S1: From the newsrooms of the Sydney Morning Herald and The Age.
S1: This is the morning edition. I'm Samantha Salinger Morris. It's Tuesday,
S1: March 25th. Cosmetic injectables like Botox and dermal fillers have
S1: been around for so long now that it's easy to
S1: think that hopping into a chair to opt for a
S1: quick needle or two is about as routine as getting
S1: a haircut and is safe. But riding alongside the boom
S1: of this industry, now worth $4 billion in Australia, is
S1: easy access to telehealth appointments, which have led some people
S1: to getting injectables after a consultation with a doctor that
S1: lasts only 52 seconds. Today, senior reporter Henrietta Cooke and
S1: investigative reporter Clay Lucas on how often unintended and tragic
S1: consequences like permanent blindness can arise from these procedures and
S1: whether this is an industry that is slipping through the
S1: cracks in terms of adequate regulatory oversight.
S2: So, Clay and.
S1: Henrietta, before we get into your investigation, can you just
S1: give us a rundown about what cosmetic injectables actually are? Henrietta,
S1: I'll go to you first.
S3: Yeah. One of the most common ones is known by
S3: the name of Botox. It's a type of botulinum that
S3: blocks nerve signals to muscles, which temporarily prevents them from contracting. Um,
S3: it's used for cosmetic and medical purposes. So it stops
S3: the muscles in the face from moving, reducing the appearance
S3: of wrinkles. The other popular substance is dermal filler. That's
S3: a gel like substance that is injected under the skin
S3: to smooth wrinkles, plump skin, and improve facial contours. Um,
S3: these are both substances that are used to prevent signs
S3: of aging and improve the appearance of the skin.
S2: And so how much do procedures like this actually cost?
S4: They can vary in price, but we've found for basic
S4: Botox starting at $300 is is usually the starting point. Um,
S4: lip filler tends to be a bit more expensive, sort
S4: of $600 650 for one mil, which is a reasonable
S4: amount for lip plumping. And then you get procedures right
S4: up to a couple of thousand for what they call
S4: a non-surgical Brazilian butt lift. A US firm did an
S4: analysis of our market in 2023, and they found that
S4: it was worth around Australian $4 billion a year, and
S4: they predicted that over the next five years, it'll grow
S4: to be worth $9 billion by the year 2030. So
S4: it's really growing fast. You can see it everywhere in
S4: every shopping centre in Australia now has, uh, I guess
S4: a day spa or a beauty clinic or a hairdresser
S4: that also offers, um, cosmetic injectables of one form or another.
S4: So you can really find injectables on every street corner
S4: in Australia.
S1: And so why? Why is this growing so much in popularity?
S3: I think there's intense pressure on people to look youthful.
S3: Social media is driving this, and these procedures people use
S3: to sort of seek them out, perhaps when they were
S3: in their 40s. 50s 60s. Now you're seeing young women
S3: in their 20s and 30s getting Botox and filler treatments.
S5: Kylie Jenner, everybody knows who she is. And they say
S5: she really is responsible for the recent trends in cosmetic surgery,
S5: cosmetic medicines and fillers.
S6: All right, mum, where are we? You're getting Botox. We're
S6: getting birthday Botox. I like my nose. I just feel
S6: like when I smile, it goes really far down. So
S6: I like when it's just got that slight little lift there.
S7: Filler is going to be out. It's going to be
S7: bio stimulators that are in which are injectable substances.
S8: This culture of fillers and Botox and plastic surgery, all
S8: of these things that were reserved for the Hollywood elite.
S4: I think this used to be the domain of the
S4: super rich, and now it's become something that just everyone
S4: can afford. And it's seen as a way of sort
S4: of pampering yourself.
S3: As a result of this, people have lost sight of
S3: the fact that these are actually medical procedures, not just
S3: cosmetic procedures, not something as simple as getting a haircut
S3: or your nails done.
S1: Okay. And Henrietta, so what is the process that someone
S1: actually goes through in order to get Botox or another
S1: similar procedure?
S3: Well, if you're using a telehealth doctor, what you would
S3: do is you'd go to one of these beauty clinics,
S3: and a nurse injected there would probably run you through
S3: a few of the side effects. Um, she will then,
S3: or he will phone a telehealth company and a doctor
S3: will remotely write a script for, um, whatever the substance
S3: is that you're injecting in your face. So Botox or
S3: dermal fillers. So the doctor will often appear on a screen.
S9: Hi, I'm John, I'm the doctor.
S3: On the nurses phone and have a very brief conversation
S3: with the patient.
S9: We just have to have a quick chat as part
S9: of the regulations. Do you have any questions at all
S9: for me?
S3: They will peer through the phone and look at the patient.
S9: I can go over the medical record here and see
S9: that you're appropriate for treatment. So we'll just go over
S9: the risks one more time.
S3: And run through a list of all the potential side
S3: effects associated with the treatment.
S9: Bleeding, bruising, infection or swelling can occur with any injection.
S9: There's a small chance that the anti-wrinkle can cause a
S9: droop of the muscle. It's about a 1% risk. It
S9: always goes away if it happens. Are you happy to
S9: go ahead? Yep.
S3: The concern is that a lot of these consultations are
S3: taking place in an incredibly short period of time. We
S3: found evidence of some of these consultations running for just
S3: 52 seconds.
S9: All right. Wonderful wish. All the best. Thanks so much. Thanks. Bye.
S1: And so, Clay, how widespread, I guess is telehealth when
S1: it comes to these appointments and how common is it
S1: I guess for one of those consultations with the doctors
S1: to be 52 seconds.
S4: So this all started when we were sent in October
S4: last year, a job ad for a company called Angel
S4: aesthetics on the Gold Coast, and they were seeking a
S4: telehealth doctor to do 150 to 200 calls a week.
S4: And it stated, just bluntly stated, most consults will be
S4: 1 to 2 minutes long, and then you'll have to
S4: spend five seconds filling out a script. And when we
S4: got that, we thought, well, this seems like an issue.
S4: But when we looked further, we found that Australia's biggest
S4: telehealth clinic was a company called Fresh Clinics. Now they
S4: provide services to between 1500 and 2000 nurses in clinics
S4: all over Australia. And they're the biggest. But there's a
S4: few others. One's called duvet. One's called triple A, another
S4: is called APA. According to Fresh's own research, they do. 80%
S4: of the appointments in this industry is done by telehealth,
S4: so it's a huge industry. The companies make money by
S4: charging $25 per consult to the nurse. This is fresh.
S4: Fresh charges $25 per consult, but they also make a
S4: lot of money by then selling the product to those nurses.
S1: Okay, but online appointments, I mean, they are pretty par
S1: for the course now, right? In medicine ever since the
S1: Covid 19 pandemic. So Henrietta, I'm just going to go
S1: to you. What other problems are we seeing here with
S1: regards to telehealth appointments in this industry?
S3: I guess in this space there is a a treatment
S3: that takes place after the telehealth appointment. It's not simply
S3: a check in with a doctor that you might do
S3: if you're sick or need a prescription for something, there's
S3: actually a medical procedure that takes place. So it's quite
S3: unlike other forms of telehealth. Um, also, I guess you've
S3: got a situation where the nurse and the doctor are
S3: not working side by side. So the issue is that
S3: there's not that sort of oversight that you would get
S3: in a sort of traditional clinic setting with a doctor
S3: who is prescribing, um, a sort of cosmetic procedures. And
S3: I guess also the issue is if something does go wrong,
S3: you don't have a doctor immediately available. Sometimes there interstate.
S3: We've also come across cases where they're overseas. So the
S3: management of that complication is, um, you know, that presents challenges.
S1: And what are the doctors who are actually running these
S1: online appointments, say, like what are the benefits?
S4: So Fresh Clinics has defended themselves by telling us that
S4: the nurses in these appointments will do quite an extensive
S4: pre check of the patient before they then come and
S4: meet the doctor for what is an average, we're told,
S4: in fresh clinics of around 30s. They haven't confirmed that
S4: for us. But that's what we've been told over and
S4: over and over by everyone in the industry. A couple
S4: of weeks ago at a cosmetic conference, there was a
S4: cosmetic doctor who got up and said there was some
S4: doctors in this telehealth space doing 300 telehealth prescriptions per
S4: day in cosmetic injectables, which is an incredible amount.
S10: You know, I am aware, and I can say this
S10: for a fact, that I know that some of the
S10: telehealth doctors have done up to 300 consultations in a
S10: single day with video consultations. Now, that's completely ridiculous. And
S10: I would suggest.
S4: But they defend themselves by saying the nurses generally have
S4: impeccable safety records. They do a lot of screening before
S4: their patient meets the doctor, and then they say that
S4: they have this 24 over seven system in place where
S4: if something goes wrong, the patient can always get in
S4: touch with that and get a doctor. We've got evidence
S4: that that doesn't always work, but, you know, that's how
S4: they defend themselves.
S1: We'll be right back. And Henrietta. I believe one of
S1: the sort of risk factors in this particular space with
S1: regards to telehealth is that, you know, there won't be
S1: appropriate screening, I guess, of patients who perhaps are suffering
S1: from disorders like body dysmorphia. Is that right?
S3: Yeah, that's an issue that quite a few psychologists raised
S3: with us. Under Australian rules, there is meant to be
S3: an assessment of each patient, and that is meant to
S3: look at whether or not they suffer from body dysmorphic disorder,
S3: which is estimated to be something that about 20% of
S3: people who are seeking surgical and non-surgical procedures suffer from.
S3: I think people who suffer from body dysmorphic disorder, um,
S3: they have unrealistic beauty standards. Um, I guess when you
S3: are someone who experiences that, you're also very vulnerable to upselling. So, um,
S3: we have interviewed some patients who have gone in to
S3: see a nurse or a doctor for a certain issue
S3: that they would like to fix, and been told that
S3: they might benefit from other work on their face and
S3: have felt quite vulnerable and yet slightly exploited. So they've
S3: gone on to have work that they didn't initially intend
S3: to have, and also become quite fixated on this issue
S3: that they didn't previously think they had. So there's concerns
S3: that that sort of screening isn't taking place in a
S3: particularly thorough way.
S1: Okay. And Clay, what other risks, I guess, are associated
S1: with some of these procedures that are taking place that
S1: you've written about?
S4: The most common thing that can go wrong is a
S4: thing called a vascular occlusion, which is particularly risky in
S4: the use of dermal fillers. So if you're having, um,
S4: lip plumping done or filler injected into your cheeks or
S4: into your, you know, into your, your eye tear trough,
S4: what can happen is that filler which can be quite solid,
S4: can get into your artery and then block the blood supply,
S4: and that can eventually kill the skin in that area
S4: if you don't get onto it straight away. One of
S4: the issues that seems to come up a lot is
S4: that if your doctor is only available via telehealth, it
S4: can be a struggle to get to that doctor to
S4: ask them what to do. And as often as not,
S4: they'll just tell you to go to emergency. We interviewed
S4: a doctor for this series of stories who works in emergency,
S4: who said he was seeing more and more people coming
S4: in with a vascular occlusion with, with, you know, with
S4: the the blood supply to the skin blocked. And that
S4: can lead to really terrible consequences. It's not common. But
S4: when it does happen, it's terrible. The worst consequences of
S4: that as well can be blindness. And we got figures
S4: from the Therapeutic Goods Administration which found that in the
S4: last few years, eight people have been blinded by cosmetic
S4: injectables and 81 people have had really serious eye disorders
S4: as a result of getting injections.
S1: I mean, it's pretty shocking. Henrietta, I just want to
S1: go to you now. More broadly, I guess what's happening
S1: with the oversight of this industry. Like, is there a
S1: gap here?
S3: Each state has slightly different rules and regulations around this.
S3: In December, Queensland Health issued a fact sheet, and it
S3: basically stated that only doctors and nurse practitioners can purchase
S3: Botox and cosmetic fillers. If that was in force, that
S3: would sort of throw the whole industry of nurse led
S3: clinics into disarray. Um, New South Wales has similar rules. Um,
S3: but whether or not they're enforced, I think is another matter.
S3: There's been a bit of a pushback to the clarification
S3: of these rules. Petition has been started that criticises those
S3: rules and said that it's going to throw the sector
S3: into disarray.
S1: And one of the ideas has actually been to establish
S1: a mandatory register of complications. So tell us about that.
S3: Yeah. So we don't actually have a sense of how
S3: many complications are occurring. People and hospitals can report complications
S3: to the Therapeutic Goods Administration. But yeah, we don't actually
S3: have a sense of how often things like vascular occlusions
S3: and other complications are occurring. So some people who want
S3: to clean up the sector are calling for some transparency
S3: in terms of, um, you know, how many complications are
S3: arising because we just don't know. And there's often a
S3: great deal of, I think, shame and stigma when things
S3: go wrong, particularly when patients have sought out these treatments
S3: to fix parts of their body that they don't like
S3: and then are left with a worse situation.
S1: And so, Clay, just to wrap up, what happens from here.
S1: I mean, does there need to be further intervention to
S1: protect patients?
S4: Yeah, the entire industry is waiting on new guidelines that
S4: are going to be issued soon by one of the
S4: federal health regulators. That will clarify a lot of the
S4: rules around this area, but it does feel a little
S4: bit like this, along with all of the sorts of
S4: medicines that are being scripted via telehealth that aren't part
S4: of Medicare. It does feel this sort of Wild West
S4: feeling of everyone's just doing what they can get away with.
S4: The regulators find it really hard to crack down on them.
S4: There's very little prosecution done by federal authorities of people
S4: who breach advertising guidelines, for instance. So unless the rules
S4: change pretty quickly and pretty rapidly, then it seems like
S4: it's just going to get worse rather than better in
S4: this space.
S1: We're so lucky that you're investigating this area. So thank
S1: you so much, Henrietta and Clay, for your time.
S3: Thank you very much.
S4: Thanks for having us on.
S1: Today's episode of The Morning Edition was produced by Tammy Mills,
S1: with technical assistance by Josh towers. Tom McKendrick is our
S1: head of audio. The Morning Edition is a production of
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S1: the morning edition. Thanks for listening.