Ahpra, MBA set sights on non-surgical crackdown

Non-surgical procedures, including neurotoxins, fillers, fat-dissolving injections and thread lifts, are now in the spotlight as part of the Australian Health Practitioner Regulation Agency’s (Ahpra) year-long crackdown on Australia’s cosmetic surgery industry.

Ahpra and the Medical Board of Australia (MBA) announced there will be new guidelines for registered practitioners performing and advertising non-surgical cosmetic procedures and will begin scrutinising doctors, nurses, dentists and other practitioners in the sector.

While medical practitioners are already subject to MBA guidelines, nurses, dentists and other health practitioners are not. As such, the new guidelines will apply to all registered health practitioners providing and advertising non-surgical cosmetic procedures.

Ahpra CEO Martin Fletcher told The Sydney Morning Herald that while injectables were not in the original scope of the review, it was time to broaden its purview as injectables became more affordable and accessible and consumers and injectors flocked to the industry.

‘It’s clear that the cosmetic sector is booming; you can’t walk down a high street and not see people offering a range of injectables, and we need to put in place guidelines to ensure consumer safety,’ he said.

‘We see the role of social media, and we see this trend that plays up the benefits [of injectables] but they don’t address the risks, they emphasise the benefits and downplay the risks. This is what we hope to address with these new guidelines.’

The planned overhaul will strengthen guidelines around informed consent and pre-procedure consultations and the prescribing and administering of prescription-only cosmetic injectables.

It will also include new advertising guidelines, with a focus on the use of before and after photos, claims about the expertise and qualifications of practitioners, and affirm the ban on the use of testimonials. Clear rules regarding the use of influencers and social media figures are also expected in the shake-up.

National Boards will soon be consulting on proposed new practice guidelines for practitioners performing non-surgical cosmetic procedures (excluding medical practitioners who are already subject to the MBA’s Guidelines for registered medical practitioners who perform cosmetic surgery and procedures).

Public consultation on the proposed guidelines will open in coming months ahead of their release in the first half of 2024.

‘Not like getting a haircut’

The cosmetic treatment industry estimates Australians collectively spend more than one billion dollars a year on non-surgical procedures ranging from Botox injections and fillers to fat dissolving injections and thread lifts performed by doctors, nurses, dentists and other health practitioners.

‘Getting these services is not like getting a haircut – these procedures come with risk. We want to ensure the public knows what safe practice looks like, and that practitioners are doing everything necessary to keep the public safe,’ said Fletcher in a statement released by Ahpra on 5 September, 2023.

Ahpra stated that stronger public safeguards are needed because of escalating consumer demand for non-surgical cosmetic procedures and more practitioners seeking a career path in the cosmetics industry.

Rising number of complaints

The number of reported complaints of serious harm from cosmetic surgery has grown significantly since attention was focussed on the sector over the past 18 months. Mr Fletcher said the more frequent use of non-surgical cosmetic procedures, and the expanded range of practitioners who provide them, creates the potential to put a larger section of the community at risk of some harm.

Some recent examples investigated by the regulator include:

• Yasmin is a patient with a history of mental illness who disclosed her history of body image issues and expressed dissatisfaction with the results of 10 previous non-surgical cosmetic procedures. Despite this history, a doctor administered a series of filler injections.
• Jennifer was treated with dermal fillers by a registered nurse, despite having several known skin conditions that made the treatments inappropriate and dangerous. Following treatment, Jennifer had an adverse reaction which required the fillers to be dissolved and steroid treatment to address the reaction.
• Amy underwent intense pulsed light treatment with a doctor to improve the appearance of skin on her neck, but instead suffered significant burns including large purple blistering.
• Carly suffered an infection in her cheek following a botched cosmetic thread lift procedure. Carly’s face became so infected she needed surgery to firstly remove an abscess, and then further surgery to restore her appearance.

*Names have been changed

Nurses and cosmetic procedures

As enrolled and registered nurses perform many non-surgical cosmetic procedures, the Nursing and Midwifery Board of Australia (NMBA) recently established an updated Position statement: Nurses and cosmetic medical procedures.

The NMBA have decided to strengthen this statement into guidelines and provides clear advice to nurse practitioners (NPs), registered nurses (RNs) and enrolled nurses (ENs) working in or wanting to join the cosmetic sector.

‘The work we have already done in our position statement provides clear advice for nurses working in cosmetics, to ensure public safety. But as the sector grows, now is the time to strengthen our regulatory position and provide further clarity to nurses looking to work and working in this space. The public needs to feel safe and know that nurses performing these procedures are appropriately educated and competent,’ NMBA Chair Veronica Casey AM, said.

One year on from cosmetic surgery review

A year after an independent review into cosmetic surgery provided a foundation to reform the industry, Ahpra and the Medical Board of Australia (MBA) say they are well underway to implement all 16 of the review’s recommendations to improve public safety, with almost all reforms now complete.

In a statement by Ahpra, the medical regulator reported that the Cosmetic Surgery Hotline, launched on 5 September 2022, ‘has received 428 calls including from patients concerned about their treatment, from other doctors who have had to address poor outcomes, and from consumers who are keen to make informed choices. In the same period, we have received 179 formal complaints or notifications. As a result, 14 doctors are no longer practising cosmetic surgery or have significant restrictions in place as an interim measure while investigations continue. A further 12 doctors had restrictions placed on their registration after an investigation.

‘These restrictions include suspension of registration, prohibition on performing cosmetic surgery, supervision requirements and formal education requirements. Our proactive advertising audits have also had an impact.

‘In one case, a doctor’s cosmetic surgery advertising was found to have several issues such as claims of permanent results (misleading), claims to improve self-confidence and self-esteem (misleading), videos of patients talking about their experience (testimonial) and use of stock imagery rather than genuine before and after photos (unreasonable expectation). The doctor changed their advertising to address some of the issues, but after several attempts to work with them on the remaining issues failed, the Medical Board imposed conditions requiring education about the advertising guidelines and restricted the practitioner’s advertising until they completed the education.’

‘We are already seeing a positive impact from strengthened practice and new advertising guidelines in the industry, and we are pleased that most practitioners have worked constructively with us towards these reforms,’ said MBA Chair Dr Anne Tonkin AO. ‘The endorsement for cosmetic surgery will also improve patient safety, by bringing in practice standards where there have been none.’

Source: AHPRA.