Skin Integrity Blog


03 Aug 2016

Should Nurses Perform Cosmetic Injections?

Dr Stephen Wassall. 

The Medical Board of Australia has introduced new guidelines on Cosmetic Injecting which will come into force on October 1st. Of particular interest are the following:

1. Medical practitioners must not prescribe cosmetic injectables unless they have had a consultation with the patient, either in person or by video.
2. If the cosmetic injectable is administered by another registered health practitioner who is not an authorised prescriber, the prescribing medical practitioner must be contactable and able to respond if required. 
3. Procedures should be performed in a facility that is appropriate for the level of risk involved in the procedure. Facilities should be appropriately staffed and equipped to manage possible complications and emergencies.

These guidelines reflect the growing concern about corporate type clinics using loopholes to allow unsupervised nurses to administer anti-wrinkle injections and dermal fillers. I have little doubt that some clinics will continue to exploit loopholes to allow nurses to perform these procedures.
There are many excellent Nurse injectors but what is clear is that they must be working in collaboration or under the supervision of a Medical Practitioner. Using video consultations with a doctor that you will never meet in person and who lives in another city and who is unable to attend to you in the result of a complication just isn't an appropriate standard of care.

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:

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 Aug 2014

New Anti-Wrinkle Injection Available

Dr Stephen Wassall. 

Skin Integrity is excited to announce that there is a new anti-wrinkle injection available. Due to TGA Advertising regulations we cannot mention it's name here. It is manufactured in Germany by the Pharmaceutical Company Merz.

This new injection is very similar to the market leader which is manufactured by Allergan. The major difference is that it is preservative free. As a result of this it is considered less likely that a client will develop resistance or have an allergic reaction. The dosage, effect, duration of onset and longevity are all considered to be very similar to the Allergan product.

As a Special Introductory Offer Skin Integrity will be offering this new product for a flat rate of $9.00 per unit on the following days:

  • Friday 5th September
  • Monday 8th September
  • Wednesday 10th September (morning only).

The average dose range for each treatment area is as follows:

  • Frown Lines: 16-24 units
  • Crows Feet: 16-24 units 
  • Forehead Lines: 8 -14 units

The following conditions apply for this offer:

  • Only available to existing Skin Integrity cosmetic clients.
  • A separate appointment will be required on a different day if you want dermal fillers as well.

Our Special Days always book out quickly. Ring soon to avoid disappointment. For an appointment please call Angela or Jennifer on 4384 6191.

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.

24 Jun 2013

Anti-Wrinkle Injections $3.30 per Unit!

Dr Stephen Wassall. 

Skin Integrity is once again offering a very special promotion.  Due to TGA regulations we are unable to name the product used for this special.  It is a generic form of a very popular anti-wrinkle injection and is extremely popular in Europe and becoming more popular in Australia.  We will refer to it as Product 2.  The more well known brand will be referred to as Product 1.

For School Holidays, we will be offering Product 2 Injections for the special price of $3.30 per unit.  Another clinic is currently offering product 2 injections for $3.49 per unit.  Apart from our lower price, there some other factors to consider:

  • No minimum dose required for special.  
  • All injections performed personally by Dr Wassall, not a Registered Nurse.  Dr Wassall is the most experienced Cosmetic Injector on the Central Coast and has injected over 5000 patients in the last 10 years.
  • Treatments are performed in a dedicated Medical Clinic where privacy and discretion are paramount, not a busy shopping centre or beauty salon.
  • Dr Wassall is available for follow up if there is a concern or complication.

The average dose range for each treatment area is as follows:

  • Frown Lines: 40-60 units
  • Crows Feet: 40-60 units 
  • Forehead Lines: 25-40 units
The number of units of Product 2 required is considered to be 2.5 times greater than Product 1 to achieve a similar effect. Therefore, a price of $3.30 per unit of Product 2 is equivalent to $8.25 per unit of Product 1.  Individual results may vary. Some clients prefer Product 1 over Product 2 whilst others prefer Product 2 over Product 1.  Most clients that have tried both have no strong preference either way.

The following conditions apply for this offer:

  • Offer applies from Monday 1st July to Friday 12th July on a first in best dressed basis.
  • A consultation is required to ensure each client is suitable for treatment.  Pre-payment is not permitted.
  • Only Product 2 will be administered on the day. If you wish to have dermal filler as well please notify reception when making your appointment so extra time can be allocated.
  • If extra Product 2 is required in the month following the treatment, it will also be charged at $3.30 per unit.  After a month, the normal prices will apply. 

Ring soon to avoid disappointment.  For an appointment please call Maxine or Angela on 4384 6191.

    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.

    17 Apr 2013

    A Quick Update .....

    Dr Stephen Wassall. 

    I am writing to inform you of the current situation at Skin Integrity.  As many of my clients are aware, I recently suffered a shoulder injury whilst Mountain Biking in New Zealand.  It seems that my body doesn't bounce quite as well as it used to!  As a result of this injury I have had surgery but I am now back at work.  I am currently unable to perform skin checks or surgical procedures but I am able to perform cosmetic anti-wrinkle injections and dermal fillers.

    Unfortunately one of my competitors is informing people that I will no longer be performing Cosmetic procedures.  This is simply untrue.  Now is actually a good time to have a cosmetic procedure at Skin Integrity as availability will be good for the next few weeks while I am not doing skin cancer work.  When I return to full duties I anticipate appointments will be less readily available as I catch up on the back log of skin cancer work.

    I appreciate the messages of support I have received following my accident.  I will be making a full and complete recovery and hope to get back on my bike in a couple of months.

    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.
    07 Apr 2012

    Inhaled Pain Relief Now Available

    Dr Stephen Wassall. 

    Skin Integrity is pleased to announce that inhaled medication is now available to assist with pain relief during cosmetic procedures.  The inhaled analgesic (similar to happy gas) that can make procedures such as dermal fillers, anti-wrinkle injections, chemical peels and photodynamic therapy considerably more comfortable. 

    The inhaled medication consists of a hand held device that has been used in Australia for more than thirty years and is often used by ambulances.  It provides strong pain relief. The client is in control of the device, therefore feeling more comfortable. It is safe and can be used in most situations.

    It has a rapid onset of action and is short lasting.  After a short period of observation (generally around 30 minutes) most clients are able to drive home.  Understandably, many clients are anxious about needles or pain during procedures.  Inhaled analgesia is an excellent option to help these clients tolerate their procedure.  Other modalities used at Skin Integrity for pain relief include ice, local anaesthetic cream and nerve blocks.

    The cost of this medication is $50 in addition to the procedure cost.  It can only be administered under medical supervision.

    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.

    • 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.