Skin Integrity Blog

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21 Oct 2015

Medical Board publishes Cosmetic Guidelines Submissions

Dr Stephen Wassall. 

Recently the Medical Board of Australia released some draft guidelines for Medical Practitioners practising Cosmetic Medicine and Surgery.  They sought feedback and received over 600 submissions from doctors, nurses, stakeholders and consumers.  These submissions are published on the Medical Board website and can be at:

http://www.medicalboard.gov.au/News/Past-Consultations/Consultations-March-2015.aspx

The submissions make interesting reading and there appears to be a lot of turf protection with many nurses currently operating outside of doctors clinics sending in petitions from patients.  One nurse even went to the trouble of sending a draft letter to her patients and asking them to submit this under their name.  As a result, some of the submissions received are identical!

It will be interesting to see what comes of this.  If the draft guidelines are ratified then we will see some significant changes in the industry.



30 Oct 2013

Lidocaine Allergy - The Sleeping Giant

Dr Stephen Wassall. 

Modern dermal fillers often have lidocaine blended with them. Lidocaine is a local anaesthetic and it is mixed with the filler to reduce the disconmfort of injections. there is no doubt that this is effective and clients universally find injections fillers blended with lidocaine much more comfortable.

However, some people have an allergy to lidocaine. This most commonly will manifest as a skin rash but in some situations anaphylaxis can occur. Anaphylaxis is a severe, life threatening emergency. It often presents with flushing and itching and is quickly followed by feelings of anxiety and increasing shortness of breath. If untreated a patient will quickly lose consciousness and may suffer brain damage or die. The lady in the picture had an allergy to lidocaine injected prior to a biopsy. This is a severe skin reaction and requires medical management.

It is vital that anybody administering dermal filler injections with lidocaine has the ability and the resources to deal with this rare but serious risk. It is possibly somebody will die as the result of an anaphylactic reaction from receiving dermal filler.

Issues you need to consider:

  • Dermal fillers are medical treatments. Medical treatments should be performed in Medical Clinics.
  • Doctors are trained to treat anaphylaxis. Nuses are trained to assist in treating anaphylaxis but are not qualified to treat it unassisted. 
  • Resuscitation treatment should be available. To treat anaphylaxis oxygen, adrenaline, intravenous fluids and a defibrillator need to be available. If they are not available precious minutes will be lost whilst waiting for an ambulance.


04 Jun 2013

Cosmetic Disasters

Dr Stephen Wassall. 

As dermal fillers have become increasingly popular the number of reports of side effects has increased.  Most side effects are relatively minor and short lived but tissue necrosis is a rare but potentially serious and can lead to permanent scarring if not detected early and managed appropriately.

What is necrosis?

Necrosis refers to tissue death.  It leads to ulceration and scarring.  In the case of dermal fillers it is caused by inadvertent injection of product into an artery.  This blocks the circulation which starves the skin of oxygen and leads to skin breakdown.  Fortunately, if this complication is recognised early it can be treated with a substance known ashyalase in order to dissolve the dermal filler.

  

Tissue necrosis following dermal filler injection


What are the Symptoms of Necrosis?

Some of the symptoms that filler has been injected into the artery and that necrosis is occurring are as follows:

  • Persistent pain after injection
  • Persistent whiteness or redness in or around the area of the injection site
  • Small pimples in or around the area of the injection site
  • Persistent skin bruising or ulceration
It is important to realise that the symptoms of necrosis don't always occur at the actual site of injection.  For example, filler injection at the side of the mouth can cause necrosis on the tip of the nose.  This is because the artery that supplies the tip of the nose runs past the side of the mouth.

Minimising Your Risk

Dermal Fillers are now injected by a variety of Practitioners varying in knowledge, skill and experience.  A few points to consider:

  • Dermal fillers, anti-wrinkle injections and hyalase are all prescription medications and can only be prescribed by a doctor.  Nurses injecting prescription medication without doctor authorisation and support are acting illegally.
  • Your injector should be contactable and readily available in case of a medical emergency.  Necrosis is a medical emergency and must be diagnosed and treated early.  
  • The treatment for necrosis requires injection of a prescription medication known as hylase.  Hyalase can cause severe  allergy (anaphylaxis).  Any practitioner or clinic using hyalase should have immediate access to oxygen, adrenaline and a defibrillator.  
  • Beauty and Hairdressing salons are not medical facilities and not equipped to deal with emergencies such as anaphylaxis or necrosis.  Doctors and nurses that work in this environment frequently travel to numerous locations and may not be available to manage complications in a timely manner.
  • You should be confident that your injector is experienced and has detailed understanding of facial anatomy and potential complications of the procedures they perform.  Early necrosis can be difficult to diagnose.
  • Permanent and semi-permanent fillers can't be dissolved.  Hyaluronic acid based fillers are considered much safer due to the ability to dissolve them with hyalase.

IF YOU THINK YOU MAY HAVE SUFFERED TISSUE NECROSIS AS THE RESULT OF FILLER INJECTION PLEASE CONTACT YOUR INJECTOR IMMEDIATELY.  IF THEY ARE UNAVAILABLE PLEASE CONTACT SKIN INTEGRITY FOR ADVICE OR PRINT THIS PAGE AND TAKE IT TO THE NEAREST HOSPITAL EMERGENCY DEPARTMENT.
19 Jun 2012

Beware of Advertising Tricks

Dr Stephen Wassall. 

In our society it has almost become acceptable for advertising to be misleading.  As consumers we expect this and hopefully don't always believe what we read.  However, the standards for Medical Advertising are expected to be higher and there is legislation to protect the public from sensational, inaccurate and deceptive advertising.

Lately there has been increased advertising of prescription cosmetic injectables.  Much of this advertising is based around price.  As it is illegal to use the actual names of prescription products in advertisements, often the terms Anti-wrinkle Injections or Cosmetic Injections are used.

Sometimes the advertised price can be deceptive.  Please consider the following factors when reading these ads:

  • There are two "anti-wrinkle" injections available in Australia.  There is a well known market leader and a lesser known brand. For the purposes of this article I will call the market leader Product B and the lesser known competitor Product D. Product D is cheaper to purchase for the doctor and is most doctors will charge less for this product.  Which product does the advertised price refer to?
  • Prices for anti-wrinkle treatments are generally advertised as price per unit or price per area treated.  If you are looking at a price per area treated advertisement you need to know how many units of product are being used and how an area is defined.  It is generally accepted that an area of treatment is either the frown lines, forehead lines or crows feet.  Areas such as bunny lines or brow lift need less product and to classify these as an area is somewhat deceptive.
  • The doses or units used for the two products are not the same.  The manufacturers of Product D recommend 2.5 times as many units to achieve a roughly equivalent result.  In other words, if you normally receive 20 units of Product B in your frown lines, you will probably need around 50 units of Product D for a similar result. Therefore, it is vital to know if the advertised unit price refers to Product B or Product D.  If somebody is advertising $10 per unit but they are using Product D, this is actually the equivalent of $25 per unit of Product B!
  • There is no recommended retail price for Product B or Product D.  
  • It is also important to know if the advertised price comes with any terms or conditions.  For example,do you have to purchase a certain amount of product or treatments in advance for the price to be valid?  
  • When looking at dermal fillers it is important to realise that there are a vast variety of products and syringe sizes available.  These vary considerably in price.  When comparing prices ensure that you know what product and syringe size is being used.
I hope this information is helpful.  If a clinic or practitioner is advertising in a deceptive manner it is probably already telling you something.
28 Mar 2012

Is There a Doctor in the House?

Dr Stephen Wassall. 

Despite its increasing popularity, it is important to realise that Cosmetic Injections such as anti-wrinkle injections and dermal fillers are medical procedures.  In addition, the products used are prescription only and can only be prescribed by a Registered Medical Practioner.  Therefore, it is illegal for these products to be administered by a Nurse or any other person unless the injector is being supervised by a doctor.

Availability for follow up following any Medical procedure including Cosmetic injections is also important.  As with any Medical procedure, Cosmetic Injections can have adverse reactions and side-effects.  It is essential that the treating doctor be available to address any concerns following your treatment, preferably by face to face consultation.  By operating at one location on the Central Coast, Dr Stephen Wassall from Skin Integrity is able to offer the highest level of Medical care and follow up.

Skin Integrity is a properly equipped Medical Clinic.  It has been purpose designed to ensure that all treatments are given in an appropriate Medical environment.  Medical standards and procedures such as patient confidentiality are strictly adhered to.

Be aware that some practitioners working out of Beauty or Hairdressing Salons are describing these as "Clinics".  In Dr Wassall's opinion, this is potentially misleading.


12 Jan 2012

The Ultimate Celebrity Beauty Secret!

Dr Stephen Wassall. 

Skin Integrity has just become aware of the best kept beauty secret ever!  We now know what keeps those Hollywood stars looking amazing.  Watch the video below to reveal the secret.  This video is only recommended for those people with a sense of humour ............

 

Fotoshop by Adobé from Jesse Rosten on Vimeo.

02 Dec 2011

Skin Integrity awarded Platinum Plus Status

Dr Stephen Wassall. 

Skin Integrity is pleased to be classified as a Platinum Plus Injecting Clinic. This status is awarded by Allergan, the manufacturer of the most popular and well known anti-wrinkle injection and dermal filler. It is an achievement that Skin Integrity is very proud of, particularly as Dr Wassall is the only doctor injecting at the clinic.


Platinum Plus status is a further reassurance that your cosmetic injections are being performed by a very eperienced practitioner. Dr Wassall started performing cosmetic procedures in 2002 and has performed thousands of procedures. Despite his experience, he maintains a very competitive pricing structure. Furthermore, Platinum Plus status guarantees that the product used is fresh, giving the best opportunity for optimal outcomes. By being based at one location on the Central Coast and not travelling to multiple sites the potential problem of product dergredation is also avoided.

01 Nov 2011

Why Choose Dr Wassall?

Dr Stephen Wassall. 
Dr Stephen Wassall was born on the New South Wales Central Coast.  He continues to work and live on the Central Coast and is actively involved with the local community.  As he lives locally, he is available to attend to your needs in the unlikely event of a complication or side-effect.  

Some practitioners travel from other destinations to perform treatments on the Central Coast.  They will usually offer services at Beauty Salons or even hairdressers.  Some medical cosmetic treatments consist of the administration of a relatively fragile purified protein.  The integrity of this protein can suffer if it is not stored at a certain temperature or it is subject to movement.  Always ensure that your practitioner is using fresh, non-reconstituted product for each site they are performing procedures, particularly if they have travelled long distances.

Dr Wassall has been performing Medical Cosmetic Procedures on the Central Coast for 10 years.  He is highly experienced and has performed thousands of procedures.  Despite this, he offers a very competitive pricing structure.  Clients that purchase larger volumes of product can save more.  There are practitioners that are considerably less experienced charging considerably more for the same products.  Dr Wassall offers no obligation consultations and price quotations.

Dr Wassall is committed to ethics, integrity and professionalism.  He will not compromise his medical standards for profit.  He often declines to perform procedures he does not believe are in the best interests of his clients. For further information on Dr Wassall's education and training click here.

23 Oct 2011

MoleMax vs Digital Camera

Dr Stephen Wassall. 

Dr Wassall was the first doctor on the New South Wales Central Coast to use a MoleMax machine. This device is designed to take a digital image of a suspicious mole to allow monitoring for future changes which may indicate that it is a melanoma. Dr Wassall used this machine as the workhorse of his Skin Cancer Practice from 1998 until 2006. Due to advances in technology, Dr Wassall no longer uses the MoleMax camera but rather uses a digital camera attached to a dermatoscope to take photographs of suspicious moles.

A lot of patients ask him why he has changed his method. Look at the photographs below and the answer should be apparent.

Dr Wassall has taken a photograph of a melanoma using the two systems. The first photograph is taken with the MoleMax camera and the second one with a digital camera attached to a dermatoscope. It is obvious that the digital camera image is much clearer with more colours and features visible. These photographs had to be reduced in size for publication on the internet. When these photographs are looked at next to each other at full size the difference in quality is even more apparent. Some of the features that identify this lesion as a melanoma are not visible on the MoleMax photograph.

It is more time consuming to photograph and store images using a digital camera as opposed to a MoleMax machine. However, Dr Wassall believes the extra time and effort is justified when the differences in image quality are so significant. It is also for this reason that Dr Wassall uses hand held dermatoscopes for his examination rather than the MoleMax machine. He believes that the features visible with the MoleMax machine are often not sufficient to allow a precise diagnosis in many circumstances. His opinion is that the MoleMax machine is still a useful tool for monitoring moles for change but is not the best tool available for initial diagnosis.

For more photographs taken with a digital camera attached to a dermatoscope, please go to the Image Gallery.

30 Apr 2011

Mediskin Clinic to become Skin Integrity!

Dr Stephen Wassall. 
As many of you may be aware I recently resigned as a partner of Terrigal Medical Centre. From July Mediskin Clinic will be renamed Skin Integrity and I will be responsible for running the business. It will operate exclusively as a Skin Cancer and Cosmetic Medicine Clinic.

I wish to offer a premium Skin Cancer service and will be expanding the range of services available. Total Body Photography has been proven to be an invaluable tool in the early detection of melanoma in high risk individuals. I will installing a high quality photography studio to offer this service to new and existing patients. I have also recently invested in equipment to perform a procedure known as Photdynamic Therapy. Photodynamic Therapy is a light based treatment used to eliminate certain precancerous spots and superficial skin cancers. It gives excellent cosmetic results and is considered the gold standard treatment for skin cancers in certain circumstances. This system complements the array of treatment options I already offer to ensure each patient is given the optimum treatment for their particular condition. I will also be setting up a dedicated Operating Theatre with modern sterilising and surgical equipment. We are also hoping to offer twilight sedation and will be able to perform more complex surgical procedures onsite than is currently possible. We will continue to use digital monitoring of suspicious moles but with higher resolution cameras and monitors.

I will be employing Registered Nurses and investing in their ongoing education in Skin Cancer Medicine. They will be able to assist me in offering the highest standard of care. I have completed a Masters Degree in Primary Care Skin Cancer Medicine and I am hoping to continue my education. 

New computers and software will be installed to streamline the appointment process. SMS and email reminders will be available for appointments and follow up. We are hopeful of reducing waiting times for appointments and improving access to care. We will also be liasing more closely with your usual GP to ensure they are informed of significant findings.

The aim of Skin Integrity is to offer the highest quality Primary Care Skin Cancer service possible. Service and treatments will be personalised and optimised for each individual. As you can imagine, the costs involved in setting up and running a premium service of this nature are considerable. Unfortunately the Medicare rebate from the Government is insufficient to subsidise this level of service and facilities. As a result, there will be a modest increase in fees for skin checks and procedures performed in the Operating Theatre.  Discounts are available for Pensioners and Children under 16 but bulk billing will generally be unavailable. I understand that some individuals suffer genuine financial hardship and I am always happy to discuss individual circumstances to ensure patients are not denied access to care.

Skin Integrity will offer a more comprehensive range of diagnostic and treatment services than any other Primary Care Skin Cancer facility on the Central Coast.

SKIN INTEGRITY OFFERS COSMETIC CLIENTS THE FOLLOWING BENEFITS
  • SAFETY: A genuine medical clinic offering safety, discretion, hygiene, sterility and the ability to deal with emergencies. These standards are not available in Beauty Salons with visiting practitioners.
  • VALUE: The best prices for injectable cosmetic treatments performed by a doctor on the Central Coast.
  • EXPERIENCE: Dr Wassall has been practising Cosmetic Medicine since 2002 and has performed over 10 000 procedures.
  • REWARDS: Cosmetic clients of Skin Integrity will also have the option of receiving access to Special Offers and Promotions. These include discounts on anti-wrinkle injections and dermal fillers.