Do Your Beauty Homework
Before jumping in, here’s what to consider prior to undertaking an appearance medicine procedure.
The world of aesthetic medicine is evolving quickly, bringing us a wealth of possibilities to refresh or enhance our appearance and changing the beauty industry in exciting ways. However, the common nature and resulting ease with which we now can access a huge variety of options, should not prevent us from considering the fact that treatments like injectable dermal fillers and anti-wrinkle treatments are still medical procedures. As such, they come with associated risks.
It means before undergoing any treatment, there are a number of important considerations to make that will ensure you receive a safe and effective treatment, with results you’ll love.
We asked two experts what we should consider before proceeding and what to ask your provider during a consultation. Dr John Mahony is a cosmetic physician and a board member and treasurer of the CPCA (Cosmetic Physicians College of Australasia). Dr Shona Dalzell is an appearance medicine doctor at Skin Institute.
What credentials indicate the standard or reputable nature of a practitioner?
Dr John Mahony: The first nationally recognised qualification one should look for is pretty straightforward: registered medical practitioner. This is because it is the role of a medical practitioner to assess treatment candidates holistically, prescribe these treatments (that all appear as Schedule 4 substances under the federal “Poisons and Therapeutic Goods Regulation 2008”), and be responsible for the outcomes. Some clinics function with a nurse, or other person, performing the treatments following a FaceTime look by a doctor in another place, even another state. The “reputation” of the service lies in a brand name, rather than in the actual doctor or the actual nurse, whose reputation might be ... what? When all goes well, that’s well and good. But in the event of a problem, who is the responsible party? The nurse? Or the doctor? Or the company? Beyond that, a number of medical colleges have arisen to offer training and set standards among doctors doing non-surgical cosmetic work. Of these, the CPCA is the best established and represents the most senior figures in the field of cosmetic physicians.
What do you suggest someone consider when choosing a cosmetic practitioner?
Dr Shona Dalzell: Make sure you ask as many questions as it takes for you to feel confident and comfortable with that provider. For example, how much training they have had, or how many patients they have performed the treatment on. If you are seeing a doctor, then you might like to ask if this is a specialist area for them for which they have undertaken further training. If you are seeing a nurse, then asking about how they are supervised might also be helpful. Ask about the products they use to ensure they are well known and reputable, but also so you have understanding of these.
Other considerations would include knowing how much consultation time they allow before a treatment, and also if the facilities are of a sufficiently high standard to allow a safe treatment.
Dr John Mahony: It is not so much a question of what the patient should know about their condition or their treatments (of course, more knowledge is always better, and the most knowledgeable patients are always best prepared for any procedure) but rather about choosing a doctor who is knowledgeable and experienced and demonstrates commitment to managing patients over the long term.
What should you consider before undertaking an injectable treatment?
Dr Shona Dalzell: If you’re booking in with a nurse for example, enquire how closely they work with their supervising doctor. Only doctors can prescribe botulinum toxin or the dissolving enzyme that is essential for dealing with complications from dermal filler treatment. I’ve heard of nurses saying a doctor is not needed and they work independently – this is simply not true! All nurses should work closely with their supervising doctor including the supervising doctor regularly reviewing the treatments given by the nurse and ensuring they are delivering treatments which reach the required standards.
Another good question to ask and understand is around how much downtime you might expect with this treatment and is there anything you should avoid afterwards.
A good practitioner will give you this information without you having to ask, but there’s no harm in clarifying exactly how long you need to avoid certain things such as sun exposure after laser treatment, or dental treatment after dermal filler. This gives you the best chance of a great result – you don’t want to undo all that hard work! And finally, make sure you’re aware of any rare but serious adverse effects and how the provider might treat them. This is very important to understand before any treatment. There are risks with all medical procedures, but having a highly trained and experienced provider goes a long way in minimising these.
Dr John Mahony: It is always great if a patient has done a lot of research into this or that treatment, but it is really the role of the doctor to decide whether to recommend, and perform, any injectable treatment or a laser treatment or any other treatment. From time to time it will occur in my practice that a patient will attend with a firm idea as to the exact treatment they want, having done what they consider substantial research, only to find me unwilling to proceed. And in such cases I don’t proceed because despite all the patient’s research there are factors they’ve not considered, factors that argue against their proposal. And so, in their interests, I do not proceed, and I generally offer instead a better way for them to achieve what they wish to achieve.
What are some red flags that might indicate you should reconsider the practitioner you are considering?
Dr Shona Dalzell: In general it’s about making sure you feel comfortable. Some areas to consider include whether or not you feel a thorough consultation has been offered, and whether your medical history has been reviewed appropriately.
There should be questions asked of you about your desired result, and you should feel listened to and clear about what will be done. If the provider does not instill confidence in you, then that is a bit of a red flag and possibly time to meet another who may be a better fit. The old adage around if the price of the treatments on offer is considerably lower than average or market prices (or the promise markedly higher!), that might be a red flag, too!
Dr John Mahony: It’s a red flag if the practitioner doesn’t take your history. It’s a red flag if the practitioner isn’t interested in your general health, or the medication you might be taking, or your lifestyle. It’s a red flag if the practitioner doesn’t generally examine your face and photograph your face. It’s a red flag if the practitioner never warns against a treatment, or is willing to do whatever you want.
It’s a red flag if the practitioner looks like they’ve had too much work done themselves. It’s a red flag if the practitioner is excessively flattering, and theatric in their performance. Obviously it is a red flag if the practitioner is working out of a house, or a car. It’s a red flag if the practitioner asks you to be a guinea pig in exchange for a free treatment. Cosmetic medical practice is complex and demanding – there are red flags everywhere!
What are some of the risks you face as a result of not doing due diligence on a cosmetic practitioner?
Dr Shona Dalzell: Your practitioner should absolutely tell you about rare but serious adverse effects and how they can be treated – for example, the tiny risk of blindness with dermal fillers. It’s very important that you are fully informed about any treatment you might choose. We take even the smallest risks very seriously at Skin Institute, and have created systems, processes, and protocols to strongly minimise their occurrence.
Dr John Mahony: Following an injectable filler treatment, the worst outcome that can arise is blindness in one eye, consequent to the filler being inadvertently injected into an artery carrying said filler to the back of the eye. But there is no such thing as a human activity that cannot be done badly, and there exists a legion of ways to muck up cosmetic treatments. And there’s no hiding the results – there they are, right there on the face.
The thing to remember is every treatment is done by a person, and you have to know something about the person actually doing the actual treatment. Company reputation doesn’t matter, reputation of some doctor somewhere at the end of a phone or on Zoom doesn’t matter. Your result depends on the experience, knowledge and skill of that person standing right beside you at the bedside intending to treat you – and if you don’t know much about that person then you don’t know much about what you might be in for.
How much time should someone spend considering a procedure?
“IT’S A RED FLAG IF THE PRACTITIONER DOESN’T TAKE YOUR HISTORY.”
DR JOHN MAHONEY
Dr Shona Dalzell: Whilst it shouldn’t be a rushed or spur of the moment decision to have any sort of appearance medicine performed, if you see a practitioner within an established, reputable clinic, you should have a great experience and be very pleased with the end results.
Dr John Mahony: As much time as they want, and if in doubt, take more time. It is perfectly fine, indeed preferable, that people attend their chosen doctor to consult and discuss treatment proposals before necessarily proceeding. That said, I believe a treatment should be undertaken only when the patient is quite sure they want to proceed. If uncertain or 50:50 about the idea, they should not go ahead.
Any other advice?
Dr Shona Dalzell: It’s always important to make sure that your practitioner is able to ensure that the treatment is right for you, including advising you against treatment if it is not safe or – equally – not needed.
I always recommend making sure you receive an after-treatment care plan following treatments (especially so with fillers), so that if things don’t feel right or you are concerned, then you know how to contact your provider for help.
Dr John Mahony: Look for a doctor with whom you can partner long-term. Cosmetic management is a journey. Quick fixes are a bad idea, as a rule. So choose someone whom you can trust to co-navigate your cosmetic journey into the future.