Speaker 1: Already and this is the Daily This is the Daily OS.
Speaker 2: Oh, now it makes sense.
Speaker 3: Good morning and welcome to the Daily OS. It's Wednesday,
Speaker 3: the fourth of June. I'm Emma Gillespie.
Speaker 1: I'm Sam Kazlowski.
Speaker 3: The growing popularity of cosmetic procedures like injectables and fillers
Speaker 3: has sparked growing concerns about patient safety, regulation and.
Speaker 2: The responsibilities of practitioners.
Speaker 3: This week, health regulators have actually released a sweeping set
Speaker 3: of reforms aimed at tightening the rules around these procedures.
Speaker 3: So in today's deep dive, we're going to explore what
Speaker 3: these new guidelines say, who they'll affect, and what they
Speaker 3: mean for anyone considering a cosmetic procedure as well as
Speaker 3: anyone administering one.
Speaker 1: M Cosmetic procedures are huge business in Australia right now,
Speaker 1: It's nothing new. I feel like they've been around for
Speaker 1: decades in its current form. But give me a sense
Speaker 1: of the backdrop that we're talking about today.
Speaker 3: Yeah, you're right that these kinds of procedures have existed
Speaker 3: for decades, but the industry as a whole has really
Speaker 3: grown quite rapidly in popularity over recent years, to the
Speaker 3: point that we are now talking about a billion dollar industry.
Speaker 3: Now that's according to estimates by the Australian Health Practitioner
Speaker 3: Regulation Agency APRA, So they put the dollar value of
Speaker 3: this industry at a billion dollars.
Speaker 1: And let's be really clear on what exactly we're talking
Speaker 1: about when we're talking about cosmetic procedures. We're not talking
Speaker 1: about getting your nails done right exactly. Sorry, I know,
Speaker 1: I know that's silly, but question here, question, I'm kind
Speaker 1: of new to this industry, so I'm kin to understand
Speaker 1: exactly what you mean here exactly. Well.
Speaker 3: APRA's definition of cosmetic procedures is pretty broad. It defines
Speaker 3: cosmetic procedures as ones that quote revise or change the appearance, color,
Speaker 3: textra structure, or position of normal bodily features to achieve
Speaker 3: what a patient perceives to be a more desirable appearance.
Speaker 3: But narrowing down on that a little bit, this broad
Speaker 3: term can include everything from surgical to non surgical options.
Speaker 3: But specifically today we're going to talk more about non
Speaker 3: surgical procedures, so things like filler anti wrinkle injections Botox.
Speaker 3: Botox is a brand of anti renkal injections, some laser
Speaker 3: skin treatments anything that falls under that umbrella.
Speaker 1: It's interesting how that definition incorporates the why behind the treatment.
Speaker 1: So somebody trying to achieve a more desirable appearance, because
Speaker 1: I know people who get botox for injuries that they've
Speaker 1: had or post surgical stuff for disability.
Speaker 3: There are some medical reasons why people will access botox
Speaker 3: for non esthetic purposes, I suppose, And those procedures are
Speaker 3: subject to different regulations.
Speaker 1: And this space, though, is cosmetic, So who's responsible then
Speaker 1: for that space?
Speaker 2: So this is regulated this space by.
Speaker 3: That regulation agency OPRA I mentioned and the National Boards
Speaker 3: APRA is tasked with ensuring registered health practitioners basically have
Speaker 3: appropriate training, that they have the qualifications to practice, and
Speaker 3: that all of that aligns with prioritizing patient safety. And
Speaker 3: that is the body that's just released new national guidelines
Speaker 3: that will apply to all registered health practitioners performing as
Speaker 3: well as advertising these non surgical cosmetic procedures.
Speaker 1: And do you think there's been a trigger for these
Speaker 1: new guidelines to be released or is it more of
Speaker 1: an accumulation of bad behavior in the industry.
Speaker 2: Yeah, it's been.
Speaker 3: A movement that's been kind of a few years in
Speaker 3: the making. There was an independent review a couple of
Speaker 3: years ago which brought some concerning practices to light, and
Speaker 3: I think there is concern overall from the regulator that
Speaker 3: non surgical cosmetic procedures are still risky procedures, but that
Speaker 3: maybe they're being minimized or downplayed by some providers.
Speaker 2: Over the past few years, more.
Speaker 3: Complaints have been lodged with concerns around unqualified or undertrained
Speaker 3: people offering these services. And until now, some professions have
Speaker 3: had more specific rules than others, like doctors under the
Speaker 3: Medical Board are subject to different frameworks and regulations than
Speaker 3: nurse practitioners, for example, But now APRA is saying that
Speaker 3: it wants to standardize these processes to avoid confusion, so
Speaker 3: the same rules apply right across the board when we're
Speaker 3: talking about non surgical cosmetic procedures.
Speaker 1: And as with any industry, I think it's probably important
Speaker 1: to say that most people who would work in this
Speaker 1: space are well meaning people who follow the rules and
Speaker 1: have patient care at the heart of their practice. But also,
Speaker 1: as with most industries, there's people who don't do that.
Speaker 1: Do we have a sense of the scale of the
Speaker 1: complaints that are being issued from that sector or the
Speaker 1: damage that's being done.
Speaker 3: So between late twenty twenty two and early twenty twenty five,
Speaker 3: APRA looked into about three hundred and sixty complaints related
Speaker 3: to these types of cosmetic procedures. Most of those complaints
Speaker 3: are now closed, but the concerns raised ranged from a
Speaker 3: lack of training from providers to poor patient outcomes. And
Speaker 3: these complaints didn't discriminate across professions. We had complaints about doctors, nurses, dentists,
Speaker 3: even psychologists, Chinese medicine practitioners. So the narrative from those
Speaker 3: complaints speaks to broader gaps in care across the board.
Speaker 1: So there's this gap and care in the non surgical
Speaker 1: cosmetic industry. Some new guidelines come into play. What exactly
Speaker 1: are those guidelines aiming to change.
Speaker 3: Well, there are a few new rules that are really
Speaker 3: interesting that I wanted to talk through today. But one
Speaker 3: of the first ones that stands out is changes around
Speaker 3: the training of staff and minimum requirements so approcalls this
Speaker 3: practitioner's scope of practice and basically in the past or
Speaker 3: up until now, just because someone has a general health qualification,
Speaker 3: so for example, as a nurse or as a dentist,
Speaker 3: that can no longer automatically mean that they are qualified
Speaker 3: to perform cosmetic procedures. So from the second of September,
Speaker 3: in just under three months time, practitioners will need additional
Speaker 3: training or education if they want to safely expand into
Speaker 3: the cosmetic procedure space. So it can no longer just
Speaker 3: be that you are a qualified nurse who decides you
Speaker 3: want to expand your business and dabble in injectibles. You
Speaker 3: will have to undertake more training. On that example of nurses,
Speaker 3: there'll be a certain period of clinical experience required before
Speaker 3: they can begin offering non surgical cosmetic procedures. The regulator
Speaker 3: says this reform is also about future proofing the industry,
Speaker 3: so it warns that maybe some practitioners have been drawn
Speaker 3: to non cosmetic procedures because it's a very lucrative industry. Interesting,
Speaker 3: so these new protections, it said, highlight that many practitioners
Speaker 3: need more than just the foundational qualifications in included in
Speaker 3: their initial training before they can safely perform these procedures
Speaker 3: like cosmetic injections, and trying to get people away from
Speaker 3: that financial motivation to work in this space.
Speaker 1: We'll be right back after a quick message from our sponsor.
Speaker 1: Now one thing that really stood out to me in
Speaker 1: these guidelines was how specific the protections were for young people.
Speaker 1: What's changing there?
Speaker 2: Yeah, this is really interesting.
Speaker 3: There are two big things to talk about. Firstly, any
Speaker 3: advertising of these procedures aimed at under eighteen year olds
Speaker 3: will be completely banned.
Speaker 1: So right now you can advertise cosmetic procedures to under eighteens.
Speaker 3: Well, it's a gray area I suppose about who an
Speaker 3: AD is targeted towards, but there are stronger protections that
Speaker 3: say a vague AD could be seen by under eighteen
Speaker 3: year olds and that that's therefore inappropriate, so clamping down
Speaker 3: on that. And secondly, if a child or teen does
Speaker 3: want an underage cosmetic procedure, there'll now be a mandatory
Speaker 3: seven day cooling off period between their first consultation and
Speaker 3: actually getting the treatment, and so this is aimed at
Speaker 3: preventing impulsive decision making. Regulators say they want to reduce
Speaker 3: pressure on young people to rush into cosmetic work, particularly
Speaker 3: considering the added pressures of social media.
Speaker 1: But just to clarify there, we're still saying that under
Speaker 1: eighteens can access cosmetic procedures.
Speaker 3: Well, the jury is kind of out on that one,
Speaker 3: because I took a closer look at the copy of
Speaker 3: these new guidelines for registered health practitioners. They come into
Speaker 3: effect in September, and there's a dedicated section to additional
Speaker 3: responsibilities around providing these nonsurgical procedures for under eighteen year olds,
Speaker 3: which says practitioners have a responsibility to assess a patient's
Speaker 3: capacity to consent to a procedure, so there has to
Speaker 3: be an evaluation there. It also says registered health practitioners
Speaker 3: should have regard for the views of a parent or
Speaker 3: guardian of a person under eighteen, including whether or not
Speaker 3: they support the procedure being performed. But the regulator does
Speaker 3: not endorse prescribing botox or similar injections, dermal fillers things
Speaker 3: like that for cosmetic purposes for any under eighteen year olds,
Speaker 3: and eligibility can only be assessed by registered nurses or
Speaker 3: nurse practitioners. Now they must quote, know and comply with
Speaker 3: relevant legislation of the jurisdiction in which they're practicing in
Speaker 3: in terms of any restrictions on cosmetic procedures for under
Speaker 3: eighteen year olds.
Speaker 1: So I'm kind of guessing here, but I assume then
Speaker 1: that an update on those guidelines and those jurisdictional rules
Speaker 1: would be part of this added qualification that medical professionals
Speaker 1: would need to be able to perform the procedures. But
Speaker 1: there's many jurisdictions in Australia and that would also be confusing.
Speaker 3: Yeah, it is a gray area and it really depends
Speaker 3: on what the procedure is and where the procedure would
Speaker 3: be taking place. There's actually an interesting report by the
Speaker 3: Royal Australian College of General Practition on this that points
Speaker 3: to concerns about the ethics and the practice of children
Speaker 3: undergoing cosmetic procedures. It says that Australia blacks reliable data
Speaker 3: on this issue and the prevalence of these procedures on children,
Speaker 3: but it points to concerns around kind of these high
Speaker 3: rates that we are hearing about of body image dissatisfaction
Speaker 3: and how that could be driving more young people to
Speaker 3: these procedures. But nationally, the Australian Medical Association's position is
Speaker 3: that patients under eighteen years old should not have procedures
Speaker 3: to modify or enhance physical appearance unless it is in
Speaker 3: their medical and or psychological interests. New South Wales guidelines
Speaker 3: advise a longer cooling off period, so they advise a
Speaker 3: three month cooling off period between the initial consult and
Speaker 3: a procedure on an under eighteen year old, and that
Speaker 3: goes well beyond APRA's new mandatory seven day cooling off period.
Speaker 3: But Queensland is the only state that's actually legislated a
Speaker 3: ban on performing a cosmetic procedure child that was introduced
Speaker 3: in two thousand and eight. Everywhere else, it's kind of
Speaker 3: up to the practitioner. There are steps that they have
Speaker 3: to take, but actually enforcing any of these kind of
Speaker 3: rules is a little bit murky.
Speaker 1: And I'm really interested in this advertising band that you
Speaker 1: spoke about because it brings in the whole other discussion
Speaker 1: that I know you've been very involved with for most
Speaker 1: of this year around the way that social media is
Speaker 1: used to influence the way that young people especially think
Speaker 1: about their bodies. Yeah, can you tell me a little
Speaker 1: bit about how this framework changes what's happening there.
Speaker 3: Yes, So social media has become such a big part
Speaker 3: of how these procedures are marketed. We know that young
Speaker 3: people are on social media, so they're the people seeing
Speaker 3: these messages. As I flagged, any advertising targeting under eighteen
Speaker 3: year olds will be banned in the non surgical cosmetic
Speaker 3: procedure space. But there are some other pretty comprehensive reforms
Speaker 3: that will change how advertising works for high risk procedures.
Speaker 3: Now most injectibles are included under that category. So, for example,
Speaker 3: ads will have to contain information about the practitioner performing
Speaker 3: the procedure so patients know who they're engaging with. And
Speaker 3: there are measures to strengthen a ban on the use
Speaker 3: of testimonials from social media influences. And there's also a
Speaker 3: ban on ads that sexualize or trivialize cosmetic procedures.
Speaker 1: What exactly does that mean.
Speaker 3: It means anything that minimizes the invasiveness of cosmetic procedures
Speaker 3: or misleads patients about how complex a procedure might be.
Speaker 3: It is worth pointing out when I say advertising here,
Speaker 3: this can include any kind of social media post. So
Speaker 3: a practice could post about a procedure that they offer
Speaker 3: that is, under these guidelines considered a form of advertising.
Speaker 1: I feel like the thing that comes to mind is
Speaker 1: the classic kind of before and.
Speaker 3: After exactly, and they will be changing under these regulations,
Speaker 3: So any advertising, all those kinds of posts that include
Speaker 3: things like emojis won't be allowed. Words like transformation, artistry, perfect,
Speaker 3: silhouette sculpting. They're all inappropriate for advertising, and other terms
Speaker 3: that minimize procedures like gentle, simple, safe, quick, easy. They
Speaker 3: appro say detract from the seriousness of a procedure, so
Speaker 3: they will also be banned.
Speaker 1: So there's some pretty sweeping reforms that we've talked about,
Speaker 1: but this isn't the first time that this space has
Speaker 1: had regulation. Give me a sense of what those other
Speaker 1: regulations are, yees.
Speaker 2: So I mentioned earlier.
Speaker 3: There was a review in twenty twenty three, and this
Speaker 3: crackdown is really building on that. APRA shared at the
Speaker 3: time some pretty serious case studies, including the story of
Speaker 3: a patient who suffered severe burns from a light based treatment,
Speaker 3: another who developed an abscess after a threading procedure gone wrong,
Speaker 3: and in one case, a practitioner ignored a patient's skin
Speaker 3: condition and went ahead with filler and that injectable led
Speaker 3: to a serious reaction. The regulator said at the time
Speaker 3: these are not isolated events. They really represent a broader
Speaker 3: pattern of shortcomings within the industry. So that review found
Speaker 3: there was no universal minimum standard of education or training,
Speaker 3: and experts warn that was leaving patients at risk, and
Speaker 3: in response, the Medical Board and OPERA accepted sixteen major
Speaker 3: recommendations to improve patient.
Speaker 1: Safety and those are in place now yep.
Speaker 3: So essentially in the area of injectibles, those regulations have
Speaker 3: been rolled out, but clearly there is more to be done,
Speaker 3: which is why we've seen these new rules. But back
Speaker 3: in twenty twenty three, there were new rules about consent consultations.
Speaker 3: You might remember headlines at the time about psychological evaluations,
Speaker 3: tightening who can prescribe and administer procedures, and that was
Speaker 3: the start of a ban on testimonials from influencers, a
Speaker 3: clamp down on influencer marketing, and these reforms are really
Speaker 3: an evolution of those changes.
Speaker 1: So we have a reaction from industry bodies here.
Speaker 3: Yeah, we've heard from the Australasian Society of Esthetic Plastic
Speaker 3: Surgeons ASAPS. That's a peak industry body and it's welcomed
Speaker 3: the call by OPRA to require better education, training and
Speaker 3: ongoing education for non surgical cosmetic practice. It says regulations
Speaker 3: haven't kept pace with the popularity of the procedures. But
Speaker 3: in addition to clinical safety, the body says there should
Speaker 3: also be greater attention on ethical practice, with a focus
Speaker 3: on patient interest over commercial profits.
Speaker 1: Interesting, there's a lot in that sentence exactly.
Speaker 2: It's a big, big sentence.
Speaker 3: These new guidelines now stipulate that additional training that we've
Speaker 3: talked through. But ASAPS, this body says that there's no
Speaker 3: minimum quality standard for providers ongoing professional development and education
Speaker 3: and no plan for enforcement.
Speaker 1: So it's all very well and good having an education requirement,
Speaker 1: there's no guidelines that this body is saying as to
Speaker 1: who's teaching that and how it's being enforced.
Speaker 3: Exactly, So more to be done, according to ASAPS. Meanwhile,
Speaker 3: the Medical Board of Australia chair doctor Susan O'Dwyer said, quote,
Speaker 3: these guidelines make sure we're all working from similar playbooks
Speaker 3: for the safety of our patients.
Speaker 1: Said. These regulations come into force in early September. What
Speaker 1: else happens next?
Speaker 3: Practitioners have three months to get themselves sorted, be that
Speaker 3: advertisers or healthcare providers. The guidelines are online now, so
Speaker 3: stakeholders essentially have the three months to get ready, update processes,
Speaker 3: get qualified or retrain their staff if needed. For consumers,
Speaker 3: especially younger Australians, you know, nothing will really change dramatically,
Speaker 3: but there is a stronger safety net in place. Essentially,
Speaker 3: that is what the regulator says. These rules don't stop
Speaker 3: cosmetic work from happening, but they shine a spotlight on
Speaker 3: ethics and safety and informed decision making. And I'm sure
Speaker 3: it's not the last we're going to hear about regulation
Speaker 3: in this space.
Speaker 1: It has been an interesting space to watch over the
Speaker 1: years because there seems to be quite a steady flow
Speaker 1: of regulation that has been rolled out. It hasn't been
Speaker 1: this kind of sense of sweeping regulation that turns the
Speaker 1: entire industry on its head, rather kind of tweaks along
Speaker 1: the way to what is the livelihood for a lot
Speaker 1: of people, but also putting a lot of people at
Speaker 1: risk should it be done incorrectly.
Speaker 3: And so often in medicine, I think we see the
Speaker 3: popularity come first and the regulations come second.
Speaker 1: And thank you so much for that, And thank you
Speaker 1: for joining us on the Daily OS this morning. If
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Speaker 1: your headlines. Until then, have a great date. My name
Speaker 1: is Lily Maddon and I'm a proud Arunda Bunjelung Kalkutin
Speaker 1: woman from Gadighl country. The Daily oz acknowledges that this
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Speaker 1: and pays respect to all Aboriginal and Torres Strait island
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Speaker 2: We pay our respects to the first peoples of these countries,
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