Home' Clinical Aesthetics : CA issue 6 Contents Jean Huang
DON'T GO OUT OF
Dr Russell Knudsen, speaking on behalf of
the Australasian College of Cosmetic Surgery
(ACCS), said the organisation has long
warned that beauty salons are out of their
depth when it comes to providing cosmetic
injections like anti-wrinkle injections and
"In the unlikely event of an adverse
reaction, you have to have medical-
grade resuscitation equipment available
immediately and that's not going to happen
in a beauty salon," Dr Knudsen said.
"If they are being done in a non-medical
setting like a beauty salon or a so-called
Botox party that we hear about, that is
Dr Knudsen said any beauty salon that
has hired a cosmetic nurse must ensure
a registered doctor is involved in the
"It may be breaching the law depending
on the contact between the patient and the
doctor who is the person responsible for the
prescribing of the medication," he said.
"There are always risks so you need
a comprehensive medical history of the
patient to make sure they are not going to
react or be aggravated.
"We fully support any regulations that
NEED FOR ENFORCEMENTS
According to Dr Danae Lim, a practitioner
with 12 years' experience in both emergency
and cosmetic medicine: "It [the problem]
is actually not the lack of regulation of the
cosmetic medicine industry, but the lack
of enforcement due to due to jurisdiction
Dr Lim runs the HD Cosmetic Clinic,
a "leading provider of cutting edge non-
surgical anti-ageing treatments" in Sydney's Alexandria that focuses
on Asian aesthetics.
"Legitimate providers will always comply with regulations, going
above and beyond to make sure patients are safe," says Dr Lim.
"AHPR A can only regulate medical practitioners and lack
jurisdiction over non-medical personnel.
"Only when a criminal offence is committed do the police
step in, by which time it is already too late. The illegal sale of
restricted medications over the internet has been unbridled for
some time, not to mention blatant advertising of overseas doctors
as qualified medical specialists performing procedures in many
beauty establishments, but is extremely difficult to investigate
"It is not likely that any Australian registered medical practitioner
would have made the same mistake [as in Jean Huang's case].
"Tramadol for human use generally comes
in 50-100mg vials. To administer 1.5g would
have required 15-30 vials of medication
depending on formulation.
"The usual dose is 50-100 mg and it is
not a common drug used intravenously,
especially not for pre- operative pain relief. It
is neither the drug of choice nor the correct
way to dose it.
"Due to the growth of the cosmetic
medicine industry over the last five years
or so, many have tried to ride the wave,
including an exponential growth in the
illegal practitioners with an epicentre mostly
in the [Sydney] inner city areas in the past
two to three years.
"Some of the illegal home practices are
now so popular, one actually has a `clinic' in
the retail area now.
"While there are a few clinics with
Australian registered doctors in those
districts, most of these use illegal
practitioners, or have cosmetic nurses
claiming to be `specialists' and operate
without a super vising doctor.
"Some perform procedures nurses are not
authorised to perform at all, and do home or
hotel visits. So there is a mix of the illegals
and legals doing illegal procedures.
"Even legal practitioners over-treat in
order to make a quick buck, but that's not
relevant in this particular case.
"There are wholesalers advertising fake
drugs with the exact same packaging as the
legitimate medications, origin unknown,
and people have started home businesses
doing cosmetic injections and surgery, with
very aggressive advertising on Wechat, which
does not offer the kind of robust monitoring
system or controls that would make
accountability less challenging.
"Shut one down and then it registers
with another handle, re- establishes business
very quickly due to the demand. It is very hush-hush: only people
referred by people they know can enter those circles.
"Under Australian law, as long as there is no misrepresentation
and the patient has fully consented, anyone can undergo any
procedure by any practitioner.
"The onus is on the patient to prove misrepresentation, which is
why the NSW Health Care Complaints Commission has been powerless
to punish illegal practitioners and no one has died until now.
"Until a criminal act is committed, the police cannot step in.
There is a gap in the legislation and jurisdiction.
"Increasing the regulations for legitimate providers may
not achieve much as we will always comply -- accreditation of
facilities, resuscitation equipment, continuing medical education
-- we already do most if not all of these.
"What of the illegals or rogue operators?
Jean Juang is taken to hospital following
a botched procedure at the Medi Beauty
Clinic in Sydney (Source: Nine News)
CLINICAL AESTHETICS | 13
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