastics) and not the same as someone like me an FRACGP. All three specialities are additional training years in respective fields, with scopes of practice, so it is important to understand these, versus doctors who have the base degree (MBBS, or MD or BMed) or a dentist (BDS) or a registered nurse (BN) to know who is treating you and their likely skillset and qualifications. 2. You should have a good idea of their years of experience in aesthetics and any prior medical experience.  In Australia, anyone can look up their AHPRA registered provider using the AHPRA website to check their provider’s qualifications, whether they are specialists as well as whether they are of good standing to practice in the community and how long they’ve been working for. Someone who has qualified in 2016 is not the same as someone who qualified in 2001 and has been working all this time. Likewise, someone who has the base MBBS degree since 2016 is not the same as someone who has the MBBS, FRACGP title for example. Speciality training programs involve extra years of a structured training program, as well as multi-part examinations they must pass to qualify for fellowship which ultimately serve to benefit patients. 3. They never promise or guarantee an outcome  No one can ever guarantee you won’t bruise, or only need a single treatment or even an outcome. The face is the most mobile part of our body and we rely on it to communicate our thoughts, mood and so much more. As such, none of us is completely symmetrical and it is impossible to guarantee an outcome no matter how diligent the provider, so be wary of anyone who over promises. Equally, unforeseen patient factors may be at play in consultation that may mean the procedure needs to be abandoned partway and either revisited at a later date or referred as is appropriate. When this happens, it is important to understand what the options are including around payment and your obligation for equipment and your doctor’s time. 4. They seek clarity with you regarding your wishes to allow your photos to be used to show other patients or on social media, and any conditions attached to these, in writing.  It is a direct violation of your rights as a patient to have photos or information disseminated without your consent. Being a highly visual industry, your doctor may ask for your consent to share photos with patients in clinic, or even on social media. If you say yes, they should clarify with you the extent of your consent, preferably in writing so there is no miscommunication. 5. They use machines and products that are TGA registered.  This is a big one. Terms such as “low level laser” and “medical grade” and even “standard dose” are in and of themselves, meaningless. What you are seeking to know ultimately is, whether your provider uses machines and products that have passed safety requirements ie are TGA registered (and therefore more expensive to buy, own and to maintain, raising cost of treatment) and not bought off back alleys or overseas or via eBay. 6. You know what is done and what products are used  At Skin Essentials, we aim to minimise paper wastage and email itemised receipts to you after each consultation and treatment with the name of the product that was used as well as the dose used if appropriate and cost included any discounts applied so you are in the know, and can also use this information with any other care providers you see in future. Equally, our initial comprehensive consultation plan is usually a written treatment plan emailed to you for your records of what was discussed including consent to share photos and for you to share with any other care provider. We aim to be as upfront and transparent as possible to minimise misunderstanding barring unanticipated patient factors. 7. They will refuse to treat at “injectables parties” and the like  We have all, at one time or another been asked if we’d treat at these parties. The problem with this is manifold. Injectables parties and medical procedures do not mix: guests may be drinking alcohol and may not be able to properly consent in the event of an adverse outcome alcohol is generally avoided at least 24 hours prior to injecatables in gatherings, we cannot guarantee privacy for patients, who may not want their medical history disclosed to friends. in the event of an adverse outcome, a home or party venue is not suitable to manage unlike

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