The Last Word: Australian Perspective

The Last Word

Dr Jake Sloane outlines the prevalent challenges currently facing the Australian injectables industry as well as a proposed solution

Australians per capita undergo more cosmetic procedures than the US, and the COVID-19 era has further exacerbated the insatiable demand for procedures.1 Yet, like in many other countries, Australia lacks any formal qualification or a consensus of standards that injectors must achieve to prove their competence, which I believe is the current downfall. This opinion piece aims to raise awareness about the issues in another country outside the UK so we can share information of what works, and what doesn’t.

Australian aesthetics Australia permits doctors, registered nurses, nurse practitioners and dentists to inject. Unlike the UK, non-medics are prohibited from injecting. Each profession injecting is governed by its own college and each profession’s scope of practice is loosely defined by their respective college framework. But, in reality, there are continual inter-college issues that crop up and registered nurses currently cannot work independently; they must work under the supervision of doctors. The definition of ‘scope of practice’ is not explicit in any way when it comes to injecting, and this is where issues have cropped up.

The problem Many injectors in Australia begin their aesthetic career within ‘chain clinics’ – large franchise models of clinics who typically employ multiple injectors per site.2 These injectors will usually be offered in-house training within their own clinic. The standard and length of this varies widely, from just some informal webinars up to eight full weeks. Injectors who work independently outside of the chain clinic will typically learn to inject via a variety of third-party foundational courses offered across Australia. According to some training provider websites, after doing their two day ‘combined’ course, ‘you will learn all 18 common procedures... after this course you will be able to get indemnity insurance and start treating paying patients straight away’. This model of training has clearly not evolved since the early days of cosmetic injectable training in the early 2000s and yet is still tolerated because there are currently no other credible alternatives. In 2017, a patient named Jean Huang died as a result of a botched breast filler procedure and this sparked a new round of introspection within the industry.3 Knee jerk reactions were made by the various state health departments,4 clinics were visited by undercover health inspectors and one notable prescribing doctor was sanctioned for unsatisfactory professional conduct.5 Some new definitions that mainly affected cosmetic surgeons were made and a clarification of the minimum expected standards,6 but no significant changes came and the status quo continued. In the aftermath of Jean Huang’s death, an enquiry was held in Parliament and representatives of some of the various colleges attended. Notably, the nurses had no cosmetic college of their own and were vulnerable to being sidelined, and so the ‘Cosmetic Nurses Association’ (CAN) was formed in 2020 to advocate for nurses providing non-surgical procedures.7

Suggested steps Whilst the UK is often used as the worst example of the ‘Wild West’ of injecting, it does have an agreed standard known as the ‘Level 7 Qualification’ that was first adopted by Harley Academy.8 In February 2022, intentions for a newly-proposed license for non-surgical treatments in England were also announced in Parliament.9 So, steps are finally being taken to formalise facial aesthetics as a specialty in its own right. What I believe is needed in Australia is an open and honest round table discussion to air views in a formal capacity but without government over-reach. We need to try and find a way forward for an agreed consensus in training standards, workplace regulations as well as continuing professional development. In my podcast Inside Aesthetics – Episode 126,10 we took the first step of doing this by bringing together the President of the Cosmetic Physicians College of Australia (CPCA), the President of the newly formed CNA in addition to globally-renowned key opinion leaders from the plastic surgery and dermatology perspectives. Strong views were exchanged, controversies were brought up, but in the end more common ground was found than division. In the end, the President of the CPCA agreed to meet the President of the CNA for further discussions to resolve their long-standing concerns. I think it has become increasingly obvious that if we want to recognise facial aesthetics as a true specialty, we’ll likely need to establish a facial aesthetic college that accepts all backgrounds of medical injectors under one united banner. Tribalism in medicine has always seemingly been tolerated but we need to end this immature mentality if we want to create a safer and better environment for both our patients but also the injectors. Without this, we are essentially accepting that poorly trained injectors can continue treating the public with impunity. This makes patients vulnerable to poor results and injuries whilst the territorial fights between the various groups of injectors over the control of the industry and their commercial interests will continue.

Final thoughts Currently the ball is in the injectors’ hands. They can create change themselves if the will and motivation are there to evolve and elevate what we do. This would seem far more sensible than the prospect of sweeping and imposed changes led by the Government. If regulation is forced onto the industry from the top down, I think it will highly likely be done in way that is far less appealing to work in and will likely be detrimental to the current business model of many clinics. Going forward, we are watching what happens in the UK very closely to see what comes of the new legislation.

Dr Jake Sloane is an aesthetic doctor originally from London who now lives and works in Sydney. He’s an international key opinion leader for Allergan Aesthetics and is currently being mentored by Dr Mauricio De Maio. He co-hosts the aesthetic podcast, ‘Inside Aesthetics’. Qual: BSc, MBChB, MRCS

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