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Exercise care in non-medical 'youth' treatment

A large number of people around the world and South Africa are calling on the skills of plastic surgeons or aesthetic GPs to either enhance their appearance or delay the effects of aging. However how does one decide which doctor to see and is one actually aware of what one agrees to have injected into one's body?
The lure of a youthful appearance is irresistible and the 'cure' for many is laser treatment, chemical peels, dermal fillers and use of neurotoxins. Done correctly, the results can be astounding, taking years off appearance, but the opposite also holds true. With little formal regulation of these treatments in the South African market and elsewhere, consumers need to be aware of the potential dangers.

Global expansion drives poor practices

Globally, the anti-ageing market is expected to reach about $274 billion in 2013, with more than $100 billion of that spend devoted to appearance. There is a lot of money to be made and it has seen the beauty and aesthetic medicine industry expand, in good ways and bad. The dangerous elements are the entry of illegal, low-grade products on the market and their use by unethical industry practitioners. The other challenges are more subtle: bad results most often occur when an inexperienced, unskilled or ill-informed practitioner applies an incorrect technique, dosage or dilution.

"Consumers need to increase their awareness of the challenges the industry is facing," says Dr Alek Nikolic, a practitioner of aesthetic medicine for over 14 years. "There is little regulation in this sector because treatments with dermal fillers and Botox, two of the most effective tools in the arsenal of aesthetic medicine, are not considered permanent. Botox, like all neurotoxins, is a prescription only (Schedule 4) product, so you can only get it from a registered medical professional - that's also who should be administering it; not a beautician or spa technician.

"Consumers need to know who may and may not inject, that these treatments need to be done in an appropriate medical treatment setting, and that the effects they get are a result of two things: the medical practitioner's experience and injecting skill, and the quality and appropriateness of the product used."

Bad treatments can result in permanent damage

Bad results are not hard to find. At best, the treatment is ineffective and you have wasted your money; at worst, there is disfigurement. Poor technique can cause lumping and skin discolouration or misdistribution of the product, which may result in asymmetry and unexpected silhouettes. Overfilling gets you the Hollywood 'trout pout' and unsubtle use of a neurotoxin guarantees a 'frozen' look. There are remedies if you take a cautious approach, and the professional you've selected is competent and pro-active.

However, not only plastic surgeons offer these treatments; you can get your facial injectables (fillers and neurotoxins) from a dermatologist, a full time aesthetic medical practitioner or your family general practitioner (GP). Says Dr Marshall Murdoch, a plastic and reconstructive surgeon, "There are many 'non-plastic surgeon' aesthetic practitioners whose skills are sharply honed. They bring different perspectives and skills that we can all learn from."

On the other hand, Dr Murdoch, like Dr Nikolic, is very aware of the pitfalls. Both have done national and international training for a number of years with Allergan, manufacturers of leading facial injectable medicines and fillers. Notes Dr Nikolic, "Depending on the level of experience, training and knowledge of the medical professional, we often see a lack of understanding of facial anatomy (i.e. the location of major nerves and arteries), injection techniques and approaches, and even of the ageing process of the face."

Academy launched

Allergan is taking this challenge seriously and has recently launched the Allergan Medical Aesthetics Academy (AMAA) in South Africa. It is dedicated to training medical professionals on intermediate and advanced injection techniques of fillers and neurotoxins. It uses a formal training model that incorporates theoretical and practical elements, and provides a platform for collaboration among professionals to share knowledge and discuss new approaches and advances.

The company has also launched an international consumer education campaign, which encourages consumers to ask their medical practitioner about the quality, heritage and scientific research behind facial injectables that the practitioner has chosen to use.

"If you are considering dermal fillers or using a neurotoxin there are three key rules of thumb: ask to see before and after photos of procedures performed by the doctor; get a direct word of mouth referral; and ensure you have a proper consultation with your doctor. You need to understand the treatment alternatives and the risks associated with each treatment and have realistic expectations of outcomes," says Dr Nikolic.

Dr Murdoch also emphasises caution, "Internationally, there are more than 180 different types of hyaluronic acid dermal filler. While reputable pharmaceutical companies make many of these, there are some products, which are of dubious quality and may even be harmful. It is difficult for patients to have the inside track when it comes to knowing which fillers are reputable. While the Internet and lay publications may be able to provide useful information, patients should not be afraid to ask their doctor about what products they use. Furthermore, I believe that it is critically important, in the case of fillers, to show the patient the unopened syringe packaging - this assures the patient of both the brand used, as well as the sterility of the device."

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