Aesthetic medicine is slowly getting out of control: experts estimate that every year in Poland there are more and more offices where treatments that in other countries are reserved for doctors are performed by people after short courses. Along with them, unfortunately, the number of complications and even deaths increases.
The black market in aesthetic medicine is booming. Why Poles use such services despite the obvious risk, what are the risks of improving their beauty in a random office and why there is still a lack of provisions to prevent it, we talk to prof. dr hab. n. med. Aleksandra Lesiak, specialist in dermatology and venereology, professor of the Department of Pediatric Dermatology and Oncology at the Medical University of Lodz and the owner of the Dermoclinic.
- Professor, various experts estimate that we spend about PLN 4 billion a year on improving our beauty, and research shows that every third Pole knows someone around him who has benefited from aesthetic medicine treatments. Is it a lot or a little compared to other countries? Can it be said that Polish women and Poles are eager to improve their beauty?
Even very gladly. The most popular treatments are hyaluronic acid, which give immediate results - the patient pays and leaves after the treatment with, for example, enlarged lips. Botox, lifting threads and platelet rich plasma are popular.
Statistics show that this market in Poland grows almost twice as fast as on a global scale. And because the demand is so high, the number of people doing such procedures is also growing. And here we come to the heart of the problem: research carried out by one of the companies dealing in the distribution of preparations in the field of aesthetic medicine showed that 45 percent. of our market are services that are satisfied by non-professionals, not by doctors.
These are terrifying statistics as they show that almost half of the people who perform such procedures have neither the appropriate qualifications nor the right to do so. I can see that this problem is growing at an alarming rate, perhaps even faster than the number of people who want to improve their appearance.
- Why is this a problem?
Because someone who performs a procedure in the field of aesthetic medicine, although he should not, because he has no medical education, can hurt the patient. And it often does, which is also shown by numerous complications. There are many badly performed procedures.
- What kind of harm are we talking about?
First of all, about complications and consequences that may arise as a result of improperly performed surgery. And there can be a lot of them. I mean, for example, the possibility of HIV or HCV infection, bacterial skin infections, the formation of granulomas, vascular necrosis and even blindness. In addition, a poorly performed procedure not only does not add beauty to the patient, but even disfigures her: the injection of hyaluronic acid or Botox by a non-professional often results in exaggerated faces, "duckbills", puffed cheeks, filled with valleys of tears.
Beauticians or tattooists who perform such treatments often say that they are manually more efficient than doctors. And sometimes it may be so, because it's also a matter of practice or the number of repetitions. But you have to remember that these are treatments involving disruption of the skin, injection of a preparation that is to fill specific places or temporarily stop the work of muscles. A doctor after medical studies knows anatomy very well, a tattoo artist or beautician - not anymore.
Such treatments are also often performed by cosmetologists who think that since they graduated from cosmetology at a medical university, they have both medical education and appropriate qualifications.
However, this is not a medical profession and the study program strictly defines what their graduates can do afterwards. No cosmetologist has the right to perform procedures that violate the cutaneous-epidermal border, and therefore, inter alia, to perform punctures.
Of course, complications may also occur when the procedure is performed by a doctor, but these are much rarer cases for which the doctor takes full professional responsibility. It is also worth emphasizing that both the preparations used for the procedure and anesthetics, such as lignocaine, or the topical EMLA cream for local anesthesia, may cause a very strong systemic reaction of the body, and even anaphylactic shock, in a predisposed person.
There is a properly trained medical staff in the doctor's office who knows how to react, there is a doctor, there are also drugs that can be given to the patient, saving her life. And who will help such a person in a beauty salon?
- Why, then, such salons have clients at all, and their employees decide to undergo such treatments?
For the person who offers such services, the primary reason is, of course, the desire to earn money. But clients also have their reasons. Many of these people are afraid of doctors, they trust more Kasia or Mrs. Krysia, with whom she has been doing nails, henna or masks for twenty years, and for fifteen they are by name. And when such a lady offers her one time to enlarge her lips, she believes her, because she is a good friend, she will certainly do it much better than some foreign doctor and you know - she will not do any harm.
I am ironic, of course, but most of the time it is like that. Unfortunately, patients undergoing aesthetic medicine treatments are not aware of the risks that such a treatment may entail, especially if it is not professionally performed.
- There are many advertisements on the Internet advertising trainings for people who are not doctors, but - after such trainings - are to acquire competences similar to medical ones in the field of aesthetic medicine treatments. They even receive certificates, which they later proudly hang on the walls. Are such courses different from those for doctors?
Such courses are a misunderstanding for me and a certificate of completion is usually of little value - especially if it is a training course that took an hour or two. Any training will not replace the skills acquired during medical studies, and in the case of dermatologists also during the five-year specialization. Some of these courses are designated by the employment office and are conducted as part of retraining, training courses, and there is funding from the European Union.
They are often carried out by people without proper qualifications. They teach you how to inject hyaluronic acid, platelet-rich plasma, and some even train you on botulinum toxin, which is a drug and you buy it with a prescription. A doctor from training on, for example, the use of a new preparation conducted by another professional will have completely different skills than a beautician who lacks the basics.
- Being a potential client, I would definitely consider one more issue: costs. Preparations for aesthetic medicine treatments are not cheap - 1 ml of a preparation containing hyaluronic acid in Warsaw offices costs PLN 700-1200, and the doctor decides how much of this preparation will be used. During one visit to the office, you can leave several thousand zlotys. Taking into account the amount of earnings in Poland, the average Polish woman must work a month, sometimes longer, for one treatment with a professional, and during this time not to eat or pay bills. So it is not difficult to imagine that when he stumbles upon a "bargain" and a dream treatment he can do for a fraction of the price, he takes advantage of it. Why does it cost so much, and is it worth overpaying, since Ali Express can buy a similar one for a fraction of the price?
It's good that you said "similar". With preparations for aesthetic medicine treatments it is just like with cars. They are going, but differently. The Louis Vitton purse and its counterfeit also look the same. Products of well-known top companies are medical devices that have undergone reliable certification and doctors work on such products that are tested.
The market is very saturated, the competition is immense, you can buy a variety of preparations, even those whose names resemble the top ones, but cost a third of the price. If, on average, a milliliter of an ampoule in a wholesale store costs PLN 200, 250, you can buy counterfeit products much below PLN 100. But what's in them nobody knows.
On the other hand: how much is a procedure that is not a life-saving procedure supposed to cost, but its purpose is to beautify and improve the image? It is known that these will not be cheap services. That's why a lady beautician who made nails and earned PLN 20 on it, now suddenly can earn 50, so she decides to do it. A good doctor does not count milliliters, but looks at the effects, makes the procedure safe and effective.
- Often you can also hear the opinion that doctors artificially raise the prices of treatments in order to earn as much as possible ...
The approach is this: the doctor pushes up prices because he definitely wants to earn on it. But when someone goes to the hairdresser and pays PLN 400 for coloring, while the paint used for the treatment costs PLN 20, we are dealing with an identical phenomenon. The whole service market looks like this. However, it is worth remembering that there is a completely different background behind the doctor, first of all, a well-equipped office and years of hard medical studies.
- What education and preparation should a person wishing to perform such procedures have? Why does it have to be a doctor in any case?
Because these treatments are connected with breaking the continuity of the skin, and their complications can be so serious that they require professional care. But the procedure performed by a professional does not only involve the injection of the preparation, but also professional care before and after. The doctor will also pay attention to other aspects of the appearance, most notably the condition of the skin. Personally, I am of the opinion that such treatments should be performed primarily by dermatologists.
Of course, I will praise my specialization, but it is dermatologists who know the skin best, they can assess which skin lesions should be treated, they know how to identify a precancerous condition, they are able to recognize skin cancer. We are also more conservative, we do not force certain things, we also know that some effects can be achieved in other ways, not necessarily with such invasive methods.
When an acne patient comes to me and says: I want to have beautiful lips, I first have to take care of the condition of her skin, and then I think what shape her lips should have and how to enlarge them. Aesthetic medicine should not radically change the shape of the patient's features, it is supposed to improve the condition of the skin so that it looks fresher, younger, with less signs of aging.
It is best that the doctor is also a clinician, because in the event of unexpected complications he will be able to help effectively or refer the patient to the appropriate specialist.
- Suppose I would like to change my profession and open a practice of aesthetic medicine. Will the regulations in force in Poland allow me to do so?
Unfortunately, yes, because such an office can be opened by anyone, it is enough to have the right amount of money. I am even inclined to suppose that after a few courses you would probably be able to perform basic procedures yourself, for example hyaluronic acid injections.
People who do these treatments seem very simple. In fact, they are not very complicated at first glance. If you had taken two courses and had no awareness or imagination, you would also be able to do such treatments, the basic ones for sure. Lack of criticism and knowledge make people without medical preparation nonchalant, they think that they can do everything, and the treatments are so simple that nobody will be hurt. But it often happens, which you can read about in the newspapers later.
- In shopping malls, you can come across beauty salons with signs that an aesthetic medicine doctor visits here ...
There is no aesthetic medicine doctor. There is no such specialization. Aesthetic medicine in Poland is dealt with by doctors, beauticians, cosmetologists, tattooists, hairdressers, and sometimes nurses. Unfortunately, in our country there are no legal regulations that would define who can perform such procedures.
- Why aren't they there?
Because there is not enough lobbying. I hope that the Minister of Health will finally be able to deal with it and everything will be legally regulated. Three societies - the Polish Dermatological Society, the Association of Aesthetic Dermatologists and the Polish Society of Aesthetic Medicine and Anti-Aging have joined forces and want to talk to decision-makers on this matter. However, as long as there are no regulations, there are no rules on who can perform such procedures. This is not only our Polish problem, other countries are also struggling with it.
I dream of a law that is in force in France, which clearly defines who can do botox and who can do hyaluronic acid. It is not unattainable, it is a matter of multidirectional activities: media, patients, scientific societies. It is known that there will always be a gray area and that the regulations will not eliminate all those who harm the patient.
But such persons will then be subject to the criminal code, not the civil code, so they will think twice before carrying out such an operation without having the right to do so. Currently, a victim of a beautician, cosmetologist or tattoo artist practically cannot claim his rights from a criminal action, with completely different consequences, but from a civil one. However, if complications arise after the procedure performed by a doctor, he may be prosecuted by a criminal action as a malpractice.
- If I wanted to enlarge my mouth or inject botox here and there, what should give me food for thought when choosing an office? Should the low price of the procedure be the only criterion here?
First of all, you should check whether the treatments are performed by a medical doctor, if he has a specialization and what is his experience. I will always say that a dermatologist will be the best choice, especially if something happens later, but such procedures are performed by dentists, anesthesiologists and doctors of other specializations.
You also need to check what courses the doctor has undergone, what is his reputation among patients, whether he has his own certified office, what happens with medical waste from this office, whether it is a doctor who only deals with aesthetic medicine, or a clinician who in case of complications, he knows how to treat, he has a wide range of medications at his disposal and he will cope. Is it a recommended and recognized person, what preparations does it work on, or are they top brands - because there are only a few that count.
- As a layman, can I recognize that the product used for the treatment is original?
The doctor should show it to you and stick its serial number and expiry date on the procedure information card. He should also open it in front of you, so that there is no doubt that it is a fresh product and no one has used the same contents of the ampoule before, because, unfortunately, such practices sometimes happen in the salons of non-professionals.
You should also explain what effects to expect, what may happen, and how to proceed then. He should give himself a phone number in case something goes wrong outside of his working hours. These are the things that characterize the safe use of such services.
- Do you happen to save victims of poorly performed procedures?
No, I do not see such patients, but I know doctors who have extensive experience in treating complications after such procedures. I always follow the principle of primum non nocere - from me, the patient will come out with less preparations than too much, because in the end we are not fighting for life, but improving the condition of the skin.
He is a specialist in dermatology-venereology, professor of the Department of Pediatric Dermatology and Oncology at the Medical University of Lodz.
Author and co-author of many original and review articles in Polish and foreign magazines. Her research work focuses mainly on the problem of skin cancer, psoriasis and skin diseases in children. Professor Lesiak is a board member of the European Academy of Dermatology and Venereology, a member of the Polish Dermatological Society, and the European Society for Dermatological Research.
She completed internships abroad (France, Great Britain). In 2011, she received the prestigious L'OREAL scholarship for Women and Science, and in 2012, she won the Super Talents in Medicine competition. Since 2014, she has been the vice-president of the Youth Forum Section of the Polish Dermatological Society, and since 2015, the vice-president of the Oncology section of the PTD.
