0:00

So I have here a little kit that

0:02

I call the blindness kit that I have

0:04

already made up. Don't

0:07

be alarmed, but this is cosmetic

0:09

doctor Sarah Hart showing me her

0:11

special emergency kit in

0:14

case things go wrong while she's

0:16

injecting dermifilla into a client's face.

0:19

There's a reason she calls it

0:21

a blindness kit. Which is that

0:24

if filler went

0:26

backwards down an artery and got to the back of the

0:28

eye, that's a

0:31

devastating side effect that

0:33

all injectors need to know about and

0:35

be ready to have an emergency

0:38

procedure instituted in that situation. Every

0:40

member of the New Zealand Society of

0:42

Cosmetic Medicine must have an emergency kit

0:45

that enables them to dissolve

0:47

the filler. But it's

0:50

not mandatory in the industry. What's

0:52

more, you don't have to have

0:54

any medical qualifications to do this

0:57

treatment. I'm

0:59

Sharon Brick Kelly and today

1:01

on the detail cosmetic surgery,

1:04

appearance medicine, beauty clinics, laser

1:06

clinics, the industry is exploding.

1:08

The clients are getting younger.

1:11

You know there are a number who are

1:13

driven by social media and who have these

1:15

dysmorphic states where you know once they start

1:17

they can't stop and they overdo it and

1:20

they don't realise how bad they look and

1:23

there's no one to guide them. And

1:25

things can go wrong. They get

1:27

scarred and they have a difficult time

1:29

or they get bad staph infection or something and

1:31

burns and so on. It eventually ends up with

1:33

ACC and nobody knows what to do with it.

1:36

We'll delve into the rules and

1:38

regulations or the lack of it

1:40

in this industry. But first

1:42

we're in Dr. Sarah Hart's Ponsonby

1:44

Clinic. Really my main equipment is

1:47

by hands. These are the

1:49

most valuable part of equipment. And what I

1:51

like is that they don't break down the

1:53

way that big machines do. So

1:56

what I have here is I have gloves. I

1:58

have antiseptic. Equipment

2:02

that I need to deliver the injectable

2:04

and here we have kept him out

2:06

which became popular his way of more

2:08

safely administrating. General Fella. actually we have

2:10

any dogs and you could say it's

2:13

Nato see Aspirin when a straining popular

2:15

talks. But that's not

2:17

what they were defined Designed for.

2:19

Lisa Incentives: Religious that are designed.

2:21

For. Giving is Sheila. Am Nc

2:24

to see that to reach renewed

2:26

meeting. Yeah used. It ends.

2:28

Most people would notice Botox who is

2:30

the the main ingredients that you were

2:32

using here he is. So Botox is

2:34

the brand name since a little bit

2:36

like the rocks or coup that other

2:39

and three good brands in New Zealand

2:41

that are approved New Zealand by talks

2:43

to Sport and see a month. The

2:45

all really good friends. Whose house as

2:47

he got this is. So am I

2:49

a mirror? Very important months. When I'm

2:51

doing treatment and when I'm done consultation I

2:53

like my price of silicon were and point

2:56

out. What they consume the Us

2:58

but also when I do treatment I'm

3:00

I'm periodically showing the patience am as

3:02

I'm do the demo fellow treatments. What

3:04

it looks like a christian or fella

3:07

is very much like sculpting. And

3:09

the change happens as he do. It and

3:11

so who am when I'm working with a

3:13

patient's on. when I leave feedback on i'm

3:15

yeah see thoughts on what the in point

3:17

should base and been I came time to

3:19

move as to where the in point as

3:22

as well with regards to the swelling and

3:24

other things you might see on the that

3:26

mirror up. Very important is your only days

3:28

in a cosmetic doctors. I'm. Really sorry I

3:30

do fella maybe he says it. Also

3:33

explain that Saddam of Scylla is a

3:35

shell that you inject and and it's

3:37

physically takes up space in the face

3:39

and the doom of fun as I.

3:42

Use are all made from Hunter on

3:44

a Cast said which is and natural

3:46

carbohydrate component of the skin. And

3:48

we find it and very large

3:50

amounts. And the skin, the joints,

3:52

the eyes, qassamits and it decreases.

3:54

I have a time sets at it's highest

3:56

when we born in the guys down over

3:58

time now hundred and are cassidy the molecule

4:01

that sucks a lot of water to s

4:03

and it's am had a supporter of our

4:05

role and the body. It helps the body

4:07

my college I'm sorry. What they've done

4:09

is that the companies that make fella have

4:11

found out a way to make hundred and

4:13

a cast said have very. Easily. Brewing is

4:15

hop. My youngest. And in the fella

4:17

companies for the in cross legged

4:20

cat and that can make different.

4:22

Strengths of am hundred and a

4:24

cast. A gel Very much like a jelly.

4:26

So if you think of a jelly without much

4:28

gelatin, it would be sentenced. Brady. Yeah, and you

4:30

think of a jelly with the normal amount of

4:32

jelly. It's kind of what makes you think about

4:34

a jelly made. With three times the amount of

4:36

gelatin would be like a thin film shoot. Him

4:39

with less at the same that com and

4:41

a priest so syringe like this year and

4:43

that free from threats he see that cleared

4:46

jail and the syringe it's a one will

4:48

surrender vs a sponsor and gives you some

4:50

one patient. And. Net would go

4:52

we're on the size and so

4:54

send months you would use in.

4:56

The top surface of the scan

4:58

for hydration and gradients and glow

5:00

and we called I Skimmed Boosters.

5:02

The medium tix you want as you'd use

5:05

and the lips and good use and of

5:07

folds around the mask and the more stronger

5:09

tix you'd ones you might use and that

5:11

cheeks and the end of really. Full on

5:13

months you might use in this and to bring

5:16

it's an out of someone's centers, a little retreated

5:18

or perhaps what we commonly referred to as a

5:20

week and. Now we need to

5:23

point out he had that zero

5:25

hot weeks and one corner of

5:27

the industry injectables to medical career

5:29

Started Susie years ago and hospitals

5:32

and doing locum work and general

5:34

practice since he went back to

5:36

study psychiatry and the emerging area

5:38

of cause me sick, Need a

5:41

son. Cosmetic. Medicine One

5:43

essentially am I actually abandoned

5:45

my psychiatry. Training because this area

5:47

was just so innovative and new

5:49

and exciting. You know? I guess people

5:52

might be surprised that you've moved on

5:54

to this area as you gonna be

5:56

really critical you might say you not

5:58

such a superficial. Ah, case. That's

6:00

exactly what my mum said. My

6:03

mum said, you really want to be doing

6:06

that? But you know, I

6:08

was working in cosmetic medicine besides

6:10

psychiatry for quite some time, doing both

6:12

part-time. And it's

6:15

interesting, the strength of the

6:17

changes that we make make

6:20

people feel better. It

6:22

really can be powerful. Our

6:24

face is our social interaction with

6:26

the world and social relationships are

6:29

incredibly important and have been

6:31

found to be a key part of longevity,

6:33

for example. Good social

6:35

relationships are just as important

6:37

as the exercise in our health and wellbeing.

6:40

And so I've witnessed many extremely

6:43

positive changes for people's lives from

6:45

doing this, what

6:47

seems to be trivial and superficial treatments.

6:50

People report people treating them

6:52

differently. It's a

6:54

sad fact of our humanity that

6:56

we do judge by appearances. And

6:59

if someone's face makes them

7:01

look angry, tired or sad, we might

7:04

be less likely to interact with them.

7:06

And it seems to be getting

7:09

more and more that way. Do you think or

7:11

not? It's always been that way. Look,

7:14

studies show that babies

7:17

preferentially gaze at faces that

7:19

are conventionally considered to be beautiful. So

7:21

there's definitely an innate preference

7:26

for faces that are more welcoming

7:28

and inviting. And we tend to look

7:30

a lot at the eyes and the lips. But I think it

7:32

is more these days. And

7:35

I think social media selfies filters

7:37

have driven this immensely. I

7:40

think that the younger generation is so much

7:42

more aware of what they look like. And

7:45

filters have demonstrated

7:47

very powerfully what a small change in

7:49

appearance can do. And

7:52

the younger generation have been used to filtering

7:54

their appearance. And then that, I think, drives

7:57

them to change their appearance in real life

7:59

as well. And

8:01

what do you think about that? I think

8:04

that's the bad side of what we do.

8:06

So you know that I love the good

8:08

side of what we do which is making

8:10

people's faces look emotionally more inviting. I

8:13

think the bad side of this area,

8:15

this field, is overuse or

8:18

particularly overuse on young people and and

8:21

I think that the young people

8:23

are vulnerable. I think that they need

8:25

to be protected from impulsive decisions particularly

8:28

ones that are presented to them on a

8:30

very powerful medium like social media. And

8:33

when you say overuse what do you mean

8:35

by that? I mean starting

8:38

treatment with botulinum toxin when

8:40

they're very young in their early

8:43

20s perhaps. I believe that's unnecessary

8:45

for aging or I think having

8:48

the lips made too big, the cheeks

8:50

made too big, distorting the face, two

8:53

frequent treatments and people

8:56

who are beautiful, they're young and I

8:58

think that's the sad side

9:00

of this field that is something that I'm seeing

9:02

more of now than we did in the early

9:04

days. And what do you say if someone comes

9:07

in the door and says

9:09

I want my lips?

9:11

Yes, if I could tell you about

9:13

a young woman who came in 22

9:15

came in and said I would like

9:17

some Botox but I'm really anxious about it and

9:20

I said well first tell me why you would like it and she

9:22

said well all my friends are doing it and I feel like if

9:24

I don't do it on this out she

9:26

had no lines on her face at

9:28

all. And I said well you

9:31

don't need to do Botox when you don't

9:33

have lines on your face in your early 20s

9:35

with no lines on your face. There's no evidence

9:37

to show, there's no studies that show you have

9:39

to start at that age. There

9:41

is a social media push that

9:44

you do and maybe your peers are being

9:46

folding into that but go

9:49

away put sunscreen on you really don't need it.

9:51

And what was wonderful was being able

9:53

to explain that honestly to her. She

9:55

was very happy with that. people,

10:00

mostly women, looking for treatment.

10:03

It is the proliferation

10:05

of unregulated shops offering

10:07

things like laser treatment.

10:10

Something that really worries people

10:12

like dermatologic surgeon Dr. Ken

10:14

McDonald. He's the chair

10:16

of the New Zealand Cosmetic Dermatology

10:19

Surgical Group. We don't have

10:21

the Therapeutic Goods Act, which Australia

10:23

does, and which tends to regulate

10:25

devices. So if you're a businessperson,

10:28

you can buy a device. Now

10:31

a laser is a device, and in

10:33

New Zealand, everyone can buy a laser.

10:35

The problem is it then crosses

10:37

into the medical area. But you

10:39

can almost operate in

10:41

the medical area by default, because you can

10:43

just buy a device. And then

10:46

you can say, oh, I can take your sunspots

10:48

off, or you can just choose off and advertise

10:50

for it. And you don't come under the

10:52

sorts of controls that doctors do, like

10:55

with the medical counsel, the health and

10:57

disability commissioner, and you don't have the

11:00

standards that we

11:02

would expect. The

11:05

professional maintenance of equipment, the

11:08

calibration of reliability

11:10

of the devices, the facility

11:13

electrical standards, laser

11:15

safety understanding, photobiology, photophysics, those sorts

11:18

of things, and also basic hygiene

11:20

and health and safety standards, which

11:23

are just simply absent in the majority of

11:25

cheap basic, which can

11:28

have a sort of flashy

11:30

sight. And the

11:32

public really has no clue about

11:35

what they're in for. And then, of course,

11:37

you have the issue of

11:39

people dealing with the skin, which is

11:41

the largest organ in the body, and

11:43

really a myriad of diseases. And

11:46

of course, as we know, there are so

11:48

many diseases that present on the skin, like

11:51

melanoma, cats, and inflammatory disease, and so on.

11:53

But you have people who are then using

11:55

devices on skin with

11:58

absolutely no idea. idea of

12:01

diagnosis, no told

12:03

training, no training in cosmetic medicine.

12:06

A lot of business people who frankly have

12:08

no knowledge, no understanding, in fact no interest

12:11

in duty of care or medical ethics or

12:13

anything like that. The other side of the

12:15

equation is that of course

12:17

many of the treatments whether it's hair removal

12:19

or tattoo removal or other things are quite

12:22

inadequate because you know the

12:24

emphasis often is the bottom line and getting people

12:26

back. So Ken,

12:28

are you saying that anybody

12:31

could purchase these

12:33

machines like a machine

12:35

that does laser treatment

12:38

or microneedling, that kind

12:40

of thing? Yeah, well

12:42

the lasers are a different order to

12:44

microneedling. Okay, is it the lasers

12:46

that can soon you the most? They

12:48

can do a lot more damage. The

12:50

issue with lasers is that you

12:53

just wrongly and particularly say cheap

12:55

and nasty knockoffs from certain

12:57

parts of Asia which don't have proper

13:00

cooling systems, don't have anything

13:03

to protect skin essentially. You're going to

13:05

get photothermal burns and we see a

13:07

lot of those. So anybody

13:09

could buy one of these

13:11

laser machines online, set

13:13

up a shop somewhere

13:15

and offer the treatment

13:18

without needing any

13:21

or showing any kind of

13:23

qualification or training in this

13:25

area. Yes, now

13:28

there might be a few local

13:30

regulations in Auckland and you can talk to

13:32

Sarah about that but I don't think they

13:34

have any teeth but essentially that's

13:36

the case. So you

13:39

might then advertise that you've done the

13:41

laser course but that could be two

13:43

hours online which is a

13:45

little bit different to five

13:48

years in medical school, four

13:50

years as

13:52

a physician, another five years as a dermatologist.

13:54

I mean it's just it's not

13:56

the same. So how has

13:58

this been allowed to happen? I don't

14:01

think anyone's sort of

14:03

allowed to do it, it just happened because

14:05

these devices are not regulated. You know, a

14:07

few years ago, I mean, it never occurred

14:09

to us basically that any Tom

14:11

Deere had to get one of these machines, but

14:14

it's happened because

14:16

clearly it's sort of a medical

14:18

area and this sort of

14:21

almost happened by default. But

14:23

there is another important issue, which

14:25

is that not all the

14:28

laser companies have what

14:30

we would consider a proper ethical

14:32

stance. In other words, they

14:34

are prepared to sell the devices

14:37

to anyone who would pay for them. Now

14:40

that might not be the case

14:42

for all lasers, for example, our

14:45

powerful CO2 resurfacing lasers. There aren't

14:47

many of those around at the

14:49

moment and there certainly shouldn't be

14:51

because laser procedures generally which

14:53

are done under sedation anyway, so it's

14:56

sort of more surgical. But

14:59

technically, even

15:01

the resurfacing lasers could be sold

15:03

to anyone. And

15:05

also, I imagine that people

15:08

just, you know, might go drop

15:10

into a laser clinic on main

15:13

shopping street because

15:15

it's advertising, say,

15:17

a hair removal or

15:19

something like that pretty cheaply. So I

15:21

think I'll just go in there and

15:24

get... And if they

15:26

have a professional website, it probably looks a

15:28

lot more attractive than our

15:31

website, for example, which we're probably not

15:33

concentrating on enough. But you

15:35

know, so if you Google something

15:37

and you find something attractive, you

15:40

might go for that if you don't have an

15:42

undercurrent of knowledge about the

15:44

medical side of things. And

15:48

then things can happen because you

15:50

would be treated by

15:52

someone who wouldn't, for example, pick

15:55

up your early melanoma.

15:57

They might just think it's

15:59

an age- spot. And after

16:01

all, now, he's going through

16:04

advertising for photo rejuvenation. They have

16:07

IPL machines, which

16:10

is sort of laser light, but not a

16:12

laser. It's a light-based system. And you mentioned

16:14

needling. There are lots of these energy-based systems.

16:18

But then they say, oh, yes, we

16:20

can treat that. But they don't know

16:22

what it is. And so

16:24

there's obviously been clearly a failure

16:26

of diagnosis. So we would say,

16:29

you're safer if

16:31

you want these things done to actually

16:33

go to one of the bigger clinics,

16:35

which at least have a medical component.

16:39

Because frequently, you know,

16:41

these light-based devices will say activate Perpys

16:43

simplex, so you'll get sort

16:45

of bad headache infections. And they won't

16:47

be diagnosed or treated. And they

16:50

all end up at poor old GP. And

16:52

then they get scarred and they have

16:54

a difficult time or they get bad staph

16:57

infection or something and burns and so on.

16:59

It eventually ends up with ACC and nobody

17:01

knows what to do with it. Because

17:03

of course, the other issue in New

17:06

Zealand, you can't sue. As

17:08

you said, you're seeing the results of

17:10

procedures that have gone wrong all the

17:12

time. I mean, how many of these

17:15

procedures are you seeing, these bad

17:18

laser dunes? Well, because we're so

17:21

busy, we're just not seeing most of

17:23

them. You know, we're really short of

17:25

dermatologists and that again is an issue

17:27

in itself. Now, I

17:30

suppose there are exceptions in

17:32

certain areas like hair removal where

17:35

in certain sites, maybe the underarm

17:38

or the key line and things where, and

17:41

there are probably good sites for lower level

17:43

clinics to do. But once you're

17:46

treating hair which might be over a

17:48

mole, for example, you're over a tattoo,

17:50

suddenly you get into trouble. You

17:52

can't teach people about the skin

17:55

and the diseases of the skin and

17:57

all the different sorts of lesions.

18:00

that we see, you just can't do

18:02

that in a few weekend courses.

18:05

But what would you like to see

18:07

happen? I

18:09

personally think

18:12

that lasers should be in

18:15

a more supervised environment,

18:17

where at least there's access to

18:19

medical advice and

18:21

help. And

18:23

where the health and

18:25

hygiene standards and

18:28

health and safety standards are adequate,

18:31

there's got to be policed standards

18:34

and ideally an association

18:36

with medical clinics so

18:39

that people can get a prescription for

18:41

infections or they can get early skin

18:43

damage treated in an appropriate

18:45

way. But if you're talking

18:48

about dermal fillers, I would never

18:50

go to a non-medically supervised clinic

18:52

because after all, worldwide there have

18:54

been over 500 cases of blindness

18:56

from dermal fillers and so you

18:59

have to know exactly what to do if

19:01

you start getting into trouble with skin necrosis

19:03

or failing vision and so on. Now,

19:06

Botox is a bit safer. Unfortunately, people don't

19:08

tend to get a lot bigger. The

19:11

story I read about in Australia,

19:13

the facial injectables market in

19:15

Australia is worth $3.9 billion

19:18

a year and projected to grow

19:20

by 24% by the end of

19:23

the decade. And

19:25

I assume that New Zealand is following

19:27

similar kind of trends. So

19:30

it's big money and you'll understand

19:32

that some of the chain clinics

19:34

which are certainly better than

19:37

small operators are

19:40

operating independently who are not properly

19:42

supervised, but they are now run

19:44

by private equity companies like

19:47

KKR and the States. And

19:51

the bottom line is what matters.

19:54

This has gone beyond being

19:57

anything to do with a medical clinic.

20:00

So you have a certain

20:02

amount of time to keep

20:05

people. You don't do the

20:07

complicated things and you have a

20:09

whole set of algorithms to

20:12

put into play if you're

20:14

having trouble with people. And

20:17

in the end, if you make

20:19

your money, then you'll get your bonus

20:22

or whatever. But

20:25

it's bottom line stuff, it's driven

20:27

by financial considerations, not

20:30

duty of care or any medical ethical

20:32

thing. And there are a number who

20:34

are driven by social media and who

20:37

have these dysmorphic states where once they

20:39

start, they can't stop and they overdo

20:41

it. And they don't realize how bad

20:43

they look and there's no

20:45

one to guide them. Trying

20:47

to research this industry in New Zealand

20:49

on its own is very

20:51

convoluted. I mean, there's a lot of different

20:54

organizations, societies

20:58

and also a lot of different

21:01

products out there. Is

21:03

it regulated at all? So yes,

21:06

it is, but we believe it's not

21:08

regulated enough. And like

21:10

many new areas, the legislation

21:12

is simply didn't even

21:14

dream of this area. So

21:17

the Medicines Act from 1981, none of this existed. So

21:21

you have 1981 legislation trying

21:24

to deal with the

21:26

advertising on social media of these products.

21:29

We think it needs to be better

21:31

regulated in order to protect the public.

21:33

In what way? What would you like to see?

21:35

I mean, I know in Australia, they've brought

21:37

in some off new

21:39

roles over there recently. Yeah, yeah.

21:42

Look, it's really interesting. In

21:44

some ways in New Zealand, we've avoided some of

21:46

the problems that Australia has because

21:49

the medical council has actually put good guidelines in

21:51

for doctors, But there aren't

21:53

good guidelines in for other practitioners in

21:55

the areas yet who may be working

21:58

in this area. We

22:00

were rather excited about was that

22:02

the Therapeutic Products and Natural Health

22:05

Act twenty Twenty Three has just

22:07

been passed. And that

22:09

put into legislation the A. Bullet

22:11

Seed supports uses supply restrictions around

22:13

medical devices and that's partly because

22:16

of the problems that medical devices

22:18

have caused. For example, that the

22:20

Ginormous which has caused terrible problems

22:22

and so there is no restriction

22:25

around the use of that and

22:27

the same way that is no

22:29

restriction around the a demo fun

22:31

as the caused. Currently

22:35

risks. With

22:39

twenty. Twenty Three allows.

22:42

For restrictions to be put around us.

22:45

But. I'm not. So with that legislation's

22:47

can't stand. The coalition government has campaigned

22:49

on on repealing I think Winston Peters

22:52

campaigned on repealing that acts and so

22:54

we just watching to see what's gonna

22:56

happen. That's

23:00

it said today that these hell

23:02

is supported by Aryan Seed and

23:04

in Sit on E S. Today's

23:07

podcast was produced by Going Mcclure

23:09

and Alexia Russell's and engineered by

23:11

William Saunders thanks to Sera Hearts

23:13

and Kin. Macdonald Cut it is.