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Blinded by beauty: The risks of undergoing cosmetic surgery

We’re plumping and paralysing our faces for perfection in rapidly increasing numbers as appearance medicine goes mainstream – but the industry’s risky side is emerging, too. Donna-Marie Lever investigates.

Within minutes of the nurse piercing her skin, there was pain. Then the patient’s face began to change.

The 44-year-old Auckland woman had just had dermal filler injected near her nose to plump up the bridge and enhance its shape. Almost immediately, her nose and the skin between her eyebrows reddened then turned purple, and the vision in her right eye became blurry. She was rushed to Auckland City Hospital’s emergency department.

There, doctors were perplexed and – according to a specialist spoken to by North & South – ill-equipped to deal with what was a rare complication. What they didn’t realise was the woman was rapidly developing a major vascular occlusion, or blockage, with a clot obstructing vital blood supply to her retina.

Injecting filler near the nose, among the maze of blood vessels that lie under our facial skin, carries Russian roulette-style dangers. Hit a blood vessel that feeds directly to the eye and you risk causing catastrophic damage. Once filler enters that critical vein, there’s a window of just 90 minutes before irreversible retinal cell death occurs.

It took three-and-a-half hours before the woman was finally in the right hands – those of oculoplastic surgeon and ophthalmologist Dr Paul Rosser at Auckland DHB’s Greenlane Clinical Centre. He is one of a handful of specialists in New Zealand who knows how to handle this sort of emergency – and, more importantly, knows what sort of emergency it is. But in this case, it was too late. The filler had starved the woman’s eye of blood and oxygen supply, causing permanent damage and leaving her clinically blind in one eye.

Working as quickly as possible, Rosser had immediately given the woman two injections directly behind the eye of hyaluronidase (or Hyalase), a prescription medicine that works like an “undo” button to dissolve filler. “Within the first 24 hours... if something is going to help, it will help very quickly,” he says. “In this case, it didn’t. We then put her in hospital and gave her IV steroids in case it was swelling that could be reduced, but those were all just hopes. After that didn’t help, we knew pretty quickly... She was upset, really upset, devastated to lose vision in her eye.”

Dr Paul Rosser

In fact, when a procedure like this goes wrong, no one knows if using hyaluronidase to prevent permanent damage to the eye is a treatment that actually works. In a 2015 international study that looked at around 100 cases of blindness caused by filler, not a single patient received the injection within that crucial first hour and a half.

In the Auckland case, which happened in March, the dermal filler had been injected by an experienced nurse, under the supervision of a plastic surgeon. The woman who lost her sight declined to talk to North & South and her devastating experience has not previously been reported. But while it may have gone publicly unnoticed, what happened that day has sent jitters through an industry desperately wanting to see regulatory change.

Rosser’s not surprised by the case, the first of its kind in New Zealand. “Unfortunately, it’s one of those things that can’t necessarily be prevented,” he says. “It’s generally bad luck when you enter a vessel that happens to link with the ophthalmic artery.”

What does surprise him is that so few complications are associated with facial filler. “The amazing thing is that it’s as safe as it is, because you’re injecting a foreign body into someone’s face, and yet it’s generally fairly well tolerated. The vast majority of people don’t end up with problems.”

With the towering, snow-dusted Remarkables as their backdrop, the beautiful people have gathered in Queenstown. Around 200 industry insiders, mainly doctors and nurses from around the country, have poured into the tourist hotspot for the New Zealand Society of Cosmetic Medicine’s annual scientific meeting – a three-day conference with international speakers, masterclasses and workshops on appearance medicine.

It’s hard not to gaze at their faces and wonder who’s had “work done”. Some are blessed with natural (or subtly enhanced) beauty; others appear plumped to within an inch of bursting point, or flash flawless, frozen faces. Only a few seem comfortable exposing the laughter and frown lines we are all gifted in time.

There are two main treatments in the injectable world: Botox, which is a prescription medicine and can only be injected by a trained professional or under the supervision of one; and dermal filler, which is classified in New Zealand as a medical device and subject to far less regulation, meaning it can essentially be injected by anyone.

Botox is actually a brand name, but has become the go-to word for any sort of injectable derived from the toxin botulinum but administered in a highly diluted dose. There are several other products on the market, such as Dysport, which effectively do the same thing.

A temporary treatment that knocks out muscle action, it’s used to treat fine lines and wrinkles by relaxing facial muscles, preventing them from forming deeper lines. Results aren’t immediate and it usually takes a few weeks for the full effect. Botox can treat crows’ feet, squint and frown lines, lines around the mouth and chin, forehead creases, and lines in the neck area; it can also be used to help medical issues such as excessive sweating. Clients typically spend around $300-$500 on a treatment, which will last between three and five months.

Dermal fillers, the other major area of injectables, refill and re-inflate areas where you have fat loss, and stop skin sagging where you’ve lost volume. Results are immediate but often subtle.

“People look a lot better but others can’t pinpoint why,” says The Skin Institute’s Dr Hans Raetz, who is president of the New Zealand Society of Cosmetic Medicine. “Clients don’t want to go to work the next day and have people say, ‘Oh, you had filler.’ They want to go to work and have people do a double-take, while trying to figure out what’s different.

“What our patients like to hear is, ‘Oh, you had a great holiday… you look so much fresher.’”

Filler also inflates lips – a big trend in New Zealand right now. It’s where the term “trout pout” came from a few decades ago, but specialists say it’s more about the natural look now.

Collagen, a natural protein which was all the rage as a skin plumper in the 90s, has been largely replaced by hyaluronic acid fillers such as Juvederm and Restylane, which don’t require allergy tests, last longer and are more versatile. (Injectable collagens are mostly made from purified cow and pig skin collagen, while human collagen implants are more often used to treat burns and ulcers.)

Industry experts say 99 per cent of fillers used here now are based on hyaluronic acid, a substance that occurs naturally in the body and is a common ingredient in anti-ageing skincare products. More expensive than Botox, a filler treatment could cost between $700 and $1500 and last anywhere from six months to two years.

Over the past few years, the popularity of injectables has soared, not just with the old and wrinkly, but also with the young and beautiful. Treatments involve minimal pain, very short recovery times, and are seen as a safer, less-invasive, modern alternative to a facelift or serious plastic surgery. Startling results are talked about openly in social gatherings and splashed over social media – some happy customers even live-stream direct from the treatment table. Like the wrinkles these dermal fillers are used to treat, the stigma and secrecy that once surrounded “appearance medicine” seems to have simply vanished.

Delegates from Queenstown’s Skin Institute at the formal dinner and graduation ceremony at the New Zealand Society of Cosmetic Medicine’s annual conference.
The conference in Queenstown starts with a mingle and lunch. Everyone seems to know each other and there is much catching up to be done as they forensically dissect their sandwiches – leaving the bread and other carbs to one side, while inhaling the protein and vegetable fillings. This is the appearance industry and the ones cashing in on it are clearly health-conscious. No surprise that they care about their looks.

The rocking tones of David Bowie’s “Let’s Dance” boom over the speakers – a signal for everyone to move into the theatre. It’s time to start.

Many of the doctors attending are members of the society (NZSCM), the single unified body for cosmetic medicine in this country, which represents doctors and provides training and supervision, as well as professional accreditation.

The organisation evolved four years ago from what began with a small group of doctors who formed the Appearance Medicine Society of Australasia (AMSA) in 1995. And while it’s still finding its feet, the society has around 60 members and hopes to banish “cowboys” from the business. It also runs New Zealand’s only Medical Council-accredited programme to attain a practising Diploma in Cosmetic Medicine.

Today, the first masterclass is on anatomy. Australian plastic surgeon Dr Peter Callan doesn’t mince words when he talks about the risks of danger zones on the face. The Auckland blindness case is a hot topic, too. “Fillers [can be] dangerous,” he says. “I started injecting fillers in 1995, using collagen and we knew little about it then...”

Callan flicks through a series of slides that show a latex face being injected and just what goes on under the skin as the injector wiggles in a needle or cannula to plump out the wrinkles and lines. “Do you know where you are?” he asks the audience. “It’s impossible to know where you are on the end of a needle. These things are everywhere – you’re always in a blood vessel or coming out of one, so you just have to keep moving.”

The crowd is captivated by his energy and charisma as he talks about complications from fillers. “You’re only remembered by your errors,” he says. “I give patients my mobile number and say, ‘Ring me at three in the morning if you have pain or whatever.’ If you’re going to inject noses, you have to be prepared for trouble.”

The nose is one of two areas on the face Callan signals as a red flag. The other is the glabella, just between the eyebrows.

The danger of blindness from injectable fillers hit the headlines across the Tasman in July, when top plastic surgeons went public to warn of this rare side-effect. Plastic surgeons talked of complacency in Australia, where being injected with filler is as common as having a manicure or wax: the Australasian College of Cosmetic Surgery puts expenditure on cosmetic surgery and medical treatments at a billion dollars a year. “With the increase in use has been an associated downgrading of the risks that come with hyaluronic acid fillers,” Australian Society of Plastic Surgeons (ASPS) president Mark Ashton told news.com.au.

The article cited a new study from South Korea, which has the highest number of plastic and cosmetic procedures per capita in the world. Nine patients were examined who had experienced vision loss after being injected with fillers. “All nine patients were female, ranging in age from 26 to 45, and in all cases hyaluronic acid fillers were injected by doctors, including board-certified plastic surgeons and dermatologists,” reported the study from Seoul National University, which was published in the journal of the American Society of Plastic Surgeons.

Ashton warned that blindness from filler can occur following an injection anywhere on the face, not only around the delicate eye area – even with lip injections, which are hugely popular in Australia and New Zealand.

“The blindness is instantaneous and permanent and can be one or both eyes. No one has been able to successfully fix that blindness.”

Peter Callan, based in Geelong, Victoria, believes open discussion of the risks around fillers is the best thing that could have happened here. At the Queenstown conference, he speaks with the bluntness of a man who’s dealt with the ugly side of the beauty industry, fixing filler side-effects caused by his own and others’ mistakes. “This tragic event [in Auckland] can only elevate the standards here,” he says. “I like that the New Zealand industry is discussing it and trying to work out a way of preventing it happening in the future. These events are very rare – but they do occur.”

Dr Hans Raetz.
So, why would any appearance specialist risk major medical misadventure for the sake of making a few bucks out of giving clients the line-free look?

Hans Raetz has been injecting faces with Botox and fillers for decades, and the Auckland case has him rattled. “I’m stepping back from noses, now that we know what it can do,” he says. “I don’t have the experience, so I send these patients off to someone who does more noses. It’s a statistical certainty that you will have a complication if you do enough of them.”

Raetz’s German accent still lingers, blended with English and New Zealand tones. He’s well travelled, highly educated and experienced, partially Botoxed himself, and has been a practising doctor since graduating in 1991. He’s also a champion for change.

In New Zealand, dermal fillers (unlike Botox) are classified as medical devices. This means anyone can inject them – with no requirements for training or qualifications.

“Fillers are a free-for-all,” says Raetz. “Most drug companies are somewhat careful who they supply to, but you can get fillers over the internet from Mexico, the US, Europe and China, no questions asked. I’ve been offered Chinese fillers for $1 per millilitre. There is absolutely no way this is a pharmaceutical product, sterile or even body-compatible. You might as well inject motor oil.”

Fillers were reclassified (from a medicine) by the Ministry of Health and Medsafe in 2014, based on the fact that no biochemical change occurs in the body. However Medsafe’s website warns of dermal fillers’ association with blindness from cases dating back to the late 80s; it advises practitioners to discuss the risk with patients, and warns fillers should not be used on certain areas of the face. It also states there is no pre-market approval process for medical devices in New Zealand, so clinicians who use filler should confirm for themselves that it’s been approved by a regulatory body for injection, and that it’s safe.

Raetz claims the industry was blindsided by Medsafe’s decision to reclassify filler, which he says was made without discussion or consultation, based on a limited understanding of the impact fillers have. “If you put a hip replacement in, that doesn’t cause any change in the body’s biochemistry: therefore it’s a medical device, like a heart valve,” he says. “They [Medsafe] applied the same rule for fillers. It just fills up and lifts the skin.

“We know now that’s rubbish. Medsafe looked at this when the research on fillers was not fantastic and didn’t really stress there was a biochemical change. We now know there certainly is, because once the filler has disappeared the skin has changed permanently – there’s a significant increase in the number of collagen fibres. It’s not just a bit of padding you put in.”

Hyaluronidase (or Hyalase), the “fix-it” drug that dissolves the filler, is a prescription medicine and can only be injected by a doctor or under the supervision of one.

“If [a product] is a medical device, Medsafe relies on the manufacturer applying an ethical sales policy – which is fine for the big brands and suppliers. They don’t want to be associated with stuff-ups, so they don’t sell to non-medical people,” says Raetz.

“But if you have a little Chinese outfit in Beijing, for example, they don’t give a toss, really. A beautician here wanting to inject fillers could go [to China], pack some into her suitcase and bring them back. No one is going to stop her. It’s not a medicine. Customs don’t have any power, even if it is declared, which it probably isn’t. It’s legal to bring it in and then it’s legal to inject it.”

Raetz wants to see filler reclassified as a prescription-only medicine, which he believes would provide tighter guidelines and control over who can administer it, and how. He’s been lobbying Medsafe to revisit the issue since the decision to classify filler as a medical device was made in 2014.

Medsafe’s general manager, Chris James, acknowledges receiving a report about the woman left blind in one eye after being injected with filler, describing it as a “rare but known possible adverse event”. In the Therapeutic Products and Medicines Bill, expected to go before Parliament next year, Medsafe is looking at extending the classification system currently in place for medicines to other therapeutic products, and James says the Auckland case helps demonstrate why including the use of medical devices needs to be ‘seriously considered”.

A key concern for Raetz is that while doctors and registered health professionals (including nurses) can be held to account by bodies such as the Medical Council and the NZ Health Practitioners Disciplinary Tribunal, the current lack of regulation means others can inject filler without being subject to the same ethics and standards. “The moment you are not a doctor or nurse, the rules don’t apply. The less qualified you are, the less that applies. It’s insane.”

Blindness is not the only serious risk or complication from fillers; you can literally lose your face. The danger comes once again by getting it into the wrong area – not just hitting a blood vessel or artery, but completely filling it up. If you cut off blood supply to the face, the result is similar to frostbite. “You lose the oxygen supply to skin in that area, which means skin will die, ulcer and eventually fall off,” says Raetz.

More minor damage can be fixed by injecting Hyalase to dissolve the filler within a 24-hour window. It’s expensive stuff, but Queenstown-based Raetz keeps several vials of it at the ready – not just for emergencies but to dissolve filler in the face that a client may not be happy with. “The main reason for me to have it in my clinic, and the reason I sleep at night, is I know if we inject something we shouldn’t have, there’s a pretty good chance we can reverse that before it causes damage.”

Then, there’s the risk of damage by putting your face and your faith in the wrong hands. Raetz believes a new dangerous and unstable black market is slowly emerging on our shores.

“People are going into hotel rooms or private homes where they are injecting patients. That’s insane. But let’s say the patient is happy they’ll get an optimal outcome from that environment, then you need to be sure everything is on hand to deal with complications, because sometimes you only have minutes to deal with them. You don’t want to have to drive for two or three hours to get something done,” he says.

“It’s already happening in Chinese communities; I’ve seen the videos, so it’s definitely happening. One of our colleagues’ nurses is Chinese and every now and again she finds ads on Facebook and passes them on. But it’s difficult to pin these things down, because it’s mostly on social media. There’s no advertising in the big papers. You need to go looking for it and be able to translate Mandarin. We didn’t hear about this three or four years ago, and now I’m getting an email from members every few months asking if we can do something about this. The answer is no, we can’t.”

But the Health and Disability Commissioner can – to an extent. While the HDC doesn’t monitor compliance, it will investigate when a complaint is made.

Forty-two complaints about appearance medicine have been investigated by the HDC over the past decade, with the numbers steadily increasing in more recent years. Most were over issues with treatment, consent or communication.

ACC holds treatment injury data, but because not all cases end up there, that’s not fully accurate, either. It accepted 98 claims in the past financial year relating to appearance medicine or cosmetic surgery, one of the highest figures in a decade. Most injuries related to breast reconstruction and implants, facelifts and nose jobs. But more common procedures such as laser treatment, facial peels and collagen injections featured significantly on the claim list, too. About 40 per cent of these claims were for infections.

Both Botox and fillers are also readily available in shopping malls, with some chemists offering injectable treatments by a registered nurse. The law doesn’t prevent this, but again Hans Raetz says patients need to do their homework about who is holding the needle, regardless of where they choose to go.

So, apart from the odd rare complication, or perhaps being left with a strange expression for a few months, where’s the hard evidence on the safety of injectables? Put simply, there isn’t any.

While Botox is derived from the toxin which causes botulism – a rare but potentially fatal illness – the dose used in cosmetic medicine is extremely low and there have been no cases of poisoning reported in New Zealand.

The owner of Auckland’s Ponsonby Cosmetic Medical Clinic, Dr Paul Nola, says, “We have Botox data from the early 90s, and hyaluronic acid fillers from the late 90s, so we’re coming up to 30 years of data. We need to give it more time. But basically, nothing has come up yet, which is as good as it’s going to get.”

Dr Paul Nola, owner of the Ponsonby Cosmetic Medical Clinic in Auckland.
The main suppliers of injectable products in New Zealand are Allergan, Galderma, Merz and NZMS (NZ Medical and Scientific), with a few other smaller players that offer single product lines.

Raetz believes lack of knowledge among the public and also within the appearance medicine industry itself is a key problem. “There is still confusion even in our [medical] population over what qualification you need to inject these products,” he says.

In New Zealand, you can inject Botox if you are a GP and have a Diploma in Cosmetic Medicine from the New Zealand Society of Cosmetic Medicine; or if you’re a surgeon or dermatologist. It’s also legal for a nurse or a doctor who doesn’t hold the diploma to inject under supervision from a qualified doctor, surgeon or dermatologist. The problem, says Raetz, is there are no guidelines on what supervision means or how it is policed. He’d like to see the Medical Council lay down clearer rules.

“The Medical Council needs to clarify what ‘supervision’ actually is. Last time I was discussing it with them, they said there were no rules about how many times a year you have to meet your surgeon, or whether that surgeon has to see the work you’ve done on patients, or even if the surgeon has to review your notes. There’s no auditing required at all. So, at the moment, if you meet your surgeon once a year on the golf course, that could count as your supervision being done.”

Raetz believes that’s confusing and even dangerous. He wants the Medical Council to rethink its rules – especially around filler. “If you don’t know what you’re doing, the likelihood of causing lasting damage is greatly increased. If you’re injecting fillers and you don’t have a licence, then you don’t have access to Hyalase, which is the only medication that gets you out of the shit if you do have a side-effect.”

When Raetz first learned about nasal injections 10 or so years ago, he says using filler wasn’t yet socially acceptable and few patients wanted it done. Now, he estimates the number of filler procedures has increased at least tenfold.

In the Auckland case, the dermal filler was injected by a nurse under the supervision of a plastic surgeon. What’s particularly worrying, says Raetz, is that the nurse was highly specialised and experienced in nasal fillers – having performed, at her own estimate, some 800 injections around the nose.

“She’s one of the more experienced injectors in that area. [But] if you do enough, eventually it will catch you. It’s a numbers game. You get better [the more injections you do], but you can’t completely get out of that risk zone.”

Raetz says the nurse has now stopped performing that procedure, but that presents its own problems.

“So, who’s going to do them? Patients still want to get their nasal deformities sorted out. So they will go to someone else who hasn’t heard about blindness or doesn’t really give a toss. I’m not so sure that if you scare off the experienced operators, you’re going to end up with a better outcome.”

The ripple effect from the Auckland procedure going so wrong has been far-reaching.

In Hamilton, Dr Kirshni Appanna spends half her time as a GP, the other half on cosmetic medicine. “Every time you have a needle in your hand, you have the heebie-jeebies,” she says. “It’s huge, huge talk in the industry right now and is so scary. I’ve always been sceptical about doing fillers mid-face, in particular, and after the nose-filler blindness case, I’ve put almost every patient off having nose filler done.”

Appanna is now very selective about performing the procedure and always warns her patients about the risk of blindness. Like Raetz, she wants to see filler reclassified by Medsafe urgently and its use regulated. “It’s sickening what’s happening here in New Zealand – it definitely needs to change.”

Appanna is cute and quirky with a beaming smile and a natural beauty. Her face lights up and moves as she talks; a blunt fringe bounces around under the rim of her hat. She loves caring for skin, she says. And if her own appearance is anything to go by, she’s very good at it. But she is also far from blasé about the work she does. When it comes to Botox and fillers, part of her consultation process is spending up to an hour on educating her patients.

Appanna’s cosmetic clients are a mix of men and women in their 20s and 30s wanting preventative work, as well as the rich, the famous and more mature clients. One woman saves up the money she earns from cleaning to pay for her treatments. Younger clients aren’t worried about lines and wrinkles, she says; it’s all about plumping and impact. The trend is for big lips, big eyebrows and eyelash extensions and thickening. And it’s the younger women who tend to be loud and proud of their “work”.

“They’re so open about it and say, ‘I’m happy to put this up on Facebook; I’ll go on your Instagram and be your ambassador.’ It’s really changed,” says Appanna, who had one client in her late 20s ask permission to live-stream her lips being injected and plumped. “It’s like they’re having their hair coloured. But they still have to remember it’s a medical procedure.”

She’s realistic about what all these products and procedures can really achieve. Talking to North & South during a break between conference sessions, she scans the room and lowers her voice to a whisper. “There are a few overfilled faces here... despite the risks. A lot of people have the overfilled look, but our theory is no one should know [you’ve had work done]. Every face tells a story. We can help you edit it, but we can’t help you change it.”

The stigma that once used to encourage clients to keep their procedures secret may have waned, but there are no official figures on who is getting work done and mistakes aren’t subject to mandatory reporting, either.

The annual international IMCAS (International Master Course on Aging Science) conference, held in London last year, attracts around 8000 international delegates from dermatology, plastic surgery and related professions to explore the hottest topics in the medical aesthetic field.

Figures from 2016 put patient spend on cosmetic medicine at $US12 billion worldwide – a figure climbing annually by at least 10 per cent. It also reported that five per cent of all women in Europe use facial injectables, and the market size is predicted to double by 2020.

Based on supplier information here, Raetz believes the industry growth is similar. “The year-on-year increase in cosmetic medicine appears to be within that 10 per cent band, but total growth is probably up more like 15 per cent each year. We also have an increase in the number of providers, clinics popping up and new product lines coming on the market.”

Auckland payroll manager Emma Andrews is the kind of client who’s boosting those statistics. The 40-year-old mother of one could simply have fabulous genes – and she possibly does. But over the past 11 or so years, injectables have become part of her beauty routine. “I think prevention is better than cure so you don’t have to try and get rid of wrinkles, because you don’t have them in the first instance.”

She believes starting young means her annual spend of around $2500 is kept to a minimum. “I have Botox in my forehead, crows’ feet and my frown lines between my eyes. Most recently, I also started having it in my neck, which helps with tension and gritting your teeth at night. I also have lip filler, because my lips are uneven and a little bit of the ‘Kylie Jenner look’ is quite nice! Nothing too over the top, though.

“I’m not trying to get rid of every wrinkle on my face – that would look silly. I think there’s a big fear you lose all expression and personality, and that’s not true, either. But you do feel a bit lighter, a bit happier, a bit fresher. It has a psychological effect, but then so does exercise. It just makes you feel like you look that little bit younger – I don’t know why making yourself look younger makes you feel better, but it does.”

Andrews can’t name the risk factors surrounding her medical procedures but is certain she was told of them before undergoing treatment. “I’m sure I read something and signed it.” Told about the blindness case, she’s surprised. But while she says it sounds “horrendous”, it won’t put her off.

What she is very aware of, however, is the danger of having too much done, something she often sees in others. “The eye adjusts really quickly, so as soon as you have a slightly fuller lip it becomes the norm and you think, ‘Oh, I need to have a little bit more.’ You have to make sure you pull yourself back, and go, ‘Hang on, actually they look pretty darn good.’ Even people you see out in Auckland – not just Hollywood stars – you think, ‘Jeez dude, slow down on it a bit.’”

Raetz says many of his clients at the Skin Institute in Queenstown simply “budget” their looks into their spending. “They put money aside. You have someone who makes 600 bucks a week, but some of that goes towards Botox every three or four months. You get them from all walks of life.”

Raetz injects the rich and famous, too, but says his client list is more varied now than ever. “I always thought someone who spent $400 on Botox must have massive disposal income. That’s not the case. You find some patients rock up and pay a third with a cheque, and a third with a credit card, and another third they have in cash. They are the ones where hubby obviously doesn’t know they’re having it done.” He laughs.

And Botox and fillers are no longer just for women. Raetz says there’s a small, but growing market for men. “I think it’s about career. Now you have to give the impression of being fresh and rested, even if you’re working 12 hours a day.”

Auckland payroll manager Emma Andrews says injectables have become part of her beauty routine.
Back in Ponsonby, Paul Nola has also seen a surge in clients wanting a bit of “tox” and fillers in their lunch break. “When I started out, my clients wouldn’t tell anyone they came here, but now they do. Our biggest source of new clients is referrals, which we never got back in the day, because no one ever talked about it.”

He agrees it’s all about lips right now. “Lip fillers are the one: someone has them and is straight on to Instagram or Snapchat. There are a few people, even here [at the conference] who’ve built an entire practice on [lips].”

For the consumer, the cost of injectable procedures doesn’t appear to have dropped much since they hit the market in the 90s. There’s big money in the business, with some self-employed nurses making $5000 a day.

“When I started the clinic 10 years ago, it was a good day if a patient came through the door and spent $400 on Botox,” says Raetz. “That was like… wow... she’s got lots of money, fantastic! Now, daily, my nurse will do five Botox patients, all for $350-$450 each, and possibly three fillers at $1500 each. That’s a lot of money.”

While Nola believes while there is a moral responsibility to advise young clients of the risks, he’s comfortable allowing them to explore what appearance medicine has to offer.

“Sometimes by giving them a little bit of tox or filler, you improve their life massively. But where is that line where you’re taking advantage of these people? You’re making money out of them, and there are ethics here. You still have to do the best for the patient.”

Some of his clients are vulnerable and suffer from body dysmorphic issues and severe anxiety over their appearance, he says, but for others it’s just the right medicine. “Yes, it’s a risky medical procedure, but then the other argument is you’re only young once,” says Nola.

“I think if you don’t go too crazy, to have some lips done in your early 20s that are going to disappear in a year – is it really such a big thing? They’re young and are going to be old like the rest of us soon enough, so why not enjoy life?”

Designer Vagina

The Femilift takes off.

With the likes of Botox and dermal filler becoming part of many women’s mainstream beauty regimes, the latest hot property in the cosmetic industry – the FemiLift – is taking “appearance medicine” to a whole new level.

The what? A laser treatment, the FemiLift aims to tighten the vagina, to improve your sex life or help with stress incontinence (common after childbirth). Popular in the US and Australia, it’s now being offered by several clinics here.

The procedure is painless and involves a laser probe delivering multiple tiny shots into the vaginal wall, creating mini injuries. This stimulates the body’s natural healing process and new collagen is formed; blood flow increases to the vaginal tissues and the vaginal wall, causing the muscles to tighten and thicken.

Up to three treatments are required for the best results, costing about $1000 per session. Results take a few weeks to kick in and may last for up to 18 months.

The Light Stuff

Laser and IPL treatments are the new “facials” and hair-removal procedures.

IPL (intense pulsed light) and laser treatments are two popular cosmetic procedures in New Zealand for hair removal, photo-rejuvenation (treatment of skin pigmentation, sun damage, freckles, age spots and thread veins), and alleviating dermatological conditions such as rosacea, a chronic condition that causes redness and often small, red bumps on the face.

They’ve had their share of bad press, too, with complaints of burning, scarring and pigmentation damage – but are still in high demand from Kiwi consumers.

Laser treatment for hair removal has also become a mainstream beauty treatment: the Caci Clinic says it has treated more than 20,000 clients across the country over the past 20 years. It’s sold to consumers as a permanent fix to make you hairless without the hassle of shaving or waxing, and something that will save you time and money in the long run.

So how does it work? In laser treatment, a beam of light is directed down at the unwanted hair; the light is absorbed by the pigment within the hair shaft and hair follicle. This generates heat, which loosens the hair and disables the hair-forming cells. It’s not for everyone, however. The treatment is most effective when there’s a strong contrast between skin and hair colour, which means blonde, red and grey hairs are more difficult to remove.

Prices vary greatly. Auckland Laser Hair Removal is one of the rare clinics that lists prices on its website. A session costs between $30 and $219, depending on what part of your body is being treated. It says most people need around eight to 12 sessions, spaced out every six to eight weeks. The clinic also claims it treats “many” patients going through a transgender transformation.

IPL systems are similar, using flashes of light to rejuvenate skin or remove unwanted hair. Several treatments are recommended for skin rejuvenation, although results are also visible after just one. A series of three IPL sessions can cost around $1000, and clinicians recommend annual treatments.

Although both IPL and laser treatments are considered very safe in the hands of trained professionals, the New Zealand Society of Cosmetic Medicine’s education officer, Dr Paul Nola, describes them as “difficult technologies” and time-consuming for both the patient and practitioner.

While Nola’s Ponsonby clinic focuses more on the lucrative injectable market, he’s still busy with laser and IPL clients, and is wary of the growing do-it-yourself kits available in mainstream department stores. IPL hair removal or skin rejuvenation machines for sale on Trade Me range from as little as $150 to a secondhand salon machine for $125,000. Alibaba, China’s biggest e-commerce company, has thousands of listings. 

Nola warns there are risks – and not only of buying a dud. “If it’s uncalibrated or the wiring is bung, then maybe it’s dangerous, too.” New Zealand has no regulations or laws around product standards for IPL and laser machines, and Nola advises sticking with professional and reputable clinics. He says it’s not uncommon for him to treat people who’ve been injured during treatments elsewhere, or possibly by using DIY kits.

“My nurses do the hair removal and say they see clients who have a lot of burns around the groin area where they’ve had [IPL or laser treatments] in the past and have scarring.”

This was published in the October 2017 issue of North & South.