Fact sheet on injectables

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Supporting a safe choice about cosmetic injectables

You are entitled to safe cosmetic services. This factsheet includes information about cosmetic injectables, also known as anti-wrinkle injections and dermal fillers. It can help you understand some of the potential risks and what to look out for if you are considering a cosmetic procedure and where to go if something goes wrong.

No matter how simple it may seem, every cosmetic procedure or surgery carries risk. Even if you’ve had a procedure before, it’s important that you think carefully about your decision every time. If you decide that a cosmetic procedure or cosmetic surgery is for you – be safe first. Know which questions to ask and what to look out for, so you can make an informed decision.

Before going ahead think about:

  • the people involved in the procedure
  • the product they are using, and
  • where the procedure is taking place.

Cosmetic injectables and how they work

The two main types of injectable substances used are:

  • botulinum toxin type A (sometimes known as ‘Botox’), which temporarily paralyses the facial muscles that cause wrinkles, and
  • dermal fillers, which plump out wrinkles or other parts of the face.

These types of injectables are prescription only medicines (schedule 4 medicines). This means that only authorised registered health practitioners can prescribe them.

Questions to ask

First, make sure you consult a registered health practitioner who is authorised to prescribe injectables. Usually, this is a medical practitioner, dentist or nurse practitioner1. Before the procedure can go ahead, they must consult with you, take your full history and ensure the procedure is safe for you. They must also explain the possible risks and seek your informed consent. Make sure you discuss your expectations. The practitioner should have processes in place in case of complications or medical emergencies. Before going ahead, ask yourself if the procedure is right for you.

Questions you can ask include:

  • Will the prescriber consult with me before going ahead?
  • Will they take my full history and explain any potential risks?
  • Are they registered and authorised to prescribe the medicines used in the procedure?
  • What are the short and long-term risks and how will these be managed?
  • Are there any long-term effects?
  • How much time will I have to consider whether to go ahead?
  • Is there any other information about this procedure?
  • I have allergies. Is this injectable safe for me?
  • Is it safe to drive after this procedure?

If you have concerns about any of the above, you can contact Ahpra to make a notification.


1 Medical practitioners, dentist and nurse practitioners are authorised prescribers. You can confirm that the nurse is a Nurse practitioner by checking the national online register of practitioners.

After prescribing the medicines, the authorised registered health practitioner might administer the injection themselves. They can also prescribe the injectable for another person to carry out the procedure. However, the prescriber must make sure that the person carrying out the cosmetic procedure is authorised to administer the injectable under the relevant state and territory drugs and poisons legislation and has appropriate qualifications, skills and experience. This is usually a registered nurse or an enrolled nurse under the supervision of a registered nurse.

Anyone claiming to be a doctor, dentist or nurse, must be registered to practice in Australia. Check the national online register of practitioners on the Australian Health Practitioner Regulation Agency (Ahpra) website at www.ahpra.gov.au. This is where you can make sure the practitioners involved in your procedure are registered in Australia.

Remember:

  • It is illegal to call yourself a medical doctor, dentist, nurse practitioner, registered nurse or an enrolled nurse if you are not registered.
  • If you can’t find the practitioner you are looking for on the national online register of practitioners, or if you have any concerns about their practice, do not continue with the procedure and let us know.

However, registration may not be enough to ensure the person carrying out the procedure is qualified, skilled and experienced to carry out the procedure.

Ask questions such as:

  • Are you registered to practise in Australia?
  • What training have you had? Where did you train?
  • How many times have you done this procedure before?
  • How long have you been working in the area of cosmetics?
  • Have you ever had a bad outcome? What happened and why?
  • What are the likely results of this procedure and what can go wrong?
  • What happens if something goes wrong? Which emergency procedures are in place?

It’s very important that any medicine or health product used in the procedure has been assessed by the Therapeutic Goods Administration (TGA) for safety, quality and efficacy. Counterfeit products imported from overseas are illegal and dangerous. They can also be difficult to identify.

Cosmetic injections use potentially dangerous medicines that are regulated and must be approved for supply in Australia by the TGA. State and territory health departments regulate the supply, storage, prescription and administration of these medicines.

Make sure the injectable used for your procedure is a legally sourced product that is prescribed by an authorised registered health practitioner in Australia. You can check by asking the prescriber about this. The brand and substance of cosmetic injectables cannot be advertised, so make sure you ask the prescriber for this information.

If you have the brand name of the injectable you can search for the product on the Australian Register of Therapeutic Goods (ARTG) on the Therapeutic Goods Administration (TGA) website. This will tell you whether that product has been approved for use in Australia.

Ask questions such as:

  • What is the brand of the injectable that will be used? What substance does it contain?
  • Is it labelled in English?
  • Is it approved for use by the TGA?

You may want to ask to see the vial before the procedure to make sure the product matches with the information you have been given.

If you have concerns about the product used, you can contact Ahpra or the TGA.

The place where you are having your procedure must, at a minimum, meet infection control standards. Unsafe premises can increase the risk of you getting an infection from the procedure.

Ask yourself:

  • Is the premises clean and hygienic, does it have a waste disposal bin, a hand basin with a clean supply of water and have liquid soap and single use towels or a hand dryer for drying hands?
  • Does the person carrying out the procedure wear protective equipment, including new gloves and a clean gown or apron?
  • Are the needles taken from a sealed packet and disposed of safely?
  • Is there a dedicated space for the procedure? Be careful about having the procedure in a place that looks more like an apartment than a clinic – it may be a sign that things are not legitimate, and you may be putting yourself in danger.

The person prescribing the medicines must be familiar with and ensure compliance with relevant legislation, regulations and standards. They are responsible for the condition of the premises and should ensure that the premises are appropriately staffed and equipped to manage possible complications and emergencies.

If you see that some of the infection control or safety precautions are not in place, you should reconsider where you have the procedure and contact Ahpra.

 

What are the other risks?

Remember that all procedures carry risks; nothing is completely risk-free. We want to help you understand the risks so you are aware of them before having a procedure.

Make sure you that you know what to expect before, during and after the procedure. This includes knowing that a registered health practitioner will provide you with appropriate after care, especially if you experience any side effects or complications.

There are many possible side effects and complications associated with cosmetic procedures that involve an injectable substance.

Ask questions such as:

  • What are the common side-effects of this injectable?
  • How can I recognize a complication that requires a practitioner's attention?
  • What are the expected side-effects?

This table includes some of the possible side effects or complications for the two most commonly used products. More information is available in the consumer medicines information leaflet included in the packaging.

Botulinum toxin type A Dermal fillers
  • redness
  • swelling at the injection site
  • bruising
  • skin tightness
  • drooping of the eyelids
  • headache
  • face pain
  • muscle weakness
  • numbness or a feeling of pins and needles
  • nausea, and/or
  • blurred vision.
  • bruising
  • swelling and redness at the site where you were injected
  • itching
  • skin discolouration
  • vascular occlusion (blocked blood vessel which causes skin tissue death)
  • permanent blindness
  • double vision
  • stroke
  • bleeding
  • infection (bacterial or viral)
  • ulceration of the skin where you were injected
  • lumps (nodules) forming under the skin
  • allergic reaction
  • inflammatory reactions
  • haematoma (a collection of blood under the skin or in the deeper tissues)
  • permanent disfigurement and scarring as a result of one of the above, and/or
  • weakness of the muscles of the face, head and neck, which can cause difficulty swallowing or speaking.

Want to know more?

For more information see the cosmetic procedures resources section of the Ahpra website or contact us, see www.ahpra.gov.au.

 
 
 
Page reviewed 20/02/2020