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Good morning and welcome to the Daily OS. It's Wednesday, the fourth of June. I'm Emma Gillespie.
I'm Sam Kazlowski.
The growing popularity of cosmetic procedures like injectables and fillers has sparked growing concerns about patient safety, regulation and.
The responsibilities of practitioners.
This week, health regulators have actually released a sweeping set of reforms aimed at tightening the rules around these procedures. So in today's deep dive, we're going to explore what these new guidelines say, who they'll affect, and what they mean for anyone considering a cosmetic procedure as well as anyone administering one.
M Cosmetic procedures are huge business in Australia right now, It's nothing new. I feel like they've been around for decades in its current form. But give me a sense of the backdrop that we're talking about today.
Yeah, you're right that these kinds of procedures have existed for decades, but the industry as a whole has really grown quite rapidly in popularity over recent years, to the point that we are now talking about a billion dollar industry. Now that's according to estimates by the Australian Health Practitioner Regulation Agency APRA, So they put the dollar value of this industry at a billion dollars.
And let's be really clear on what exactly we're talking about when we're talking about cosmetic procedures. We're not talking about getting your nails done right exactly. Sorry, I know, I know that's silly, but question here, question, I'm kind of new to this industry, so I'm kin to understand exactly what you mean here exactly. Well.
APRA's definition of cosmetic procedures is pretty broad. It defines cosmetic procedures as ones that quote revise or change the appearance, color, textra structure, or position of normal bodily features to achieve what a patient perceives to be a more desirable appearance. But narrowing down on that a little bit, this broad term can include everything from surgical to non surgical options.
But specifically today we're going to talk more about non surgical procedures, so things like filler anti wrinkle injections Botox. Botox is a brand of anti renkal injections, some laser skin treatments anything that falls under that umbrella.
It's interesting how that definition incorporates the why behind the treatment. So somebody trying to achieve a more desirable appearance, because I know people who get botox for injuries that they've had or post surgical stuff for disability.
There are some medical reasons why people will access botox for non esthetic purposes, I suppose, And those procedures are subject to different regulations.
And this space, though, is cosmetic, So who's responsible then for that space?
So this is regulated this space by.
That regulation agency OPRA I mentioned and the National Boards APRA is tasked with ensuring registered health practitioners basically have appropriate training, that they have the qualifications to practice, and that all of that aligns with prioritizing patient safety. And that is the body that's just released new national guidelines that will apply to all registered health practitioners performing as well as advertising these non surgical cosmetic procedures.
And do you think there's been a trigger for these new guidelines to be released or is it more of an accumulation of bad behavior in the industry.
Yeah, it's been.
A movement that's been kind of a few years in the making. There was an independent review a couple of years ago which brought some concerning practices to light, and I think there is concern overall from the regulator that non surgical cosmetic procedures are still risky procedures, but that maybe they're being minimized or downplayed by some providers.
Over the past few years, more.
Complaints have been lodged with concerns around unqualified or undertrained
people offering these services. And until now, some professions have had more specific rules than others, like doctors under the Medical Board are subject to different frameworks and regulations than nurse practitioners, for example, But now APRA is saying that it wants to standardize these processes to avoid confusion, so the same rules apply right across the board when we're talking about non surgical cosmetic procedures.
And as with any industry, I think it's probably important to say that most people who would work in this space are well meaning people who follow the rules and have patient care at the heart of their practice. But also, as with most industries, there's people who don't do that. Do we have a sense of the scale of the complaints that are being issued from that sector or the damage that's being done.
So between late twenty twenty two and early twenty twenty five, APRA looked into about three hundred and sixty complaints related to these types of cosmetic procedures. Most of those complaints are now closed, but the concerns raised ranged from a lack of training from providers to poor patient outcomes. And these complaints didn't discriminate across professions. We had complaints about doctors, nurses, dentists,
even psychologists, Chinese medicine practitioners. So the narrative from those complaints speaks to broader gaps in care across the board.
So there's this gap and care in the non surgical cosmetic industry. Some new guidelines come into play. What exactly are those guidelines aiming to change.
Well, there are a few new rules that are really interesting that I wanted to talk through today. But one of the first ones that stands out is changes around the training of staff and minimum requirements so approcalls this practitioner's scope of practice and basically in the past or up until now, just because someone has a general health qualification, so for example, as a nurse or as a dentist, that can no longer automatically mean that they are qualified
to perform cosmetic procedures. So from the second of September, in just under three months time, practitioners will need additional training or education if they want to safely expand into the cosmetic procedure space. So it can no longer just be that you are a qualified nurse who decides you want to expand your business and dabble in injectibles. You will have to undertake more training. On that example of nurses, there'll be a certain period of clinical experience required before
they can begin offering non surgical cosmetic procedures. The regulator says this reform is also about future proofing the industry, so it warns that maybe some practitioners have been drawn
to non cosmetic procedures because it's a very lucrative industry. Interesting, so these new protections, it said, highlight that many practitioners need more than just the foundational qualifications in included in their initial training before they can safely perform these procedures like cosmetic injections, and trying to get people away from that financial motivation to work in this space.
We'll be right back after a quick message from our sponsor. Now one thing that really stood out to me in these guidelines was how specific the protections were for young people. What's changing there?
Yeah, this is really interesting.
There are two big things to talk about. Firstly, any advertising of these procedures aimed at under eighteen year olds will be completely banned.
So right now you can advertise cosmetic procedures to under eighteens.
Well, it's a gray area I suppose about who an AD is targeted towards, but there are stronger protections that say a vague AD could be seen by under eighteen year olds and that that's therefore inappropriate, so clamping down on that. And secondly, if a child or teen does want an underage cosmetic procedure, there'll now be a mandatory seven day cooling off period between their first consultation and actually getting the treatment, and so this is aimed at
preventing impulsive decision making. Regulators say they want to reduce pressure on young people to rush into cosmetic work, particularly considering the added pressures of social media.
But just to clarify there, we're still saying that under eighteens can access cosmetic procedures.
Well, the jury is kind of out on that one, because I took a closer look at the copy of these new guidelines for registered health practitioners. They come into effect in September, and there's a dedicated section to additional responsibilities around providing these nonsurgical procedures for under eighteen year olds, which says practitioners have a responsibility to assess a patient's capacity to consent to a procedure, so there has to
be an evaluation there. It also says registered health practitioners should have regard for the views of a parent or guardian of a person under eighteen, including whether or not they support the procedure being performed. But the regulator does not endorse prescribing botox or similar injections, dermal fillers things like that for cosmetic purposes for any under eighteen year olds, and eligibility can only be assessed by registered nurses or
nurse practitioners. Now they must quote, know and comply with relevant legislation of the jurisdiction in which they're practicing in in terms of any restrictions on cosmetic procedures for under eighteen year olds.
So I'm kind of guessing here, but I assume then that an update on those guidelines and those jurisdictional rules would be part of this added qualification that medical professionals would need to be able to perform the procedures. But there's many jurisdictions in Australia and that would also be confusing.
Yeah, it is a gray area and it really depends on what the procedure is and where the procedure would be taking place. There's actually an interesting report by the Royal Australian College of General Practition on this that points to concerns about the ethics and the practice of children
undergoing cosmetic procedures. It says that Australia blacks reliable data on this issue and the prevalence of these procedures on children, but it points to concerns around kind of these high rates that we are hearing about of body image dissatisfaction and how that could be driving more young people to
these procedures. But nationally, the Australian Medical Association's position is that patients under eighteen years old should not have procedures to modify or enhance physical appearance unless it is in
their medical and or psychological interests. New South Wales guidelines advise a longer cooling off period, so they advise a three month cooling off period between the initial consult and a procedure on an under eighteen year old, and that goes well beyond APRA's new mandatory seven day cooling off period. But Queensland is the only state that's actually legislated a ban on performing a cosmetic procedure child that was introduced in two thousand and eight. Everywhere else, it's kind of
up to the practitioner. There are steps that they have to take, but actually enforcing any of these kind of rules is a little bit murky.
And I'm really interested in this advertising band that you spoke about because it brings in the whole other discussion that I know you've been very involved with for most of this year around the way that social media is used to influence the way that young people especially think about their bodies. Yeah, can you tell me a little bit about how this framework changes what's happening there.
Yes, So social media has become such a big part of how these procedures are marketed. We know that young people are on social media, so they're the people seeing these messages. As I flagged, any advertising targeting under eighteen year olds will be banned in the non surgical cosmetic procedure space. But there are some other pretty comprehensive reforms that will change how advertising works for high risk procedures.
Now most injectibles are included under that category. So, for example, ads will have to contain information about the practitioner performing the procedure so patients know who they're engaging with. And there are measures to strengthen a ban on the use of testimonials from social media influences. And there's also a ban on ads that sexualize or trivialize cosmetic procedures.
What exactly does that mean.
It means anything that minimizes the invasiveness of cosmetic procedures or misleads patients about how complex a procedure might be. It is worth pointing out when I say advertising here, this can include any kind of social media post. So a practice could post about a procedure that they offer that is, under these guidelines considered a form of advertising.
I feel like the thing that comes to mind is the classic kind of before and.
After exactly, and they will be changing under these regulations, So any advertising, all those kinds of posts that include things like emojis won't be allowed. Words like transformation, artistry, perfect, silhouette sculpting. They're all inappropriate for advertising, and other terms that minimize procedures like gentle, simple, safe, quick, easy. They appro say detract from the seriousness of a procedure, so they will also be banned.
So there's some pretty sweeping reforms that we've talked about, but this isn't the first time that this space has had regulation. Give me a sense of what those other regulations are, yees.
So I mentioned earlier.
There was a review in twenty twenty three, and this crackdown is really building on that. APRA shared at the time some pretty serious case studies, including the story of a patient who suffered severe burns from a light based treatment, another who developed an abscess after a threading procedure gone wrong, and in one case, a practitioner ignored a patient's skin condition and went ahead with filler and that injectable led to a serious reaction. The regulator said at the time
these are not isolated events. They really represent a broader pattern of shortcomings within the industry. So that review found there was no universal minimum standard of education or training, and experts warn that was leaving patients at risk, and in response, the Medical Board and OPERA accepted sixteen major recommendations to improve patient.
Safety and those are in place now yep.
So essentially in the area of injectibles, those regulations have been rolled out, but clearly there is more to be done, which is why we've seen these new rules. But back in twenty twenty three, there were new rules about consent consultations.
You might remember headlines at the time about psychological evaluations, tightening who can prescribe and administer procedures, and that was the start of a ban on testimonials from influencers, a clamp down on influencer marketing, and these reforms are really an evolution of those changes.
So we have a reaction from industry bodies here.
Yeah, we've heard from the Australasian Society of Esthetic Plastic Surgeons ASAPS. That's a peak industry body and it's welcomed the call by OPRA to require better education, training and ongoing education for non surgical cosmetic practice. It says regulations haven't kept pace with the popularity of the procedures. But in addition to clinical safety, the body says there should also be greater attention on ethical practice, with a focus on patient interest over commercial profits.
Interesting, there's a lot in that sentence exactly.
It's a big, big sentence.
These new guidelines now stipulate that additional training that we've talked through. But ASAPS, this body says that there's no minimum quality standard for providers ongoing professional development and education and no plan for enforcement.
So it's all very well and good having an education requirement, there's no guidelines that this body is saying as to who's teaching that and how it's being enforced.
Exactly, So more to be done, according to ASAPS. Meanwhile, the Medical Board of Australia chair doctor Susan O'Dwyer said, quote, these guidelines make sure we're all working from similar playbooks for the safety of our patients.
Said. These regulations come into force in early September. What else happens next?
Practitioners have three months to get themselves sorted, be that advertisers or healthcare providers. The guidelines are online now, so stakeholders essentially have the three months to get ready, update processes, get qualified or retrain their staff if needed. For consumers, especially younger Australians, you know, nothing will really change dramatically, but there is a stronger safety net in place. Essentially,
that is what the regulator says. These rules don't stop cosmetic work from happening, but they shine a spotlight on ethics and safety and informed decision making. And I'm sure it's not the last we're going to hear about regulation in this space.
It has been an interesting space to watch over the years because there seems to be quite a steady flow of regulation that has been rolled out. It hasn't been this kind of sense of sweeping regulation that turns the entire industry on its head, rather kind of tweaks along the way to what is the livelihood for a lot of people, but also putting a lot of people at risk should it be done incorrectly.
And so often in medicine, I think we see the popularity come first and the regulations come second.
And thank you so much for that, And thank you for joining us on the Daily OS this morning. If you're catching us on YouTube, it's so great to have you here. It would mean a lot if you subscribed to our channel. We'll be back in the afternoon with your headlines. Until then, have a great date. My name is Lily Maddon and I'm a proud Arunda Bunjelung Kalkutin
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