Sydney, Australia
Dr Jake Sloane, aesthetic practitioner
On regulation: Having moved to Sydney from London in 2015, it's interesting to reflect on both countries' situations. For one reason only I believe that Australia is in a better position than the UK– it is illegal for non-medically trained professionals to inject at all. Toxins, fillers and Belkyra (Allergan’s fat-dissolving injections) are classified as prescription drugs and so all of the commonly-used products need a prescribers authority to use them.
However we are not perfect by any means. Like most countries we lack a formal injectables qualification to demonstrate competence. This means that patients cannot easily do their research into an injector’s skill level or experience. So for example, an RN could graduate, decide to avoid doing any clinical experience in a hospital and could start working as an injector from day one.
We also lack any common leadership or unified professional organisation to represent all of the injector professions as one group. Instead we have a number of self-appointed and self-regulated colleges who have their own specific needs and motivations. To me, this is a disjointed approach and impedes improvements in our industry as a whole.
Each state also has its own nuances about how things are carried out and we lack any over-arching body equivalent compared to the UK’s CQC or common agreed standards such as Level 7 certification.
On new products: Allergan's filler Volux launched here just three months ago and for many injectors including myself, this was the missing piece of the filler puzzle. The results that we can now achieve for chin and jawline sculpting, in addition to using it for treatments like the liquid nose job have set it apart as a game-changing product.
PDO threads have also become extremely popular here, not seemingly for the results (as before and after images are hardly ever seen!), but for the 'wow' factor of the procedural images splashed all across Instagram. Devices like Emsculpt Neo are really exciting as different technologies are now be combined together into hybrid treatments – in this case HIFEM magnetic field technology to build new muscle combined with radiofrequency heating for fat loss.
In the longer term, I'm extremely excited about the new generation of fillers that will come onto the market that promise to improve skin laxity – the holy grail for non-surgical cosmetic practitioner. When we can start to improve loose skin with injectables only, there will be a paradigm shift in what we can offer people without a scalpel and things will get really, really exciting.
Los Angeles, US
Anusha Dahan, nurse prescriber
On training: “I’ve worked in aesthetics for 17 years and trained all over the world. In the UK I’ve attended Dalvi Humzah Aesthetic Training courses for anatomy knowledge, Mr Ayad Harb’s course for non-surgical rhinoplasty and Dr Raj Acquilla’s training for full face aesthetics. Unfortunately, there’s not much training on offer in the US other than from the product manufacturers. In my opinion, this can be limiting as injectors all follow the same patterns and are only able to learn about FDA-approved indications, which can restrict them from achieving holistic results. I’ve missed being able to travel this year and learn from others. You have great training opportunities in Europe, so I would definitely encourage everyone to look further afield for different perspectives and new insights!”
On product selection: “One of the great things about aesthetics in the US is FDA approval. Compared to the UK where there are hundreds of dermal filler products on the market, we’re only able to use those that are FDA-approved, meaning they have a high safety profile. The downside is that products cost a lot more than in the UK, with many manufacturers running tier systems whereby the more product you buy, the cheaper it is. This means it can be really expensive for those starting out and many find it difficult to get their business off the ground. It also means that newer practitioners can be tempted to rush procedures and get through more product to get their money’s worth, which of course opens up the patient to more risk.”
Central, Hong Kong
Dr Stephanie Lam, plastic surgeon
On Asian vs. Caucasian patients: “Young Asian patients have always embraced filler injection. The Asian face is usually quite round and flat, so they previously had to rely on things like nose or chin implant surgery to give their face more projection. Since fillers have been available, they’ve offered a less risky alternative with minimal downtime. They are very popular amongst patients as young as 18 wanting to improve their nose and chin projection, as well as their overall face shape. On the other hand, I also see a lot of young Caucasian ex-pat patients here in Hong Kong, who are surprised when I explain how filler treatment can benefit them. They say, “Am I that old? I thought you only have filler in your 50s!” Caucasian patients tend to request botulinum toxin treatment for lines and wrinkles first, while it’s the complete opposite for Asian patients. That said, masseter toxin injection is very popular here as it’s marketed as ‘face-slimming injections’ – with that, everyone flocks to get it done!”
On ‘fly-by’ doctors: “One of the main issues we have here in Hong Kong is ‘fly-by’ doctors, who are usually practitioners from Korea or Russia who fly here for a couple of days, set up a makeshift clinic over several adjoining rooms in a hotel and treat multiple patients for a cheap price. There’s often a ‘middle-man’ who arranges everything and has lined up patients prior to their visit. As well as the cheaper prices, they market these doctors as highly-regarded professionals, who patients would be crazy to miss seeing while they’re in the country, suggesting that it would be an ‘incredible, once-in-a-lifetime chance’ to be treated by them. Of course, things go wrong and the patient never hears from them again. A number of us reputable practitioners have reported our concerns to the local police and health authority, but haven’t got very far. I think we need to raise global awareness of this issue as I’m aware it happens in many other countries too – if we can educate patients to only go to practitioners who will follow-up with them after treatment or partner with local practitioners who can, we can hopefully begin to eradicate the problem.”
Brussels, Belgium
Dr Benoit Hendrickx, plastic surgeon
On complication management: “As more and more practitioners start getting involved in injectables around the world, we see more complications. Vascular complications are by far the most dreaded; even a thorough knowledge of vascular anatomy cannot exclude this completely. It would therefore be beneficial to find a way to get a comprehensive overview of the arterial anatomy of each individual patient and be able to visualise their arteries in an easy manner each time we want to perform filler injections. It has taken years of development but I have made such a technology. Essentially, how it works is that the practitioner provides an MRI prescription to the patient (according to a protocol that we have developed and published), the MRI images are uploaded to a protected server, the arteries are identified, intracranial vessels are removed, a 3D model is built and made available to the practitioner, who can now see the anatomy of his/her patient in augmented reality on his/her smartphone. The images below summarise it well. This will be a game changer in the cosmetic medicine world, reducing the risk of one of the most dreaded complications! We’ve rolled out this technology in Benelux, France and Australia first, and will begin next year in the UK. Will likely present it at the ISAPS non-surgical symposium in the UK in March.”
On stem cells: “Some consider stem cells the holy grail of medicine. Having spent four years studying them for my PhD, I can say that they are very powerful in certain types of recovery, but their effect is variable. In my opinion, adipose-derived stem cells are perhaps most promising (as opposed to bone marrow or embryonic stem cells), although there is an opportunity for induced pluripotent stem cells (iPSC), which are mature cells that have been brought back to a stem cell state. Mesenchymal stem cells, like adipose-derived stem cells, have immune suppressive characteristics so could even be used on different patients. Nowadays, there’s a huge industry behind stem cells and patients think they’re ‘sexy’ so they ask for treatment. While in my opinion there is no real hard evidence that it actually is worth going through the effort, I would say if you do liposuction anyway so they’re easy to get, there’s ample fat, and patient demand, then go for it.”
