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.  

At heart, I’ve always been a generalist. I love people, and I love the whole person, more than I love any single body system. My years of training across two training specialities, both dealing in whole person preventive care at various life stages, taught me firsthand the importance of whole person, preventive care that is broken down into parts - short, medium and long term. It is this training I also carry into my aesthetic and skin work when I first meet you. It is not simply a quick “hello” and “you want anti wrinkle treatment? Sure, let’s do it!” Rather, it is a meet and greet, and a proper, comprehensive consultation. After all, if I don’t understand what your concerns are, what has brought you to me now, how can I possibly assess what your priorities are, and what you are hoping to get out of skin or aesthetic treatments? It may seem silly, but in order for us to accurately treat the “problem”, we need to have the correct diagnosis.  When you Book the Initial Appointment  So at Skin Essentials, we get you to prefill your information before we even meet, so I know exactly what your concerns are likely to be. Often, with skincare audits, I can already tell, based on what you’ve written, what is causing your skin stress before your appointment.  In many cases, leading up to your appointment, I have an idea, and a plan, that I’ll hone once we meet and I get to assess your face in front of me, in animation before we move to the next steps.  The Initial Consultation  When we meet at the initial consultation, we go over your general medical history - past and current. Medication. Pregnancies if relevant, past, current and planned if relevant. Prior treatments including surgery. Allergies. Then we get to your concerns. What bothers you, what you are hoping to get out of the consultation and treatment if we decide to work together. We do photos of you, barefaced, and then I ask you for your consent to assess your face and explain to you, what bothers you, and WHY. I discuss with you, how and IF I can help you improve your concerns, a timeframe and associated cost if you decide to invest.  If I can’t help you as happens occasionally, I refer you to a colleague who can eg plastic surgeon for a facelift, or dermatologist for lasers I do not offer. If I can help you, and you understand the limitations of treatments, the timeframe and are willing and able to budget, we may proceed with something on the day, or not depending on how much time we have left and if you are keen to do so. There is zero expectation on my end that we must “do something” but many of my patients are time poor, busy professionals and often ask if they can get started with something on the day.  If this is reasonable, then we can and do, and I plan next steps, including review if appropriate and when you’ll come back for the next session if you agree with the treatment plan suggested, until we hit maintenance.  What do we not do at Skin Essentials?  At Skin Essentials, we do not offer complimentary consultations - in my experience, complimentary consultations are designed by their nature to convert to treatment on the day - you invariably end up paying for the practitioner’s time by having treatment you may or may not be ready for, or need or to redeem the deposit paid.   My own view is that this feels unethical and given aesthetic treatments are largely discretionary and expensive the longer you delay them, I do not want anyone to feel pressured to have treatment if they are unsuitable. I would rather you pay for an educational experience on what the ageing process looks like on your face, and what you can do about it, if you choose to, and proceed with as much knowledge and true consent as is reasonably possible.   At Skin Essentials, we also rarely do “just lips” or “just anti wrinkle” to an area. Our area of expertise is full face rejuvenation and helping you plan to age well, and necessarily involves a whole face approach because by the time I see someone, they’ve usually been dissatisfied with the way they look for some time, but often do not know how to explain it to someone else. So we take the guesswork out of it for you, and put together a plan to follow to effect change over the coming 3-9 months, if you are willing to invest treating, with your consent, all three areas : - skin, skincare and skin therapies including hydrating and biostimulating fillers and other collagen induction therapies - injectables including anti wrinkle treatments and fillers if you are open to it (some are not, that is ok) - “other” including minimally invasive options to address excess fat in areas such as the chin, around the jowls that may be amenable to treatment.   The more restoration needed, the higher the cost is initially. I always assess for this and say to patients to allow for an amount similar to orthodontics. Maintenance thereafter is more manageable and I’d rather you understand what is involved so you can make an informed decision to proceed. Or not. There is absolutely no pressure and no upsell.  For these reasons, and more, an initial consultation is necessary for all new as well as returning patients who’ve been lost to us for a significant amount of time between treatments when ageing has continued to change our faces and there may have been other medical developments meanwhile.  Ready to begin? Let’s start here! 

This question is a regular via email and DMs on social media. Sometimes people also send us selfies to help with the quotes. Prospective patients may be asking about specific treatment options such as injectables - anti wrinkle treatments and dermal fillers - or skincare or fat dissolving treatments. The short answer is, it depends. As an AHPRA registered professional, I cannot conduct consultations via DMs and even emails until we have established a therapeutic relationship with you that must be documented. Even after we have met in person, much as you’d expect with other doctors, it is not possible to provide ongoing regular advice via emails or text messages. AHPRA specifically requires us to maintain an appropriate doctor-patient boundary that is meant to safeguard you, and us. This is why unless it is a quick yes or no answer or we have planned a followup, most replies will result in brief advice and “please book another appointment if you wish to discuss this further”. As to the rest - how much is it likely to cost and how much should I budget? The answer to this, truly, is “it depends”. What factors might play a role? 1. Your age   The younger you are, the less ageing related changes and the less outlay needed to begin to address the concern at hand. Whether that is acne, or pigmentation or volume loss in the face or even lines and wrinkles. 2. Your basic genetics Not all of us will age the same. Our ethnicity as well as lifestyle factors and other medical history (or lack thereof) will play a significant role in how we age, as will our basic bone structure. 3. LIfestyle factors By now we all know, I hope, that chronic sun exposure, even if unintended, can have a lasting impact on how your skin will age, including lines and wrinkles, pigmentation, faster collagen depletion and volume loss. The WHO estimates that as much as 90% of skin ageing is due to UV exposure. Add in factors such as smoking and these will add up quickly to more work needed just to begin to undo some of the damage. The Initial Consultation The initial consultation is where we meet and begin to address some of these and other factors, in conjunction with your concerns. We take a medical history of not only your health, but any illness, medications as well as prior aesthetic work which may have an impact on future work.  We take baseline pictures of your face at different angles and then we assess your concerns together - what they represent, and how and IF we can address them. We discuss what can be improved non surgically, what needs surgery if you can budget for it and what cannot. At this stage, I can give you a pretty good idea of what your concerns mean, and how I can help, the timeframe needed and degree of investment required, both of time, frequency and money so you can decide whether you want to proceed or not. Due to my training I tend to approach everything as a continuum - what can we do now, in the medium term and then longterm and how they can all build on each other to give you the best possible result if you stay the course. My goal, always, is a longterm therapeutic relationship with my patients because we know that gives best results.  At our initial consultation, I can also more acccurately guide you as to “how much” in terms of quantities as well as costs and timeframe. As a guide:  anti wrinkle treatments, if begun in your late 20s to early 30s when you begin to see faint lines present at rest, may need slightly lower doses compared to starting at a later age, when lines are very visible even at rest and will take continuous treatment with higher doses to begin to fade. If you stop, lines and wrinkles will gradually reappear over time.  with dermal fillers to replace volume loss, every face is different but as a guide, a minimum of 2 mls in your 20s, 3 mls in your 30s and so on. If you have a slim build, you are likely to need much more. If you look gaunt already, you will need more than this. with biostimulator fillers, and most skin therapies, there is an initial series of treatments in close succession for best results eg a session every month for 3 months, then maintenance every 6-12 months. skincare is ongoing and lifelong, beginning with the best and cheapest option of all, daily sunscreen. If you stop, your skin will gradually revert to your pre treatment state.  When we meet, I am assessing your face not only in still photos but also in animation because this is where many people go wrong - they may look great in selfies but “wrong” when animating if overfilled or overtreated. All this planning and execution takes time, attention to detail and education. It also needs a realistic discussion about your willingness to commit and to budget because you will not get best results if you are likely to struggle to remain consistent. For this reason and many more as well as the medicolegal concerns, my opinion is that it is always a good idea to invest in an initial consultation with an open mind to understand what your concerns mean, and how they can be helped, and then to decide if you want to invest in the treatment options so as to avoid shortchanging yourself. Our price guide is regularly updated, but should give you some idea of how much you can expect to spend - the more concerns you have, the more significant the cost initially. I always say to patients it is like buying a car - there is a big upfront cost, then servicing is more manageable to keep it all running smoothly.  No two faces are the same or have the same