There seems to be so much confusion about who injects wrinkle relaxers, what they are and what you are getting for your money. For this reason I have taken the time to write this information sheet as I believe that all patients should be educated about their choices and be confident they are receiving the safest, most effective and best value treatments.

Firstly, in Australia all medical consumer products, including medical grade skin care and medical devices must undergo rigorous testing before they are allowed to be prescribed by doctors to patients. The board that regulates this is the Therapeutic Goods Administration (TGA). If it is deemed harmless, it is sold over the counter at supermarkets and chemists. If it has the potential to make a change to the skin, which could be harmful if inappropriately used, then it is classified “medical” and can only be prescribed by doctors. It is then further classified into sections. Drugs such as the wrinkle relaxers and the range of fillers are classified Schedule 4. This is also the class that prescription only pain killing medication exists in. This means that wrinkle relaxers/fillers must only ever be injected after a doctor has consulted the patient. The doctor must then give a verbal or written order to nurses to carry out the treatment, or do the treatment themselves. It can never be used by a nurse without this review by a doctor. In addition, it cannot be supplied to anyone but a doctor. It is illegal to have anyone but a nurse or doctor inject Schedule 4 drugs. Furthermore, it is good practice and a requirement of ACCS/CPSA membership to have a doctor available to supervise and treat any complications that may arise out of nurse treatment.

In addition, being a Schedule 4 drug, means that advertising of any sort cannot use the trade name of the drug. This is why reputable clinics do not advertise the common names for wrinkle relaxers and fillers. Instead the TGA requires that we use alternatives such as wrinkle relaxer, wrinkle treatment and dermal filler. For more information on this you can see the TGA website http://www.tga.gov.au/docs/html/advsch4.htm. To advertise with the trade name evokes fines up to $33,000 and disadvantages those in the industry following the legislation.

By the way, wrinkle relaxer parties are illegal in Australia, and for good reason. It’s medical and should be done in a sterile environment. Infections can occur and occasional do. Beauty salons are not set up for such conditions and certainly home/office environments are not. Wrinkle relaxer parties do not provide adequate consultations as legislated for with Schedule 4. A patient has no recourse if something goes wrong and will have no follow-up help.

As a patient, you should be aware of who is carrying out your treatment and their qualifications. Just because a doctor is a doctor doesn’t mean that they are automatically qualified to inject wrinkle treatments or wrinkle relaxer products. Like all medical procedures there is a specific skill set that need to be learnt. If you needed open heart surgery would you let a gynaecologist perform it? So why would you let an inappropriately trained or inexperience injector perform a cosmetic procedure?

So what constitutes training?

Well, it might startle you to know that the majority of doctors/nurses out there have virtually no formal training. Literally, they have obtained a bottle of wrinkle relaxer/filler and have been told to inject “here”, “here” and “here” on 2 or 3 patients and then left to their own devices without further guidance. Essentially, their patients become their guinea pigs. There is no concept of what anatomical feature is being injected and why, no concept of side effects and how to treat them and no idea of tailoring the treatment to the patient’s unique features. Most injectors are not attending regular conferences or educational updates. It costs to do so, and that would decrease profit margins. Many casual injectors keep their wrinkle relaxer in the fridge for weeks until used up. This only decreases the strength of the product and makes for an ineffective treatment. Many injectors may not put adequate doses in or alternatively use grossly excessive doses, as was the case of one untrained GP. The untrained doctor did not recognize the severe ptosis that he had caused and sent the patient to a plastic surgeon to correct the droop. Fortunately, the plastic surgeon realized what had happened and after 3 months all returned to normal.

So what is the correct dose?

The answer to this is of course – “the dose that achieves what the patient desires and gives the maximal duration of effect.” Most people want a full block. That is minimal movement but with a natural appearance. This allows the product to last the longest time. On average this is 12 weeks. A few lucky new patients might get longer while rarely a new patient might only get 8 weeks. Patients who have regular treatments will often find that their wrinkle relaxer lasts longer over time. I for example, now get 6 months whereas originally I was 3 months on the dot. Wrinkle relaxers don’t just disappear. The effect gradually builds and then gradually fades. It’s best not to completely let it wear out for best effect. If someone has a very fast metabolism, exercises excessively or has been under emotional distress, it might break down faster than the average treatment. This is because of the forced excessive movement to the area. Some people will also need more, although usually in the first year only, as we try to retrain their strong muscle groups. That’s why to obtain the maximal treatment; we offer the free top up at 2 weeks after treatment. Some places will charge for this but we don’t, as we are more interested in giving the best result possible with the least stress for the patient and ourselves. This way there are no hidden costs, which may be seen when patients are paying per unit for the product or being quoted ridiculously low amounts compared to other centres. Remember wrinkle relaxers/fillers like all TGA medical goods and services are expensive items because of the cost in purifying and testing to ensure safety.

So who can inject and who is trained, and what does training mean?

Fellows of the Australian College of Cosmetic Surgery (ACCS) are doctors who have gone on to specialize in cosmetic medicine. Some in the Eastern States also do reconstructive work like tummy tucks, breast and face-lifts. They perform cosmetic procedures to the highest standards and must sit oral and written exams to prove their knowledge, must have proven their skill and experience to their colleagues and must attend conferences and/or educational activities regularly. This qualification is hard to achieve and as such there are only 4 doctors in WA with them. I am proud to be one of these doctors. For more information see the www.accs.org.au website.

Fellows of the Australian Society of Plastic Surgeons (ASPS) - are doctors who specialized in plastic surgery i.e. surgery involving the cutting of skin and muscle to create a new appearance. Some of these doctors have an interest in cosmetic medicine and I refer often to then often for such things as tummy tucks or breast surgery. Most have limited experience in injectables as they make their livelihood via larger surgical treatments and will leave injectables up to their nurses.

Facial Plastic Surgeons specialise in head and neck surgery. Some have an interest in cosmetic surgery of the area and I again refer to them for such things as face-lifts and blephroplasties. They usually have limited desire to do injectables leaving it for their nurses.

Members of the Cosmetic Physician Society of Australasia (CPSA) are doctors who have an interest in cosmetic medicine. Membership requires 2 years of practice in cosmetic procedures. The CPSA has practice guidelines for its members ensure patients are protected from unethical practioners. Unfortunately, this is not policed. It is a good place to start looking however, when choosing a cosmetic doctor. Ongoing education is encouraged with regular conferencing.

GP Doctors by law can inject, but may not necessarily be trained. If a doctor has a genuine interest, then they will at least be a member of the CPSA. Don’t be afraid to ask them.

Nurse Injectors, like GPs, have no formal training for other than the initial 3 patients. That doesn’t mean they are all bad, some are excellent. But excellence comes from a genuine interest in the subject and a desire to improve. It takes time, practice, theoretical knowledge and a mentor to show the way. That’s why when we took 3 years to decide on an appropriate nurse she had to be the right person and do all the “homework” before we felt her able to maintain the highest of standards that this clinic demands. We are very confident in her abilities and feel she is a great asset. She regularly treats staff and my family and the knowledge that she is appropriately supervised, with access to myself if there is any concern, should put the patients mind at ease if they choose a nurse treatment at ARGERA.

For all the reasons above, nurse treatments are charged at a reduced rate at ARGERA. Doctors must first hold a medical degree, which takes seven years to complete and then undergo a minimum of 2 years of dedicated training in cosmetic medicine, sit exams and carry out ongoing education to be fully qualified. This ensures a safe treatment to the patient but is a costly process in time and money. Doctors are also the end of the line and carry the burden when side effects and risks occur regardless of the injector. Nurses do not have these requirements or stresses and thus I have never felt comfortable in patients paying full price for a specialized treatment carried out by a nurse. I have been a patient myself and I feel this is fair.in giving the best result possible with the least stress for the patient and ourselves. This way there are no hidden costs, which may be seen when patients are paying per unit for the product or being quoted ridiculously low amounts compared to other centres. Remember wrinkle relaxers/fillers like all TGA medical goods and services are expensive items because of the cost in purifying and testing to ensure safety.