Cosmetic Injections – Beware of cheap unit pricing!

Experience is the key

The most critical factor to consider before opting to undergo cosmetic anti-wrinkle injections is the experience of the person performing your treatment. The product commonly used to treat frown lines, forehead lines and crow’s feet lines is a Schedule 4 (S4) drug. Only a qualified medical practitioner is able to legally purchase this drug and that person is the one ultimately responsible for your treatment. Registered nurses who administer cosmetic injections, do so, under the direction of a doctor. The doctor must first consult you face-to-face and write a specific treatment plan for you as an individual. If any complications arise, the doctor is still the person ultimately responsible, even if they haven’t performed your treatment. More detailed information on the policy for cosmetic S4 injections can be viewed on the Cosmetic Physicians College of Australia website.

Knowledge of Anatomy is of paramount importance

The anatomy of the muscles of the face is quite complex. Given that this particular anti-wrinkle treatment works by relaxing muscles, it is very important for the person performing the injections to have complete knowledge of facial anatomy and experience in the action of this drug on each facial muscle. A one or two millimetre shift in the injection point can be the difference between a great cosmetic brow lift versus a heavy hooded eye appearance!  Choosing the wrong injection point can also increase the risk of complications. For example, if the injector doesn’t have knowledge of the large surface vein that runs in the region of the lower crow’s feet area, a large bruise resulting in a black eye can occur after the injection. “Not a good look at the family reunion!” Although every person has the same facial muscles, there is individual variation in the strength and size of facial muscles. Unfortunately this can’t be learnt from an anatomy text book. It takes years of “on the job” experience, treating hundreds of different faces.

Brand differences

Experience and knowledge of the drug itself is of utmost importance. In Australia, there are three brands of drug approved by the Therapeutic Goods Administration (TGA) , the authority responsible for regulating and ensuring safety of medications. Although each brand contains the identical active ingredient, there are some slight idiosyncrasies between brands such as the unit of dosage measurement.  All three brands are distributed in sterile glass vials containing a specific number of units of the drug in powdered form. In order to enable the drug to be injected, a sterile solution of normal saline must be added to the vial before administration. This must be performed with sterility and the appropriate volume of solution must be added to the vial to determine the concentration. The concentration and volume administered at each injection point will determine the area of muscle relaxed. Without knowledge of the correct concentration for different areas of the face, results can be disastrous. For example, a high volume of a weakly concentrated solution of the drug, injected into the frown line region can result in “leakage” of the drug into unwanted muscle groups like the eyelid muscle. This results in an eyelid ptosis, also known as eyelid droop, which can last from weeks to months. On the other hand, a small volume of highly concentrated solution injected into multiple points into the broad frontalis muscle of the forehead can result in missed areas and unevenness of forehead lines.  Initial training for cosmetic injections, usually involves a ‘standardised’ concentration and technique. It is only with time and experience that individual injectors develop the skills and knowledge to fine tune the technique.

Trust in your doctor

In summary, the best result with anti-wrinkle injections, both in appearance and longevity is dependent on a specific number of units of product, at the ideal concentration, injected into very specific facial points for the individual patient. Given individual treatment plans will vary, best long term results will be achieved with the same person performing your treatment each time.  It’s just like that well-known advice – “Once you find a good hairdresser you stick with them! ” At least a  cheap haircut that goes wrong, you can wear a cap for a few weeks. However, poor results with anti-wrinkle injections are on display for three to six months.

Know how to ask the right questions

When making a decision on which clinic to attend for anti-wrinkle injections, ask firstly about the qualifications of the person performing the injections, the length of time they have been performing the treatment, whether you will be able to see them for every subsequent treatment and their policy of follow-up if you need to have your result reviewed. Don’t fall into the trap of asking “What is your price per unit?”, straight off the bat. This shows that you are uninformed and are looking for the cheapest price.  However, unit price won’t tell you how much you will ultimately pay! You need to know exactly how many units you need as an individual to work out the total cost. And this is impossible to determine over the phone without seeing you.

Face-to-face consultation before treatment

That is why it is best to have a face-to –face consultation with the person who will be performing your treatment. That old saying “ you get what you pay for” is so true in this circumstance. Many people who shop around for cheapest unit price and don’t consider the experience of the person performing their treatment may end up with inadequate results , a result that doesn’t last or a complication. What appears to be a cheap deal initially to “get you through the door” can end up being a costly treatment both financially and personally. Inadequate treatments which don’t last will end up costing more in the long run due to the need for frequent treatments . And a treatment “gone wrong” can end in the personal cost of months of embarrassment  and unhappiness.

Beware of deals that are too good to be true

Some of the unit prices advertised on the Gold Coast are less than the wholesale price of the reputable TGA-approved brands! This is a dead give-away that unapproved product from places like China are being injected into people. In this case, safety goes out the window and this is a recipe for disaster. Be informed and beware of  cheap deals on medical procedures like cosmetic injections or  you may literally "pay the price" for a cheap deal gone wrong!

Dr Kylie Regli MBBS

Cosmetique Solutions