Beginner-friendly guide to cosmetic injectables

Australia’s cosmetic injectables industry is booming. It’s worth an estimated $1.5 billion and projected to grow at a staggering 19 per cent every year until 2030. With more people opting for anti-wrinkle treatments and fillers than ever before, the trend shows no signs of slowing down.

But just because injectables are popular doesn’t mean they come without risks. In fact, choosing the wrong provider, product, or misunderstanding the treatment can lead to some serious complications.

Cosmetic injectables is a medical procedure and should be treated like one – it’s important to get the right advice from a registered health professional (registered with Ahpra, the Australian Health Practitioner Regulation Agency).

So, if you’re thinking about smoothing, plumping, or refreshing your look, make sure your face is in good (and safe) hands. Read on for everything you need to know before heading to your consultation — the more you know, the better!

What are cosmetic injectables?

The two main cosmetic injectables used are:

• Botulinum toxin type A (sold under brand names such as Botox^® and Dysport^®), and
• Dermal fillers (such as collagen, hyaluronic acid and polylactic acid).

Cosmetic injectables are classified as Schedule 4 (S4) ‘prescription only’ medicines and are regulated in Queensland under the Medicines and Poisons Act 2019 (Qld) (MPA) and the Medicines and Poisons (Medicines) Regulation 2021 (Qld) (MPMR).

As S4 medicines, these are prescription only medicines and can only be prescribed and administered by an authorised registered health practitioner.

Here’s what we mean by prescribe and administer:

• To prescribe means to direct a person – orally or in writing – to administer or dispense a medicine.
• Administer means to introduce a dose of a medicine into the body of a person (e.g. inject).

How do cosmetic injectables work?

Botulinum toxin type A

Botulinum toxin works by temporarily blocking nerve signals to your muscles, preventing them from contracting. The result? Fine lines and wrinkles soften, and new ones are less likely to form since facial movement is kept to a minimum (the muscle can’t contract, for example frown).

The effects aren’t instant — you’ll start noticing a difference around day three or four, with full results settling in soon after. While botulinum toxin isn’t forever, it does last around three to six months before the muscle regains movement.

Fillers

Dermal fillers (fillers) work by injecting a gel-like substance (commonly collagen or hyaluronic acid) beneath the skin to add volume, plump up skin, smooth lines and wrinkles, and restore volume to your face.

As we age, our body loses stores of collagen and hyaluronic acid (that keeps our skin firm and hydrated) – fillers basically replenish that supply. Fillers can also be injected into the lips to enhance lip volume and shape.

Results from fillers will usually occur straight away and can last months (some will work for up to two years).

Picture courtesy of freepik.

Can cosmetic injectables be removed after they’ve been administered?

Botulinum toxin is a neurotoxin (by definition, a substance poisonous or destructive to nerve tissue) and cannot be dissolved. Its effects will wear off naturally over time, but nothing can be done to speed up that process.

Some fillers, on the other hand, can be removed. Semi-dissolvable and non-dissolvable fillers (which cannot be removed without surgery) can be used in cosmetic injectables. For fillers that can be dissolved, an enzyme can be injected into the same spot to break down the hyaluronic acid molecules that make up the filler. Once broken down, the body naturally absorbs the filler remnants.

The effects of fillers, like botulinum toxin, will fade over time.

To find out more about types the different types of fillers, visit this injectable fillers Q&A website from the Australian Society of Plastic Surgeons.

Can cosmetic injectables move around my face?

Yes, very rarely botulinum toxin and fillers can move away from their original injection site. It’s a rare phenomenon called ‘Botox migration’/ ‘filler migration’. These migrations can cause unintended facial contours, asymmetry, or lumps on your face.

Only about one per cent of patients who get filler will experience filler migration, and less than one per cent of patients who get botulinum toxin will experience ‘Botox migration’.

To avoid cosmetic injectable migration, make sure you know if the person administering your injection is qualified and experienced, and know what aftercare is required post-injection.

Can anyone get cosmetic injectables?

No, cosmetic injectables are not suitable for everyone.

Before undergoing any procedure of this kind, your chosen service provider must complete a consultation with you.

This is so they can check your full medical history, explain risks related specifically to you, and to gain your informed consent before moving forward with botulinum toxin or filler. It is important that you are honest and ensure a full medical history is provided to ensure the prescriber can be guided to options that are safe for you.

Avoid cosmetic injectables if you’re pregnant, breast feeding, immunocompromised, infected where the injection will take place, or allergic to the contents.

What are the risks of cosmetic injectables?

Botulinum toxin

Botulinum toxin is generally considered safe – but as with every procedure, it does carry some potential risks and side effects. These will depend on the dosage of botulinum toxin and the injection site.

Here are some common side effects:

• Pain, swelling, or bruising at injection site
• Headache or flu-like symptoms
• Droopy eyelids or crooked brows
• A crooked smile or drooling
• Watery or dry eyes
• Infection at the injection site[1]

In rare cases, botulinum toxin can spread beyond the injection site and may cause some of the below symptoms. If you experience any of these symptoms, seek medical attention immediately:

• Muscle weakness
• Vision problems
• Trouble talking or swallowing
• Breathing problems
• Allergic reaction
• Loss of bladder control

Fillers

Fillers are also considered safe, but there are still some side effects to be aware of.

Common risks include:

• Bruising
• Redness
• Swelling
• Pain
• Tenderness
• Itchiness
• A rash

Less common but more serious risks include:

• Inflammation following a bacterial infection
• Raised bumps
• Open wounds
• Allergic reaction
• Skin necrosis (tissue death) – this is the most serious risk when it comes to fillers. Skin necrosis occurs when fillers are accidentally injected into a blood vessel. If this happens, there is also a risk of stroke or blindness. Chances of this happening are low.

Your cosmetic injectable may be prescribed and administered by two different people (explained below). Make sure you ask both professionals for their credentials, experience, and what risks you need to be aware of.

Picture courtesy of cottonbro studio, Pexels.

Who can prescribe cosmetic injectables?

Botulinum toxin and fillers are both prescription-only medicines in Australia. You must have a real-time appointment - which can be in person or via telehealth - with a registered health practitioner before anything can be injected.

Only certain registered health practitioners can prescribe cosmetic injectables, including a:

• doctor (medical practitioner)
• nurse practitioner (NP)
• dentist (explained below)

Dentists can provide cosmetic injectables due to their thorough knowledge of facial anatomy when it relates to dental or oral health. You may need botulinum toxin or filler to help with things like teeth grinding or headaches due to muscle tension. The Dental Board of Australia outlines the use of botulinum toxin and dermal fillers by dentists here.

It’s worth noting here that a registered nurse (RN) cannot prescribe cosmetic injectables – it is illegal for them to do this.

Who can administer cosmetic injectables?

Cosmetic injections can only be administered by a:

• doctor
• nurse practitioner (NP)
• registered nurse (RN)
• dentist (when it relates to dental or oral health)

While an RN cannot prescribe cosmetic injectables, they can administer them if they’ve had the right training and if a doctor or NP has prescribed the medicine. As mentioned above, dentists can also administer cosmetic injectables but are limited to doing so in the context of oral and dental health (their scope of practice).

This is why it’s so important that you know exactly who will be both prescribing and administering your cosmetic injectable of choice.

Does a doctor need to be on site when I get cosmetic injectables?

No. There is no requirement for a doctor or NP to be on site when the medicine is being administered, but the medicine must have been prescribed for the individual.

To stay safe and ensure you have the best possible treatment, check with your clinic if a doctor or NP will be on site, or at a minimum, available for telehealth consultation during your procedure. This is the best way to minimise risk and harm to yourself.

I’ve been prescribed a cosmetic injectable, what happens now?

In many cases, your cosmetic injectable prescription and injection are given at the same time.

Some clinics may have the medicine sent from a pharmacy and you may have a delay in your treatment. Once received, your authorised registered health practitioner will contact you to administer the injectables as prescribed by your doctor or NP.

You will not be able to get your prescription dispensed at a pharmacy to take it home. Cosmetic injectables should never be taken home and self-administered as this can lead to serious health consequences. These medicines should only be administered by an authorised registered health practitioner in the clinic where you had your consultation with a doctor or NP.

Giving your prescription medication to someone else is illegal and dangerous.

Speak to your prescriber about any questions you have regarding your prescription. You can also read Queensland Health’s Medicines in beauty treatment and cosmetic injectable businesses factsheet (this is targeted for those working in the industry, but if you’re curious have a read!)

How do I know the products being used are safe?

Only some botulinum toxin and filler products are approved by the Therapeutic Goods Administration (TGA) for use in Australia, here are a few of them.

Botulinum toxin type A

• Botox^®
• Dysport^®
• Xeomin^®

Fillers

• Juvederm^®
• Restylane^®
• Belotero^®
• Radiesse^®
• Sculptra^®

Always ask your provider what brand of botulinum toxin or filler they use and make sure they are TGA-approved.

What is Queensland Health’s role relating to cosmetic injectables?

Each state and territory has its own laws that govern how medicines must be handled in that state or territory.

In Queensland, Queensland Health regulates the use of medicines under the Medicines and Poisons Act 2019 and the Medicines and Poisons (Medicines) Regulation 2021.

Under these laws, cosmetic injectables are classed as Schedule 4 medicines. All Schedule 4 medicines are prescription only medicines and are subject to regulations around prescribing, dispensing, and storage.

Queensland Health works to ensure businesses and individuals that prescribe, dispense, administer, or buy Schedule 4 medicines comply with regulations, such as through inspections and audits.

However, it’s also important that consumers ask questions to ensure they are aware of the products used and any risks.

What do I do if something goes wrong with my procedure?

If something does go wrong with your cosmetic injectables procedure take immediate action.

Contact the practitioner who performed your procedure as soon as possible if you experience any swelling, discolouration, or other changes to the injection site. You may need antibiotics if it’s related to an infection.

In an emergency (severe pain, difficulty breathing) always call Triple Zero (000) immediately or present to your nearest emergency department if you’re able to.

What if I have concerns someone (or a clinic) is doing the wrong thing?

Queensland Health’s focus is the safety of Queenslanders, and we are committed to ensuring cosmetic injectable providers are aware of their legal obligations and operating legally.

If you’re worried about a practitioner or clinic, it’s important to let Queensland Health know as soon as possible by completing a General Report to the chief executive - Medicines.