Trish: Great, well I’m here today with Dr. Niamh Corduff. Dr Corduff is actually a plastic reconstructive surgeon. She’s based in Geelong, and Dr Corduff only does non-surgical procedures nowadays. I know we’ve been getting lots of questions about, “How do we know that we’ve got a good injector?” “How do we find one?” “How do we keep safe?” I thought I’d invite Dr Corduff along today to have a bit of a chat with us so that we know what the right thing to do is.
Thank you so much for joining us today, Dr. Corduff.
Dr Corduff: Thank you.
Trish: We’re getting inquiries from people all the time who are having injectables and then it’s all gone pear shaped, and people are always saying, “How do I know, how can I be sure that whoever I’m going to get injected by is going to keep me safe and is properly qualified?”
Can you kind of help us along there, a bit?
Dr Corduff: Okay, well. First of all a little bit about regulations. Both anti-wrinkle treatments and fillers are considered Schedule 4 drugs by the TGA. Therefore, the rules are that they have to be prescribed by a doctor, and can be administered by a doctor or a fully qualified nurse, usually an RN which is at level one but you can have level two if they’ve got the appropriate training. Now, the crux of the matter is involved in the prescription, because to write a prescription a doctor is supposed to see the patient and consult with them and advise so that the treatment is individually-based. Unfortunately, there seems to be some blurring of the margins and the rules in various places, especially some of these bulk clinics that you can find in shopping centres and things that have a high turnover and they’re often cheaper. The reason they’re cheaper is there’s usually not a doctor onsite. The treatments are not individually assessed. So you have nurses who are good nurses, but they’re often following a set rule, set prescriptions, that keeps them within the safety boundaries but there’s not much skill to it, not much variation and individualization to the patient.
This is where things can slightly go wrong. The other thing is when we talk about going wrong is actually aesthetic outcomes; they’re not what the patient actually wants and their disappointed their finding. Sometimes, if you are really concerned you maybe should be going to a specialist who has a lot of training in anatomy and can understand what’s going on underneath. Especially for more complex treatments. I would say I see at least now one patient a week who I’m dissolving out fillers and replacing them in anatomically appropriate places.
Trish: Wow, one a week?
Dr Corduff: Yep.
Trish: I know you’re saying that the person needs to be consulted by their doctor. Basically the clinics that you can find sometimes in the supermarkets, they may not necessarily even have a doctor onsite?
Dr Corduff: Yes, that’s right. They’ll be consulting by supervising doctor by Skype, hopefully at least that. But that sometimes doesn’t even happen too. Now I’m not saying that all those nurses in those supermarkets are bad, I mean there are some very good, very skilled nurses. But often they’re not in those vast chains. They move on to being a more advanced practise and with more medical practise, or more closely aligned with a doctor.
Trish: What about … I know that sometimes places have specials and things like that, and people of course are like “Omg I can get my Botox for $3 a ml or whatever.” Can you tell us about that? Give us a bit of clarification?
Dr Corduff: Okay, well first of all when you said Botox, that’s only one of the three drugs that are available now. This is problem number one. There’s Botox, there’s Xeomin, and there’s Dysport. They’re all very, very good toxins. They have very slight differences. There are some clinics that you’ll be able to have a choice between the three, but not all.
It’s actually illegal to promote a discount on a drug. That is considered an inducement, and is against TGA law. That’s number one. If you see that, then you know that those places are pushing the boundaries and are chasing the dollar and pushing patients through quickly rather than having number one priority as good patient care. That’s my opinion, anyway. I think that’s a red flag, a warning, when you see those discounts.
Dr Corduff: Because they are flouting the law.
Trish: Right, okay. Basically they’re not really … We’re not allowed by law to offer discounted specials and stuff like that?
Dr Corduff: You are not allowed to induce a patient to treatment, no. And that is one way of inducing a patient. As I said, that’s just a red flag that that’s a place where they’re more likely to be pushing the boundaries. In fact, if you … And this is another thing, patients are sort of conned I suppose by heavy marketing that you need a certain dose to get an effect. That’s not the case. Some people, say for the frown a very common treatment, I have some patients who only need five units of a toxin. There are other patients who’ll need 30 units of a toxin to get an effect. If somebody is considering it and wanting to get it done right, then they need to go to somebody who has the skill and the training to be able to give that individual variation. That girl who only needs five goes to one of these clinics and gets hit with 15, she’s got too much. She doesn’t need it. It will also probably end up with that really frozen, heavy feel. It’s too much for her. Whereas those who need 30 and they’ll get 15, then it’s not enough and they won’t get the effect. So they won’t be happy either.
Trish: Yeah, right. So when you speak to someone else and they say, “It only cost me, I only had 10 units in my forehead and I’m fine for three or six months whatever,” everyone is individual?
Dr Corduff: Everybody’s individual, yep. That’s another that can be brought up, about the forehead. We know that that’s a very common one at one of these cheap clinics, trying to get the young girls in. There’s this myth out there which makes me quite angry that putting toxin just in forehead lines will prevent lines down the future. Well, actually what it does is it weakens … Long-term it can actually weaken that one thin sheet of muscle that lifts the eyebrows. Long-term, the patients can end up with heavy eyebrows, drooping eyebrows, and can even push them into surgery.
Trish: Wow. Is there an age that if someone was to come to you and they were like 18 years old … I don’t know, is there an age that you wouldn’t treat someone? Or does it depend what the person wants?
Dr Corduff: I think having set ages is a little tricky. I mean, I have injected toxin into babies for cerebral palsy; fabulous treatment in the Royal Children’s Hospital. There are clinical indications, chronic pain, kids who’ve been in accidents. The drug is safe for children. The question is whether it’s appropriate, and you are psychologically doing the right thing by a younger patient.
I maybe am a bit conservative, but I’m also the mother of teenage girls and I don’t encourage them to have treatments. I think if you want to try to prevent lines, then you prevent it with good skin care, sunscreen, don’t smoke, be sensible. That’s going to prevent lines more than anything. Toxins, it’s a bit of a sales gimmick. I think as you get older and you’re looking to rebalance muscles and things, sure. But for young patients, no.
Trish: Okay. I totally can’t disagree with you there. I’m of the same mind myself.
We’ve been through the brands; there’s three different brands on the market in Australia at the moment. What about any side effects? Are there side effects that are possible with any of these products? Or anything that people should be aware of that could possibly happen?
Dr Corduff: Yeah, of course. There’s always side effects with anything you do. The commonest thing that will happen is it will unfortunately hurt. Can’t get away from that. It’s a needle, it’s a bit stingy but usually it’s worth it. You’ll get a bit of a red bump and swelling, which will go away. Usually in about half an hour. You may get a bruise if the needle passes through a small blood vessel or vein, then you may get a bruise.
The next one is where if you’ve interfered with a muscle or weakened a muscle it actually acts as a tissue fluid cup, so around the eye you can get swelling. The other thing is if the toxin drifts into where you don’t want it, so say around the eyes again. If a little bit of toxin drifts down towards some of the muscles that move the eyeball, or move the eyelid, then you can get a weakening and a bit of a problem from that.
Most of the problems with toxins are placed in anatomically the wrong spot. But the good thing is of course it’s going to wear off in three to four months. It’s not going to be a permanent thing, even if you do get a problem.
Dr Corduff: It has a very high safety profile.
Trish: Yeah, right. I do remember having … My forehead tends to drop, so I stay away from toxins now-
Dr Corduff: Yes-
Trish: But I remember from a couple of months … Everyone just thought I was ill because I just looked a bit sad because my whole forehead dropped. So something like that I could have actually gone back and got it fixed?
Dr Corduff: Well, if your forehead is dropping, there’s one thin sheet of muscle that lifts your eyebrows. It’s very thin. That’s it. If you weaken that muscle that’s holding up your eyebrows, it’s going to drop. Unless you’re very young and you’ve got good tissues and it stays up anyway. In which case you probably don’t need it. You always need to balance it and actually weaken the muscles that are pulling the eyebrows down. This is again where we talk about a knowledge of anatomy and what the balance of the muscles is.
Trish: Yep, right. I suppose the objective is not to get that frozen look, but to just help people to look a bit more relaxed and fresh because you’re not going to have as many frowns, I guess?
Dr Corduff: Well I think the other thing is that people don’t understand, we’re all women. We all get up in the morning and look in the mirror and wish we hadn’t, because it’s a bit scary sometimes.
Dr Corduff: You look in the mirror and you think, “I’m looking old. I’m looking old because I’ve got lines.” You’re not actually looking old because you’ve got lines. You got at Helen Mirren, Judy Dench. They are gorgeous women. They’re covered in lines. The difference is, their muscle balance is right.
As we age there are changes within the skull and the muscles get shorter. Actually the muscle that rests in the frown is tense. At rest as we age, we are constantly frowning. If you can relax that muscle with tox and open it up, we look fresher and we look happier and we look less grumpy. The side effect is that the line softens too. See where I’m coming from?
Trish: Yep, yep.
Dr Corduff: Yeah.
Trish: Does it build up over time? I’ve heard said, and I don’t know if this is true or not, but once you’ve been having it regularly then you don’t need it quite so much? Or maybe you need a little bit less?
Dr Corduff: That can be the case, because with long time toxins your muscles actually atrophy and shrink. This is a nice thing if it’s in the frown with ageing, because your muscles will relax and will be thinner, so won’t be as strong. But in the forehead, it’s a disaster. Because you want the muscles to be lifting up the eyebrows. When you mentioned about building up an accumulation of toxins, I’m going back to the safety profile, there’s a very, very, very, very rare risk in extremely high doses which we don’t use in aesthetic use but it can be used in therapeutics, where it has affected the respiratory and the breathing muscles. So people have to be a little bit careful around the neck. But these cases, as I said, are extremely rare.
Trish: Yep, okay.
So where do you treat people with Botox? If someone wants to come in and they’ve never been to you before … Say for example she’s in her mid-50s, she doesn’t want anyone to know that she’s having any injectables … Or even any age, actually. Would you start slow and build it up? Like say, what you’ll want to do over a year and this is our goal? If someone was to go to see someone, isn’t that what they should be asking?
Dr Corduff: Yep. I totally agree. I spend … My first consultation is quite lengthy. They’ll be in there for about 45 minutes quite often, half an hour. We talk about, we go through the basics. Most of the time the skin is looking like rubbish, and talking about skin health and long-term prevention of lines and wrinkles and getting that glow and that health back into the skin is actually very important.
Then we talk about what they want to achieve, whether they want a glamorous look or whether they just want to look a little bit fresher where nobody can pick it. We talk about what tools we have, so we can have a bit of toxins. We often need fillers as well as we get older, as well. Then we talk about how much it’s going to cost, and we walk out a plan. That plan may be for three years.
Trish: Yeah, okay. I think myself I look better now than I looked 10 years ago, I don’t look different I just look better because my marinette’s a bit filled out and what not.
Dr Corduff: Yeah.
Trish: So it kind of builds up over time, doesn’t it?
Dr Corduff: Yeah.
Dr Corduff: It’s a slow journey. For me, the end point is just as you have described; is just having somebody who is themselves, just looks better and fresher and happy and healthy and well. That is my endpoint.
Trish: I so agree with you about the skincare. The skin is the most important thing to have looking good anyway, so it’s really important to have good skincare.
Dr Corduff: Absolutely. The two go hand in hand. There’s no point banging away with toxin when the skin is looking rubbish. You’re wasting your money.
I was going to ask another question, because a lady asked me on the forum, she said, “What about if I just don’t have anything done and then save up over three years and go and give myself a facelift?”
Dr Corduff: Well, look a facelift is a bit different. It’s when you’ve got a lot of extra skin, and big sagging. There is a surgical indication, when you look at the patient you can see and you say, “Without surgery we’re not going to achieve a lot here.” That’s something that you could consider. But it depends what your tissues a like and what your desired outcome is. A lot of people these days don’t want that dramatic look; they just want a very subtle freshen up. The two endpoints are completely different.
If that patient wants a big result, then surgery is going to be appropriate. If that patient just wants subtle brightening, freshening, then non-surgicals is probably the better route. The two don’t get the same results.
Trish: Say for example if you go down the non-surgical path, will I still be having injections at 75?
Dr Corduff: You could, there’s no reason why not.
Trish: Okay. What’s the oldest person that you’ve ever treated?
Dr Corduff: In their 70s. I’ve got a few ladies in their late 70s. Absolutely delightful.
Trish: Go ladies I say, well done. That’s great.
Awesome. So I was going to ask you if you could give us three top questions that someone should ask when they’re going somewhere to have injectables to make sure that they’re going to be kept as safe as humanly possible, and just to sort … If there’s something they should ask to sort of … If this person asks this question wrong whether they should run really quickly?
Dr Corduff: Yep. I think one is, “Do I get to see a doctor?” Alright, that’s number one. So you know that the prescription is right. The nurse can be very, very skilled but legally they’re supposed to be seeing a doctor. Two to ask, “What are my options?” Is it just tox? “Do we have a treatment plan?” That’s the other thing.
Trish: Treatment plan, that’s a good idea. So if you want to have a treatment plan in place, yeah.
Dr Corduff: Yeah.
Trish: The third one?
Dr Corduff: The third one I would say, “What happens if I have a problem?”
Trish: Great, that’s awesome. That’s a really good question, because yeah you want to make sure that you’ve got some sort of aftercare or recall if something goes wrong.
Dr Corduff: Well also none of us are God. I have to see my patients two weeks later, and sometimes have to tweak what I’ve done because it’s not quite right. This is not an exact, guaranteed science. Which bothers me a little bit.
The other thing is when we say buyer beware, I think … It is a medical service. In a medical environment you’re going to get a safer situation and more advanced training situation, because that’s what doctor’s clinics tend to do, they tend to make sure their nurses are fully trained in what they’re doing, because they’re going to be carrying it out. Unfortunately, we have … They’re just going out to beauty clinics, we have nurses in hairdressers, where there’s no doctor onsite. I think that sort of scenario is just money-making.
Dr Corduff: Those sorts of scenarios are a concern to me. We, in Geelong, we have a place that just sells lipsticks and everything else. They’re doing tox and fillers. We have all these sorts of things that sound a bit cheap and cheerful on the edge, then you have to question what the standards are and what the level of training is. Or is it just a straight, big bucks, high turnover, money-making machine.
Trish: Yep, I totally agree with you. Actually one other thing, I’ve been really guilty of doing this myself … It’s always good to find a good practitioner, know exactly what you’re getting injected into you, and stick with the one person rather than going here and having a bit here and having a bit there-
Dr Corduff: Absolutely. I mean, it’s very hard to for the treating doctor as well because you’re going in blind. You know there’s something there, but you’re not quite sure what they’ve had before. The patient can’t remember which toxin they’ve had, which fillers they’ve had. It does make a difference when you’re following up on that.
Dr Corduff: We will often see patients for us … Those are usually the clinics that are happy to provide the notes and we can read them, they forward the notes with the patient’s consent. So we’ve got that and we provide notes and pass them onto the next clinic if that’s what the patient is moving, or whatever.
It’s nice to be able to follow up and have good records, because that’s going to be in the patient’s best interest.
Trish: Yep. As a patient you also know exactly how much you spend, how often you spend it, and you know what it’s going to cost you-
Dr Corduff: That is so important. It’s expensive stuff, you know? That’s part of having a treatment plan is actually having a financial plan. We as doctors we try and make sure that the treatment plan fits within that patient’s budget. It’s like walking into a lolly shop, and you go, “Wow I can have this, that and the other!” But then, hang on a minute how much does it cost? Maybe we’ll just take it back a bit, and just have a little bit of this and little bit of that.
Trish: Yeah, exactly. And build up over time or whatever.
Dr Corduff: Yeah.
Trish: That’s great. That’s been so helpful, today. That’s been really, really good. I really appreciate it, and I’m sure our listeners will as well.
Dr Corduff: You’re most welcome.
Trish: Thank you very much for your time. Ladies and gentleman, I forgot to mention before Dr. Corduff is actually an international trainer for Merz Pharmaceuticals, so she knows what she’s talking about.
Thank you so much for taking the time today.
Dr Corduff: Thank you, it was lovely.
Trish: If anyone would like to get in contact with Dr. Corduff, you can do that through us at firstname.lastname@example.org, or otherwise you can just look up Refine, she’s from the Refine Clinic in Geelong, and that’s refine.com.au.
Thank you so much!
Dr Corduff: Yep, that’s it. Thanks very much, Trish.
Trish: Have a great day.
Dr Corduff: Bye bye.