The appearance medicine industry is bracing for change

Donna-Marie Lever: 1 News reporter 13th August 2018

The appearance medicine industry is bracing for change as it deals with an increasing number of Asian clients wanting to Westernise their faces. The rules around who can apply dermal filler is also set to be tightened, because of the threat of rare, but serious health risks.

Asian aesthetics was a major discussion topic at the New Zealand Society of Cosmetic Medicine (NZSCM) conference in Queenstown over the weekend, attracting more than 220 doctors and nurses from the industry.

Hans Raetz, President of the NZSCM says, “We've certainly seen an increase over the past few years of five per cent a year on the year before. We estimate around 20 per cent of our clients are now of Asian extraction.”

Popular procedures include reshaping of noses, lips, eyelids and cheeks using dermal filler - but it comes with risks.

“If you inject into this area and you hit one of the arteries or veins you can cause issues at the back of the eye that can cause blindness.” Dr Raetz told 1 NEWS.

The conference covers all aspects of the appearance medicine industry, and it was at the same conference exactly one year ago where New Zealand's first case of blindness from dermal filler was revealed - something that still concerns the industry and has them calling for change.

Dr Raetz fears history may be repeated. “I’m absolutely sure it will happen again - it's a matter of how many noses do you inject before you have a side effect.”

Tighter rules around who can inject dermal filler are coming as part of a wide ranging review into therapeutic products expected later this year.

Unlike Botox-type products which are prescription medicines in New Zealand, dermal filler is classified a medical device, so anyone - trained or not - can inject it. 

“They [Ministry of Health] have agreed to look at potentially regulating this a little bit further, and restricting it to medical personnel. At the moment in theory anybody can inject dermal filler - your beautician, your hairdresser, the fireman down the road - it's not illegal.” Dr Raetz says.

Blinded by Beauty: The risks of undergoing cosmetic surgery

North & South article by Donna-Marie Lever / 12 November, 2017

Full story available here: 

Doctors want dermal filler regulated after woman blinded

ELEANOR BLACK/October 6 2017


Dermal fillers are not currently regulated.

Dermal fillers are not currently regulated.

Doctors specialising in appearance medicine want the use of dermal fillers regulated, after an Auckland woman was blinded in one eye by a nose procedure gone wrong.

Dr Hans Raetz, president of the New Zealand Society of Cosmetic Medicine, says he has colleagues who have decided not to inject noses, because of the risk. 

In a rare complication, filler injected near the nose can travel through blood vessels feeding the eye, and starve them of blood and oxygen, resulting in blindness. There have been 100 such cases worldwide. 

The first New Zealand case involved a 44-year-old Auckland woman who was blinded in March, as reported by North and South. She had filler injected near her nose, to change the shape of the bridge. Within minutes the vision in her right eye became blurry.

"That case certainly brought it to our doorstep," says Dr Raetz. "It was a central pillar of the [NZ Society of Cosmetic Medicine] conference." Some of the people involved in the case were at the conference.

Dermal fillers are used to plump cheeks and lips and alter the shapes of noses. While a nose job by a top surgeon costs around $20,000, the cost of a non-surgical nose job using fillers is around $1000. 

Under the proposed Therapeutic Products Bill, expected to go before Parliament next year, there will be a regulatory framework around the use of dermal fillers.

The classification of dermal fillers changed from "medicine" to "medical device" in 2014, meaning that anyone can use them.

"In terms of the type of classification we have for medicines in legislation (ie prescription-only, pharmacy-only under the current Medicines Act 1981), there are currently no similar legal restrictions on who can use medical devices," says Medsafe group manager Chris James.

"In the new Therapeutic Products Bill we are looking at how to ensure appropriate use of these products."

"It's very heartening to see some action," says Dr Raetz. "We saw a problem looming where this is not a medical device that you would use in a theatre with lots of medical professionals around. This is something you can do in the back of a cosmetic clinic."

Since the classification change there have been five "adverse event reports" associated with the use of dermal fillers, according to the Ministry of Health. 

When the Auckland woman was taken to Auckland City Hospital in March, doctors did not understand what they were dealing with, according to North and South. It was three-and-a-half hours before a specialist treated the woman.

But even if she had been treated immediately, it may not have saved her eyesight. Of all the cases of blindness caused by dermal filler, not one has been reversed. 

Dr Raetz says he does not think people should be discouraged from getting fillers injected, but that they should be better informed of possible problems. 

"I think the better approach is to get clients to look at the risk. [If doctors won't do procedures] these patients will go somewhere else, I guarantee it," says Dr Raetz.

"You will drive these patients from experienced injectors to complete flakes. I know there are back-street injectors out there."

 - Stuff


'Backstreet' beauty clinics operating in New Zealand

 ELEANOR BLACK/October 13 2017

Cosmetic medicine professionals say that unqualified operators are putting the public at risk.
Stock photo/123RF

Cosmetic medicine professionals say that unqualified operators are putting the public at risk.

Unqualified people are performing cosmetic procedures and importing unregistered medicines, a professional body for the country's cosmetic medicine practitioners warns.

In one case which has caused alarm in cosmetic medicine circles, an Auckland woman is advertising surgeries on social media, including eye lifts and liposuction; sources in the industry, who want to stay anonymous, say she is not properly qualified to be doing the procedures and they are not being carried out in a proper sterile environment. 

The New Zealand Society of Cosmetic Medicine is crying foul on the unlicensed operators, and the government regulatory body Medsafe is investigating the importation and use of unregistered medicines and medical devices. 


Dr Hans Raetz, the president of the New Zealand Society of Cosmetic Medicine, has taken his concerns about unqualified ...

Dr Hans Raetz, the president of the New Zealand Society of Cosmetic Medicine, has taken his concerns about unqualified people doing medical procedures to the Ministry of Health.

Two sources in the cosmetic medicine field said that the Auckland woman had claimed to be a doctor but had no medical training, and had been operating behind a hair salon in central Auckland. She has since moved her work to a private home.

"There are quite a few backstreet clinics, but she is the only one doing surgery," said one source, who believed there were at least 20 operators in Auckland using unregistered products.


Sydney woman Jean Huang died after a botched breast procedure at her beauty clinic in August.
Sydney woman Jean Huang died after a botched breast procedure at her beauty clinic in August. 

Dr Hans Raetz, the president of the New Zealand Society of Cosmetic Medicine, has shared concerns about unqualified people doing medical procedures with the Ministry of Health.

"I know there are backstreet injectors out there," he said. "There are eyelid lifts being done in a beauty therapy clinic."

He likens the services to choosing a scrapyard mechanic rather than a licensed mechanic. "I don't understand why anybody would go for these guys," said Dr Raetz. "You can always buy yourself a new car, but no such luck with a new body if your old one is falling to bits."

Ruth Nicholson, who runs NZ Laser Training - which specialises in training around the use of lasers in cosmetic procedures - said she was also aware of underground operators.

" Its a whole secretive underground industry. It does scare me, what's going on. I do think there are a lot of women out there working from garages and their homes who are not registered doing god knows what."

Sydney woman Jean Huang died after a botched breast procedure at her beauty clinic in Chippendale in August. A Chinese visitor claiming to be a doctor administered anaesthetic and breast fillers. The Australasian College of Cosmetic Surgery issued a warning about such procedures being done outside a medical setting.

The Auckland woman has reportedly been performing cosmetic procedures for the past two years. Her services as advertised include facial threading (a non-surgical facelift procedure), fat transfer (from one part of the body to another) and nose reshaping. Some of the procedures would entail use of anaesthetics, and it is unclear whether she is qualified to administer these.

Attempts to contact the woman, including via the WeChat social media app which she has advertised on, and at her last-known premises in central Auckland, have been fruitless. 

Screenshots of posts apparently written by her on WeChat  promote the anti-ageing properties of products she says come from Switzerland, Germany, Italy and Korea. The screenshots suggest she is importing dermal fillers and botox-like products that are unregistered in New Zealand. 

In one WeChat post she says she has clients coming from Wellington to get their noses reshaped.

Another example of WeChat being used to promote questionable cosmetic procedures featured another New Zealand-based woman who touted cosmetic products which are not registered for use here.

Derek Fitzgerald, manager of compliance management for Medsafe, said the regulator was aware of Raetz's concerns and complaints from other people around unregistered medical products.

"Actions in relation to the importation and use of medicines and medical devices are under investigation, including the roles played by those involved," said Fitzgerald. "Medsafe has also had a discussion with Dr Raetz about topics of concern."

However, Medsafe was unable to confirm if reports of illegal cosmetic operations were under investigation.

If members of the public were concerned about the use of medicines or medical devices in relation to a cosmetic treatment, they could complain to the Ministry of Health, he said.

 - Stuff

Botox, fillers, peels: NZ has tighter rein than UK

News from the New Zealand Doctor newsroom by Liane Topham-Kindley /02 May 2013

UK concerns about public health and safety of non-surgical cosmetic procedures need not be echoed in New Zealand, according to former GP Hans Raetz, president of the NZ Society of Cosmetic Medicine

It's not a simple process like buying a toothbrush
UK concerns about public health and safety of non-surgical cosmetic procedures need not be echoed in New Zealand, according to former GP Hans Raetz, President of the NZ Society of Cosmetic Medicine.

Industry regulation is tighter in New Zealand than the UK, Dr Raetz says

A review of the regulation of cosmetic interventions in the UK, released last week, highlights particular concerns about non-surgical cosmetic procedures such as dermal fillers, Botox, chemical peel and laser hair removal.

Under current regulations all of these procedures can legally be performed by anyone, despite the fact that, if performed incorrectly, they can result in complications such as burning, scarring, infection and even blindness.

"Given the known risks, it is not appropriate that the public has no more consumer rights when receiving a dermal filler injection, then when buying a toothbrush," the UK report says.

The review proposes much tighter and rigorous regulation for these types of non-surgical cosmetic procedures to ensure public safety.

Sector regulated in NZ

Dr Raetz, medical director of an appearance medicine clinic in Queenstown, says New Zealand has already carried out much of the work included in the UK review recommendations.
The Medical Council of New Zealand developed a statement of cosmetic procedures, recommending non-surgical cosmetic procedures be performed by a vocationally registered GP, dermatologist or surgeon.
The NZ Society of Cosmetic Medicine has also developed a training programme, which has been approved by the Medical Council, under the auspices of the RNZCGP.
The two colleges are also working together to establish appearance medicine as an extended scope of practice.

10 year campaign to clean up the industry

Dr Raetz says the college has done a lot of work cleaning up advertising and discount schemes run by some providers.
"NZSCM has run a 10 year campaign to get the field cleaned up and either get fly-by-nighters trained up, or out of business," Dr Raetz says.
"I think the relatively low level of complaints in New Zealand is credit to the general success of this strategy."

He admits there is still some work to be done in New Zealand, with cases of some nurses being given the go-ahead to carry out Botox injections under standing orders, when the doctor responsible does not know what they are doing.

"There's a bit of cleaning up still to do," Dr Raetz says.

Medical Council chair John Adams says there is still "a steady, but infrequent, trickle" of complaints about the adequacy of services and a lack of informed consent.

Boundaries still not always clear in NZ

Appearance medicine is a burgeoning business, and there are a number of areas in the industry where "the boundaries are not entirely clear", Dr Adams says.
"From the Medical Council's point of view, we are trying to ensure that patients get the safest and best services in this area."

UK report available here

New Zealand Society of Cosmetic Medicine (NZSCM) welcomes the introduction of regulations banning the use of sunbeds for people under the age of 18.

Media Release/10 April 2013

NZSCM president Dr Hans Raetz says it is well recognised that excessive exposure to ultraviolet radiation at a young age increases the risk of developing melanoma and other skin cancers.

"It is sensible and prudent that sunbed operators will have their machines strictly audited and are required by law to inform their customers about the risks inherent in sunbed usage," says Dr Raetz. "These measures will help to safeguard the New Zealand public against the rising risk of skin cancer."

The Government will amend the Health Act later this year to ban the use of sunbeds for people under 18. It is a key part of MP Paul Hutchison's Health (Skin Cancer and Trauma Prevention) Amendment Bill, which has been supported by NZSCM.

Dr Hutchison's private member's bill was designed to prevent avoidable harm from UV radiation through the use of solaria - sunlamps, sunbeds, or tanning units. The World Health Organisation reports the risk of skin cancer, particularly melanoma, increases by 75% when sunbeds are used before the age of 30.

NZSCM has also assisted Auckland Council to draft regulations in the proposed Health and Hygiene Bylaw regarding the use of commercial sunbeds and light-based therapies.

Dr Raetz says NZSCM will continue to be actively involved in measures that promote the health and safety of the public.

Smooth using Botox to look the business

By Martin Johnston /Apr 12, 2012

Rather than going under the knife, many men are opting for Botox to delay the aging process.

Businessmen wanting that look of authority are helping to drive a big increase in the use of cosmetic therapies such as Botox.

The New Zealand College of Appearance Medicine estimates that clients spent more than $22 million on injections of Botox and dermal fillers in the year ending March 31.
This was 18 per cent more than in the preceding year - compared with the 15 per cent increase recorded in Australia for all non-surgical cosmetic treatments, including beauty therapies such as hair removal.

College president Dr Teresa Cattin, the owner of the FaceWorks clinic in Albany, Auckland, said yesterday the increasing demand for injections of Botox and dermal fillers, which had occurred without respite for several years and even during the economic downturn, was probably fuelled in part by patients who might otherwise have had surgery. It was also spurred by the effectiveness and good value of the products.

Dr Cattin said the patient group had extended beyond the traditional category of women aged 40 to 55, and now included older people and patients in their late 20s and an increasing number of men.
Botox is the standard treatment sought by men, although one clinic, which offers "boob jab" injections of a dermal filler gel to make women's breasts "look fuller and softer, instantly" says this treatment is also suitable for men.

"For men it could mean defining those chest muscles that many hours at the gym are unlikely to fully achieve!" Clinic 42, of Epsom, says on its website.

The clinic said yesterday that it had given this treatment, which was relatively new to New Zealand, to a few women, but not men - "they're not brave enough to come in".

Dr Cattin said businessmen were the main group among Botox patients.
"[They] are unhappy with lines that make them look irritable and it alters the way people respond to you. When you're in a management position it's important that your face backs up what you are saying because we tend to read faces rather than question what people are saying.

"The way people respond to us, especially in a position of authority, is very much influenced by what we look like. I wouldn't say it's vanity at all. I would say it's a practical issue reflecting work needs."
She said Botox injections were a straightforward treatment, effective and relatively cheap. A single treatment of frown lines cost $400 and needed to be done three or four times a year - "it works out as a cappuccino a day".

Botox style DIY shots disfigure women

By Nicholas Jones/May 19, 2011

An increasing number of New Zealand women are being disfigured - and risking death - by buying beauty products online to inject at home.

New Zealand and Australian surgeons are warning people not to buy dermal fillers, or fake products purporting to be Botox, on the internet.

Dr Teresa Cattin, president of the New Zealand College of Appearance Medicine, said she saw women with injuries from DIY cosmetic procedures about once every six weeks. One patient was admitted to hospital for six weeks after a friend injected a substance bought online into her face." She had huge big abscesses. She went into kidney failure. We still don't know what the substance was."In one case they got it tested and it turned out to be cooking oil. "It really is scary. The products we use are prescription medicines, and they're prescription medicines for a reason - you only want to be injecting stuff that is tested." Dr Cattin said she would often refer patients to plastic surgeons to have affected areas of the face cut out.

This week photos were released by an Australian woman, who did not want to be named, showing the swollen lips and face blotches she suffered after a friend injected her with a product bought online.Her lips ballooned two weeks after being injected with supposed dermal filler, and abscesses showed on her face six weeks after the injection.She is now being treated with antibiotics and drainage, and asked for the photos to be released to alert the public to the danger.

Dr Garsing Wong, also a member of the NZCAM, told the Herald the photos highlighted the dangers of buying such products online. "MedSafe do their best to stop all prescription medicines coming in, but sometimes they can slip through. "He said it was a great concern that websites claimed to offer products such as Botox, some of which marketed do-it-yourself application kits.

The Australian woman had bought a supposed dermal filler labelled "HA 40 mg/ml", which was now being analysed. "Judging by the photos, it's very unlikely she would have got a pure form ... The worst thing is you don't know what's in it." Dr Wong said that such products could cause outcomes much worse than permanent scarring. "You risk anaphylactic shock, which in the worst-case scenario could kill you instantly. That's because it could contain impurities."

Another reason for consulting a doctor was to check the prescription against the patient's medical history and allergies. "Not only that, you need to have the options explained. Maybe that's not the best treatment for you. Maybe no treatment is needed."

Both doctors said the dangerous importation of prescription drugs bought online extended to other medicines such as Viagra, weight-loss pills and steroids.

American woman Kerry Campbell recently caused global outrage when it was revealed she was injecting her 8-year-old daughter with Botox to help her win beauty pageants.

NZ appearance medicine experts "world class"

NZCAM Media release/November 11 2009

Appearance medicine doctors in New Zealand are among the best in the world thanks to our rigorous training standards, says the new president of the New Zealand College of Appearance Medicine, Dr Teresa Cattin. "There are so many exciting developments in the field of appearance medicine and our members are right up to date with the latest techniques," she says.

"New Zealand cosmetic physicians are respected internationally and our practices and training programmes are as good as anywhere in the world."

Dr Cattin says NZCAM's primary aim is to train physicians to treat patients safely and professionally, using safe, approved products and techniques. "We want to ensure that patients are getting the right treatment from well-trained professionals – and the result is that New Zealand has an excellent record in patient safety."

When NZCAM was established 15 years ago, appearance medicine was in its infancy. Now the college has 30 fully qualified members and another 12 doctors currently undergoing training. The Diploma in Appearance Medicine is open to doctors only.

NZCAM also holds annual conferences attracting leading overseas cosmetic specialists and researchers, and college members regularly attend international conferences and workshops. Retiring president Dr John Barrett, who headed NZCAM for 13 years, says the college has developed an excellent training and auditing system over the years. "NZCAM has set the gold standard in appearance medicine in this country. This is such a rapidly changing area of medicine that we constantly need to keep up with the latest trends."

Dr Cattin was elected president at NZCAM's annual conference in October.