Cosmetic clinic mystery shop

Clinics recommended treatments without fully explaining health risks.

Woman lying on bed being administered botox filler.

Cosmetic treatments promising to get rid of your wrinkles come with big risks. But our mystery shop found beauty clinics aren’t giving customers the full story.

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“When you look in the mirror, what mainly bothers you?” That was the question our mystery shopper was asked by one Wellington beauty clinic when she went for a consultation. For our shopper’s near flawless face, the clinic recommended Botox and dermal fillers to smooth fine lines.

It also mentioned Belkyra, a prescription medicine injected into the skin to dissolve fat and get rid of a double chin.

The clinic was keen to promote the age-defying benefits of the treatments but information on the health risks that came with them was patchy at best.

It was a similar story at the other nine beauty clinics our mystery shoppers visited. Two clinics even offered treatment on the spot.

“You can customise your face”

Five of the 10 clinics recommended dermal fillers to our shoppers. These fillers are injected into the face to add volume and smooth out lines to “help restore youthfulness”.

The fillers we were offered were semi-permanent, with effects estimated to last six to 12 months. Brands recommended contained either hyaluronic acid, a substance present in body tissue, or poly-L-lactic acid, a synthetic filler.

Fillers are promoted as much less invasive than cosmetic surgery but they’re not without risk. However, our shoppers were given little information about the downsides.

Only one clinic mentioned the risk of blindness, which can occur if the needle enters an artery supplying blood to the face.

The most common side effects are bruising, redness, swelling, pain and itching. Other side effects include infection, scarring and nodules forming beneath the skin.

At one clinic, our shopper’s question about treatment risks was quickly dismissed. “There is a risk that you get nodules,” the consultant said. “With the technique I use … I haven’t had any problem,” she added, laughing.

There’s also a rare but serious risk of blindness and stroke.

Only one clinic mentioned the risk of blindness, which can occur if the needle enters an artery supplying blood to the face. This happens when a large amount of filler is injected and it travels to the artery that supplies oxygen to the back of the eye, which is only a few millimetres from the brain.

According to the New Zealand Society of Cosmetic Medicine, approximately one in a 100,000 treatments results in blindness. At least one case of blindness has been reported from the use of dermal fillers in New Zealand.

“Very minimal risk with ‘tox”

Half the clinics offered our mystery shoppers Botox or other muscle relaxants such as Dysport and Xeomin (also known as Bocouture).

Botox injection

These are prescription medicines containing the botulinum toxin at different strengths. They’re injected into the face to stop the muscles contracting, minimising the appearance of lines and wrinkles.

Getting a quick dose of Botox was portrayed as an easy procedure with little risk. One clinic told our shopper, “I have so many ladies that come in during their lunch breaks and go straight back to work”. It also said, “There’s very minimal risk with ’tox”.

None of the clinics fully explained the possible side effects. As well as swelling, numbness and bruising at the injection site, there are other more serious risks including loss of strength in muscles and double or blurred vision. Allergic reactions can also occur.

Dr Jonathan Wheeler said there is also a risk of your eyelid drooping after the procedure. However, just one clinic mentioned this during the consultation. At another clinic, our shopper was only given the information in a brochure at the end of the consultation.

Dermal needling and mesotherapy

Dermal needling, also called derma rolling and collagen induction therapy, was recommended by several clinics. According to the consultant at one clinic, the treatment creates “a million tiny, tiny wee holes on your skin that triggers a healing response from your body”.

These puncture wounds are intended to prompt the body into producing more collagen, helping to minimise scarring, fine lines and wrinkles.

DermNet New Zealand ... reports there’s very little clinical evidence to support mesotherapy’s use and no standard practice regarding the substances used or the quantities.

Four clinics recommended our shoppers have dermal needling two to three times, with sessions four to six weeks apart. They also told our shoppers they could get a “substance” injected into their face as part of the treatment, a process called mesotherapy.

Mesotherapy is typically used for fat removal but it’s also used for body contouring and to plump up the skin. Substances injected can include plant extracts, vitamins, hormones, enzymes or medicines.

Our shoppers were given little information about the substance that would be used in their treatments.

One clinic described it as a “medical grade solution” while another referred to “different serums that stimulate the skin”. A third clinic mentioned a “skin booster” that it said was similar to a dermal filler.

Just one shopper was told the substance used would be hyaluronic acid, a product common in dermal fillers.

Side effects of mesotherapy include allergic reactions, bruising and scarring. There’s also a major risk of skin infection. However, none of these side effects were mentioned to our shoppers.

DermNet New Zealand, which provides information on treatments, reports there’s very little clinical evidence to support mesotherapy’s use and no standard practice regarding the substances used or the quantities.

Downplaying safety risks

Cosmetic treatments aren’t cheap – dermal fillers can cost $500 a pop. While beauty clinics are keen to convince customers it’s money well spent, our mystery shop found they’re downplaying safety risks.

New Zealand Association of Plastic Surgeons’ president Dr Jonathan Wheeler said patients should be told about all the potential dangers of a cosmetic treatment in the first consultation.

cosmetologist pointing at the tablet screen
Patients should be told about potential dangers of cosmetic treatments in the first consultation.

“You should be told of the main risks upfront, as well as significant but rare complications in full,” he said.

None of the 10 clinics we visited did a good job of this.

Six clinics asked our shoppers to complete a medical history and consent form. Once the consent was signed, one clinic told our shopper she could make an appointment for treatment immediately. Another offered Botox at the end of the initial consultation, despite not fully informing our shopper of the risks.

Gaps in regulation increase the risk of consumers getting bad advice. Despite their potential to cause significant harm, products such as dermal fillers don’t require any pre-market approval before they can be used.

A 2013 review of cosmetic procedures published by the UK Department of Health described dermal fillers as “a crisis waiting to happen”.

The EU has since beefed up its rules, regulating fillers as medical devices and requiring manufacturers to provide clinical and safety data. Across the Tasman, fillers are classified as prescription medicines and can only be administered by registered medical practitioners. The products can’t be advertised to the public.

Last year, the Ministry of Health consulted on whether rules here should change too. We submitted in support of tighter regulation for these products because of the significant health risks they carry for consumers.

If treatments go wrong

If you decide to get a cosmetic treatment, and it goes wrong, what should you do?

If you’ve been injured, see your doctor straight away. Your treatment injuries may be covered by ACC. Last year, ACC accepted 144 claims relating to appearance medicine and cosmetic surgery.

You’re also entitled to lodge a complaint with the Health and Disability Commissioner about the care you received from the doctor, nurse or health service that carried out the procedure.

The Consumer Guarantees Act also gives you the right to expect services – including cosmetic treatments – to be carried out with reasonable care and skill. If the service you received wasn’t up to scratch, you can request a refund. If the clinic refuses your request, you can take the matter to the Disputes Tribunal. Let us know too.

Before you sign up for any cosmetic treatment, quiz the person providing it. Ask:

  • What are your qualifications and experience?
  • How many times have you performed the procedure?
  • What product will you be using and is it regulated?
  • Are there any complications associated with the procedure?
  • What aftercare is provided and is this included in the cost?

Other treatments

Our mystery shoppers were also offered several other procedures including Belkyra, lasers and platelet rich plasma.

Belkyra

Is a synthetic version of deoxycholic acid injected into your double chin to dissolve fat.

Side effects include bruising, numbness, redness and swelling, nerve injury, difficulty swallowing, and skin ulcers.

Lasers and intense pulsed light (IPL)

Emit light on a single wavelength to target a specific area of the skin to improve pigmentation, tone and texture, and reduce scarring. Darker skin types have a higher risk of burns and discolouration.

Side-affects include swelling and scarring. Skin lesions that could be cancerous can also be missed. Burns, blisters, infection and bruising are also possible.

Platelet rich plasma

(Aka Vampire Facelift) treatments draw off your blood, spin it in a centrifuge and inject it into your face to rejuvenate your skin. It’s also used on other areas of the body to help heal wounds such as ulcers and burns.

Side effects include bruising, swelling and redness. There’s also a risk of skin infection if the equipment hasn’t been cleaned properly.

Local bylaws

Some councils have public health bylaws relating to treatments that pierce the skin carried out by beauty therapists (doctors and nurses are covered by separate legislation). The bylaws set minimum requirements for hygiene and safe use of equipment. However, they don’t specifically regulate treatments such as dermal fillers and mesotherapy.

Auckland Council’s bylaw extends to salons providing pulsed light and laser treatments. In 2019, it received six complaints about these salons. Customers at one clinic complained about being burnt because staff didn’t carry out a patch test. A patch-test should be done on your skin 24 hours before treatment, although this doesn’t rule out all complications. The council gave the business a warning.

Another clinic couldn’t operate the laser properly. This business has since shut down. Other complaints related to licensing requirements and tattoo removal.

Quotes from consultations

“To get rid of this, it has to be plastic surgery”

“I also have a lot of ladies that say, ‘oh, I can’t tell my husband’, and then they tell me that their husband didn’t even notice.”

“Obviously, if I pump everything in there then you’re going to look good on that day, immediately, but it’s a process.”

“If you look on Google you’ll see blood and scary-looking things.”

“So for the price, you just do everything.”

“People comment, oh you look so good, what have you done? But they still can’t tell you if you’ve done any fillers.”

“It’s good just to have a little bit of Botox just to stop those lines [getting] deeper.”

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