Statements and notices

Increasing number of complaints about cosmetic procedures

(30 June 2016)

The NSW Health Care Complaints Commission is receiving an increasing number of complaints about cosmetic procedures being performed in residential premises and hotel rooms, by non-registered practitioners in NSW, particularly in the Sydney area.

The cosmetic services being offered by non-registered practitioners are being advertised through various social media platforms, in particular "Wechat". The procedures involve a range of skin penetration procedures and administration of Schedule 4 prescription-only medication to `improve' appearance. This includes double eyelid suturing, nose bridge lifts, protein suture facelifts, the administration of Botox, Dermal fillers and Glutathione skin whitening injections.

It is illegal for a non-registered practitioner to undertake these procedures and because there is no validation of their qualifications and experience, there is a real risk to public health and safety. Furthermore, the procedures are being performed in facilities that have little, if any, infection control measures as per the Public Health Act 2010 and the Public Health Regulation 2012 (the Regulations).

The medications used by the non-registered practitioners are imported and not on the Australian Register of Therapeutic Goods (ARTG). The import and supply of medication that is not on the ARTG is unlawful and dangerous since there is no way of determining the efficacy and safety of the medicines.

The Commission is currently conducting an investigation into a complaint made by a female who underwent a double eyelid suture procedure in a residential apartment in the Sydney area. The treatment caused bruising and scarring to the patient and damage to her eyelids. The Commission's investigation has so far determined that the practitioner who carried out the surgery is not registered as a medical practitioner in Australia and was not qualified to conduct the surgery. Upon executing a search warrant at the premises, Commission staff located a number of prescription-only medications that had been illegally imported into Australia. This included Botulinum toxin (Botox) and hyaluronic acid injection preparations (Dermal fillers).

The Commission urges those individuals seeking cosmetic surgical and medical procedures to be vigilant in their research prior to proceeding. The following factors should be considered before committing to a cosmetic surgical or medical procedure:

1. Is the practitioner appropriately qualified, experienced and accredited?

Cosmetic surgical procedures - these procedures are required to be performed by a medical practitioner and the consumer should be assessed by that medical practitioner before scheduling the procedure. Administration of Schedule 4 drugs for cosmetic use - the consumer is required to have a consultation with a registered medical practitioner (in person or by video), for a management plan to be created and for that medical practitioner to prescribe the restricted substance. The consumer is required to be under the direct care of the medical practitioner, but the substance can be administered by a registered nurse who has been appropriately trained. Consumers are encouraged to ask a practitioner about their qualifications, training and experience. They can also check to see if a practitioner is registered in Australia through the Australian Health Practitioner Regulation Agency (AHPRA) website on If the practitioner is not registered in Australia, you should not proceed.

2. Is the facility appropriately equipped?

Cosmetic surgical and medical procedures are wide ranging and as such, there is no one piece of legislation regarding the licensing and registration requirements of these facilities. Consumers considering skin penetration procedures should be mindful of the following:

  • Premises where skin penetration procedures are performed need to be registered with the local government which enables random inspections to be conducted to monitor compliance with the Regulations
  • The premises needs to be clean and hygienic, have a waste disposal bin, have a hand basin that has a clean supply of water and have liquid soap and single use towels or a hand dryer for drying hands
  • Protective equipment needs to be worn by the person carrying out the procedure, including the use of gloves that have never been worn and a clean gown or apron
  • Needles used must not have been previously used and need to be disposed of using an appropriate sharps container

3. Am I appropriately informed?

The practitioner performing the procedure should provide the consumer with enough information to make an informed decision about whether to have the procedure. Consumers should be provided with at least the following information:

  • What does the procedure involve?
  • Is the procedure new or experimental?
  • What are the range of possible outcomes of the procedure?
  • What are the risks and possible complications associated with the procedure?

For further information contact the Executive Officer of the Health Care Complaints Commission on 9219 7444 or send an email to

Five questions to ask before getting Botox (source: Australian Society of Plastic Surgeons):

  1. Who is undertaking your Botox injections and are they appropriately qualified to do so? The Botox must first be prescribed by a qualified doctor. Beware of flashy websites - these don't necessarily reflect the necessary skills or qualifications.
  2. Where are you having your Botox? It must only be administered in an appropriate setting with adequate equipment and protocols in place. It needs to be a safe and clean environment.
  3. What happens after the injections? Find out who will take care of any complications that may arise post-procedure.
  4. Why are you having it? What are your expectations of the results and what benefits do you anticipate? It's important to have a realistic understanding of the likely results and to be aware of the limitations of surgery.
  5. How much will it cost? Beware of cut-price offers or packages. If it sounds too good to be true, it probably is. If you are getting a bargain price procedure, ask if the savings being made affects the level of care, the experience of the person conducting the procedure or the standard of the facilities.

Cosmetic Surgery and the Private Health Facilities Act 2007:
The Regulation of Facilities Carrying out Cosmetic Surgery

The Ministry of Health has prepared the Discussion Paper, Cosmetic Surgery and the Private Health Facilities Act 2007: The Regulation of Facilities Carrying out Cosmetic Surgery (pdf). The paper considers whether there should be a new class of cosmetic surgery under the Private Health Facilities Act; how that class should be defined; and what standards should apply in the event that a new class of cosmetic surgery is created.

The Medical Council of NSW prepared a response (pdf) to the Discussion Paper.

On 9 May 2016 the Medical Board of Australia issued guidelines (effective 1 October 2016) for medical practitioners who perform cosmetic medical and surgical procedures.

Opportunity to improve the health complaint & notification process

Independent Study by University of Sydney Researchers:

Community expectations and experiences of health complaints and notifications processes

Researchers from The University of Sydney are undertaking an independent and anonymous survey about how complaints and notifications made against registered doctors, nurses, midwives, dental practitioners, psychologists and pharmacists are managed. Everyone who made a complaint or notification that was managed by the Australian Health Practitioner Regulation Agency (AHPRA), a National Board, the NSW Health Care Complaints Commission (HCCC) or a NSW Health Professional Council relating to one of these five health professions and whose complaint or notification was closed between 1 July 2013 to 30 June 2014 would have been invited to participate in a survey.

The Medical Council of NSW is not conducting the survey, but we are supporting it because it is part of a series of studies that will help improve the management of complaints and notifications. Individuals and organisations whose complaint or notification was closed in this period would have been automatically sent a letter with further details. This letter should have arrived in the month after you received a letter advising that your complaint or notification had been finalised and closed.

If you did not receive a letter and your matter was about one of the health professions listed above, you can contact:

If you have questions about the study, the research leader at The University of Sydney is Suzanne Pierce, who can be reached at