‘Black market’ Botox and a lack of regulations sparks increasing concern in New Zealand
The demand for cosmetic medicine is rising rapidly. The global aesthetic medicine market size is predicted to reach USD $245 billion by 2030 from USD $105 billion in 2021. The primary factors influencing this boom include increased accessibility (clinic chains, med spas, and beauty bars), shifting attitudes and growing consumer awareness, driven largely by the internet and social media.
A large majority of the aesthetics industry demonstrates good practice when it comes to patient safety, although surging demand is seeing more unqualified practitioners enter the New Zealand market. Adding to mounting concerns, as techniques become more complex and require a greater level of skill, leaders in the field believe it’s more pertinent than ever we see changes.
Dr Cat Stone, founder of The Face Place, is one of the many cosmetic doctors calling for more government regulations. “I would personally like to see much better regulation and formal training for our industry.”
“Initially, anti-wrinkle injections could only be performed by plastic surgeons,” says Dr Lynn Theron, co-founder of Clinic 42, who also expresses concern. “Then it was GP’s, nurses, dentists and soon paramedics. It is a registered medication, so it requires a prescription and oversight by a physician. However, dermal fillers were originally a medication but transitioned to ‘medical device’, so no physician oversight is required despite posing the most serious risks.”
“Back when I started, it was mainly doctors and a few nurses, in a small self-regulated industry where almost everyone just wanted to do a good job for their patients. Now, it’s become a ‘trendy’ job and self-regulation is a lot more challenging,” explains Dr Cat. “It makes me extremely concerned for patient safety, as well as the reputation of our industry if one of these has a serious side effect.”
ProCollective tapped Dr Cat Stone to learn more about the current regulations and training, the increasingly younger consumer, and worrying prevalence of inauthentic product.
PC: In the New Zealand cosmetic medicine industry, qualifications and training seem to vary substantially. What is The Face Place’s view on this and their approach?
Dr Cat: The regulations have changed since I first started in cosmetic medicine over 20 years ago, and the industry is a lot more commoditised and less regulated than it used to be. There are more people jumping on the band wagon now who don’t necessarily have the skills and qualifications to provide these treatments.
Some people are providing advanced treatments after doing a 1- or 2-day course or worse, no training at all.
Unfortunately, there is very little independent training for nurses, so over the years we have added extra courses to our training academy, as well as special events.
PC: How do anti-wrinkle treatments, like Botox, differ from dermal filler when it comes to regulations?
Dr Cat: They are still a prescription medicine, so can only be administered by those who can prescribe medicines, like doctors, or nurses under the standing order of a doctor. A reputable clinic will always get these products from the pharmaceutical company who makes them (in the case of Botox®️, this is Allergan), but there are some unscrupulous people out there selling black market product to clinicians. I know this from personal experience, as a few years ago we had four approaches over the space of three weeks with people trying to sell us ‘cheap Botox’. We got their details and immediately reported them. Who knows what would have been in those vials and the damage they could potentially cause!
PC: And, what about dermal filler?
Dr Cat: The bigger concern for me is non-medical injectors trying to inject dermal fillers, especially if they are black market. Again, there is no guarantee that what they are using is legit and in fact, it’s more likely it won’t be, as most of the major pharmaceutical companies won’t supply without a doctor’s oversight. I go to a lot of conferences and have seen too many reports of terrible side effects like massive infections, permanent lumps or scarring from these black market products and injectors. Even if they are not using black market products, they usually don’t have the training or access to the medicines needed to deal with a filler emergency like a blocked blood vessel, which puts both their patients and the industry at risk.
PC: What is The Face Place doing to protect the industry’s reputation and provide reassurance to clients?
Dr Cat: I’m a huge believer in education and ongoing training. At The Face Place, we spend a lot of time and effort on recruiting the right people for our team. All of our injectors are doctors, nurses or nurse practitioner level, and we would be one of the top in the industry with regards to our investment in training. Even highly experienced cosmetic clinicians, who join our team, usually take about a year to be fully trained to our level, while clinicians who are new to the industry generally take 2-3 years.
Our medical skin therapists go through a similar process – they must have had 5+ years as a skin therapist and we then train them in our advanced techniques.
Our whole team also receive ongoing training as new procedures and ideas come through from the multiple major international conferences I go to each year.
Through the training academy, I hope we can at least give good practitioners the opportunity to learn more to ensure we’re providing safer and better treatments.
PC: Over the past few years have you noticed increased interest in cosmetic medicine among young people? What do you think is driving that?
Dr Cat: There has definitely been a significant increase in interest from younger people in the last five years and I believe social media has a significant role to play in that. The pressure on the younger generations to be ‘perfect’ is huge, especially with beauty filters and apps like FaceTune that make it seem easy to adjust the face.
Unfortunately, there are some business-driven clinics and chain clinics that target this age group with discounts, Afterpay schemes, and imagery that specifically appeals to them.
There was a big discussion at the recent AMAC conference about whether it’s ethical to treat people in their teens and very early twenties ‘for prevention’, and the overwhelming feedback was ‘no’. If someone is in their late teens and has a valid issue such as a deep frown or excessive sweating, then it’s ok to treat, but the ‘prejuvenation’ trend is increasingly being frowned on.
In the UK, which used to be the least regulated country for cosmetic injectables, legislation was recently passed which makes it illegal to treat anyone under the age of 18 with cosmetic injectables. We are starting to see increasing regulation in other countries closer to home, such as Australia, so I’m hopeful we will start to see some positive change here soon.
PC: What advice would you give to consumers considering cosmetic medicine?
Dr Cat: If you are wanting to ensure that your clinician has at least had decent training provided to them, look for whether they have NZSCM (NZ Society of Cosmetic Medicine) membership. The NZSCM course is currently only run for doctors but is a 2-year training course, and members undergo a full audit on their practice every three years.
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