I caught up with Dr Michael Molton, President of the Cosmetic Physician’s College of Australasia, at the recent LCMC Conference held in Brisbane. We had a really informative chat on patient safety, consumer confusion, what to look out for in a cosmetic physician and so much more. This is a great podcast for any patient having or considering any cosmetic treatment.

Trish: Hello, listeners and everyone else out there. It’s Trish here from Transforming Bodies, and today I have the absolute joy of speaking with Dr. Michael Molton. Now Dr. Michael Molton is the owner, director, doctor of the Epiclinic in Adelaide in Wakefield Street. And he’s also the president of the Cosmetic Physicians College of Australasia, which is the acronym for it is the CPCA. And today or tonight we’re gonna have a bit of a chat about the state of the profession, a little bit about safety, and just kind of where the cosmetic medicine industry is headed.

Trish: So thank you so much for joining us Dr. Molton.

Dr Michael Molton: My pleasure, indeed, Trish.

Trish: So tell us, I’m really, really excited to be hooked up with the CPCA because there’s so much going on in the industry at the moment and I thought, “Who better to call upon except the industry itself to kind of give us some answers and kind of help to let us know where everything is headed?” So tell us a little bit about … I know there’s lots of stuff happening at the moment with improving patient safety and everyone working towards the same goal, because we’ve got quite a few groups everywhere. But do you want to tell a little bit about the stat of the profession, where it’s at at the moment? Because a lot of consumers are a little bit confused as to what’s what.

Dr Michael Molton: Yeah. Absolutely. There is a heck of a lot of confusion. The first confusion I’d like to clear up is the major difference between cosmetic medicine and that of cosmetic surgery. Very much like general medicine. General medicine doctors write prescriptions and do minor procedures and so forth, but they don’t actually do operations like surgeons. So there’s a big difference in the skill set, and there’s also a big difference in the actual procedure that we perform.

In terms of cosmetic medicine then, there is no recognised course of study. There’s no certain thing. There’s not item numbers to claim. It’s all privately built and so forth. What it comes down to is that the profession needs to be self-regulated, and over the years various groups have grown up in a slightly different direction. And with my presidency, what I’ve tried to do and one of the platforms of which I based my election of presidency upon was to bring those groups together to find the common ground.

Remain independent of one another because we’re all slightly different, but to at least find some really common ground and a code of conduct that we can all follow that will bring much more safety to the procedures that we perform.

Trish: Yeah, I know it was not even that long ago that I started actually relating to doctors as either cosmetic physicians or cosmetic surgeons because there is that big gap as to what each of them are. So do you want to give us a little bit about that, because I know there is stuff going on in the government. Like the joint ministerial committee meeting that was held in August or something. There’s stuff happening so that people can’t be … not mislead. Because it’s not misleading. It’s just that we’re kind of ill-informed as to what what is.

Dr Michael Molton: Well, that’s right, Trish. At the joint ministerial I was an affirmed or sworn witness. I found that incredibly interesting but also very frustrating from the point of view that even the panel of minsters themselves began to speak about cosmetic medical procedures and then in the next sentence when on to talk about breast implantation and face lifts and so on and so forth.

They didn’t seem to grasp that there was a significant difference between the skill sets, risks and complications, and the types of persons and groups of people that perform those different procedures. There is still a lot of confusion about that.

But if I can outline and answering your question, cosmetic physicians perform essentially what we call, non invasive or minimally invasive procedures. But the best way to determine the difference is we don’t do operations like surgeons.

Trish: Yeah. Okay. A cosmetic physician is a … because all cosmetic physicians and all cosmetic surgeons they’re all doctors.

Dr Michael Molton: Yeah.

Trish: But cosmetic physicians basically don’t cut the skin, is that right? Perform operations cutting skin, is that kind of right?

Dr Michael Molton: Well, if they were to, that would be very minor. So cosmetic physicians have an interest for example in minor surgical procedures for skin cancers and so on and so forth. But I think the best way to sort out that line is we don’t need a an anesthetist. We don’t go to operation hospitals. We don’t have patients that are unconscious or sedated or any of those sorts of things. We perform those procedures in clinical environments, not beauty salons or those sorts of places, in bonafide medical procedures.

But we could make the comparison or similarity or kind of analogy if you like of you’re off to your general practitioner who you might see for asthma or diabetes or blood pressure. And he would prescribe certain medications for those sorts of ailments depending on what the doctor found and so forth. And he might refer you off to a specialist to have something done.

But in the main, that’s the sort of process in a clinical environment. But it wouldn’t be an operating in the environment in which you go to see a cosmetic physician. So there’d be no operation, there would be no sedation. There would be no general anaesthetic or any of those sorts of things.

Trish: Okay. Basically what’s the difference between a cosmetic physician and someone who would call themselves a cosmetic surgeon? Because I know that there’s people out there doing surgery who don’t have a surgical qualification apart from the MBBS which is the bit of surgery training that is given when you get your doctor’s qualification, because I know that that covers surgery. Is the problem just with the term cosmetic surgeon because it’s not a recognised specialty?

Dr Michael Molton: We were asked this question at the joint ministerial inquiry, and it’s really not known to be … We were asked about protection of title of a surgeon, but the CPCA does not have a position on that. It doesn’t take up any opposition. It’s not informed enough about those sorts of issues. We’re really firmly concentration on things like anti-wrinkly injections, general fillers, and things like energy burst devices, lasers, CRYOLIPOLYSIS devices at production, non invasive procedures. These are the sorts of things.

Dr Michael Molton: We’re not in a position to comment on protection of the title of a surgeon because we’re simply not in that domain.

Trish: Yeah. And I think that’s probably the same way a lot of people actually feel, because it’s not their area. It’s not what they’re focused on. You’re right, it’s really hard to comment on that. I know that just to help with patient safety and stuff that seems to be going on, it’s always gone on. It’s just it’s been a bit more highlighted these days. And I think that’s because more people are having procedures anyway. But, is there a way that … I know for a fact that there’s a way that you and other organisations are working together to create a kind of community kind of thing where it’s all about improvements in patient safety.

Trish: Can you tell us a little bit about that?

Dr Michael Molton: Yeah, sure. We had a tragic death as we know last year in a beauty salon. Truce allegedly created by the use of a prescription only medication. And we also had earlier this year at least one case that we know of of a pendant dealing loss in a patient following the administration of a general filler in that state also.

We’ve been actually as the College have been warning about the possibility of these sorts of events because the lack of regulation. It’s not so much the lack of regulation. The regulations are probably there. But the lack of policing of regulations has been very tardy. It’s very tardy. There just has not been enough attention from the regulators in regards to the warnings that the Cosmetic Physicians College of Australasia have been constantly providing over the last two or three years.

We’ve been lobbying all sorts of government regulators to try to educate them and to try to get them to understand what are the difficulties that we face and why have we faced them and try to get them to tidy things up. A lot of that is spilling over now into the community of people understanding more about the potential risks and complications which can happen in any set of circumstances. But I think what happens at the moment, Trish, there are two things. The first is that there’s trivialization of the complications of cosmetic injections and energy-based devices. The public, I suppose they’re entitled to believe that if these procedures are performed anywhere by anybody that this is legal and that it’s safe. Unfortunately that’s not the case. This concept that all these things are safe and that you’re just gonna have a little of filler pumped into your lip or into your cheeks or wherever. Wherever you go, if you can get it done there, it must be okay. Otherwise wouldn’t the government or whoever’s regulating these things and profession, wouldn’t they step in and stop it. The fact is, it is unlawful in many, many cases, and it is dangerous in many, many cases in unskilled hands and untrained or inexperienced people. But nothing is really being done about stopping it by the regulators.

Trish: Yep. And you know what … Sorry, sorry.

Dr Michael Molton: What was the question? The second thing, I’m gonna come back to this, is that there’s not a recognised course of study that they’re many people or health practitioner regulation agency recognise as being the specialty in cosmetic medicine. We’ve got these two day, really quick course that are out there, loosely termed courses, that are not teaching, they’re shown patients. They’re showing doctors how to do these procedures, but they’re not teaching them. They’re not spending enough time observing how skillful these are.

So these are the two problems, the trivialization, and the lack of a recognised course of study.

Trish: You know what, and I reckon if somehow there can be a course of study that’s gonna be recognised, that’s gonna be the answer to all the problems ultimately in the end, isn’t it?

Dr Michael Molton: It absolutely is. Those two things are the focal point in my mind as the president of the CPCA, and now the board. As a group and also now with the Cosmetic Medical Alliance group which encompasses the Australian College of Aesthetic Medicine, and the Australasian Society of Cosmetic Dermatologists (ASCD), and also the medical faculty of the Australian cosmetic surgery, those four organisations are coming together and formulating this recognised course of study.

We’re all on the same page, that we can then present to the Australian medical counsel and say, “Look, this is the recognised course of study.” If people do not have this and have not passed this, so to say the inspection of the exam days, then these sorts of procedures have not been prescribed or performed by persons who don’t have those recognised qualifications. That’s the bit that’s lacking.

Trish: Yeah. I think that’s so true. Because then even within all of those levels, there has to be … You have to kind of work out what is cosmetic surgery then in the end. Is it a breast augmentation? Is it a tummy tuck? Do you know what I mean? Because a lot of that stuff is actually probably more than cosmetic, but we put it under a banner that relates it to cosmetic. So therein lies another issue in itself I guess.

Dr Michael Molton: That’s really up to the cosmetic surgeons.

Trish: Yeah.

Dr Michael Molton: They need to be doing that. Whoever is designated who might be regarded as surgery, we don’t have anything to do with. We don’t understand any of the stuff that they do. We don’t do it ourselves. We’re completely focused on creating a recognised course of study in cosmetic medicine.

It’s once again, I come back to this point of trivialization that we see just today. I received an alert about anti-wrinkle injections and fillers and these sorts of procedures that we do that are now being performed on cruise ships for instance.

Trish: Are you serious? Oh my god. Oh no.

Dr Michael Molton: You see, you don’t want to take away people’s preferences and choices and so forth, but you do want to say to people, “Look, if you do go on these sorts of wonderful voyages and so on which are hugely enjoyable, are you really in the right frame of mind to be thinking objectively about the potential risks and complications of what might occur when you are away from Australian waters on a ship miles from anywhere?”

But this isn’t generated by this trivialization. Somebody the other day called it the Snapchat dysmorphia syndrome. It’s a variable disease of young people taking selfies, going along to people like ourselves and saying, “I’ve used face tune to create this image, and this is what I want to look like.” The psychological approach to patients is vitally important. But you can’t blame the patients in some way because there is so much trivialization of the potential risks and complications that can occur out there.

Trish: Yep. That’s so true. So if someone’s looking for … Say for example I’m someone’s looking for somewhere to have their injectables, they’re not interested in having surgery. They just want to have injectables to maintain a level of youthfulness or to kind of fix a skin problem or anything like that, it’s kind of important to have a look at the qualifications and I guess the memberships that the person that’s gonna offer you the treatment has, isn’t it? So that things like that disaster that happened in that beauty salon last year don’t happen.

Dr Michael Molton: Yeah, yeah,

Trish: I don’t know. Like you said, it’s so trivialised, and I know because I look at myself as well and I trivialise it on myself. It’s like oh my god, I could really do with some Botox in that here. It’s kind of become the norm almost now. So years ago you’d go to the beauty therapist and you’d have a facial. Whereas now you just go down the road and have injectables in the same kind of breadth, so it’s quite simple and easy. And I guess that goes with, oh what would you call it? Kind of society changing.

Dr Michael Molton: Yeah. Absolutely. Hand in hand with that is that people need to do their research or need to as you mentioned a moment ago training these ones. We talked about a recognised course of study. But experience is also important. Even when you’ve been trained, you need procedures. And some people never get it. You have to be adept, you have to have those skills.

I can tell as an examiner for the College the moment a doctor picks up a syringe. I can tell from the moment they pick it up whether or not they’re gonna be good, bad, or average. You can tell by the demeanour. You can tell by the way they approach the patient. This is an art and a science, and it comes from experience. And it also comes from the fact that you have to really have that artistic dexterity to be able to do these, to be able to understand the science.

It’s really important to ask about how have you been doing these procedures, how many have you done, what complications have you seen? And you know what, I say this to a lot, anyone that says that they’ve never had or never seen complications, they’re either telling furfies or they just haven’t done enough work.

There is, not very often, but the one most important that they must know is how to how manage those complications, and inexperience is absolute disaster in those situations.

Trish: That’s so true. And you know that goes for surgical and non surgical because there’s always gonna be problems because everybody that you’re treating is a different person. They heal differently, they lead a different lifestyle. So it’s how those complications are handled that becomes the real issue and that’s what it’s all about, making sure that you get someone that’s properly trained and qualified. And like you said exactly, I think probably one of the most important things is the person that you’re going to has to have an aesthetic eye because it is about aesthetics. You can see people who’ve got all the qualifications, but they may not necessarily have the aesthetic eye as much as someone who may be less qualified kind of thing. So it’s still qualified to do a certain thing but maybe “less qualified.”

Dr Michael Molton: Yes. And they say beauty is in the eye of the beholder, but in our field of cosmetic medicine, we say look better not different.

Trish: Yeah.

Dr Michael Molton: And if you want to compare in any way at all between cosmetic medicine and cosmetic surgery, there are some fundamental differences in terms of that process. Is that in cosmetic surgery, you are going to look significantly different. And there are many, many, many patients that don’t want that. They want to look better, but they don’t want to look different. And so that’s why they choose the procedures that we perform. They want those subtle changes that help them look refreshed, more youthful, less tired, less angry, all those sorts of things.

Trish: I totally hear. I totally relate to it. You’ve actually said it perfectly. I don’t want to look different. So I reckon that’s the perfect way to explain it.

Dr Michael Molton: Look better, not different.

Trish: Yeah. But-

Dr Michael Molton: Say when we’re coming to see me, and people like me, it’s their greatest fear. It almost rolls off everyone’s lips for the first time that they’re seeing me is, “You aren’t going to make me look like a freak are you?” Because we see dysmorphia humongous blown up. And people that just don’t have the capacity for that. They’re not ideal candidates for those sorts of procedures.

They never work like that. The more product that you put in someone’s face, the more likely you’re gonna have a complication, a serious complication. We see these, and the problem is, with those things is the patients they feel embarrassed, they feel guilty that they’ve not done enough research, that they were persuaded and high pressured into doing something that they didn’t fully appreciate, didn’t understand. But they’re not right now to be complaining about it to the authorities. So very, very few of those patients actually make any complaint to a board or any of the other regulators.

Trish: Yeah, that’s so true. They just kind of live with it, because they think, “Oh, well I stuffed up.” Well actually just being too embarrassed to fess up and say what they had done and the fact that it was-

Dr Michael Molton: Well, they probably see themselves this manmade topic that was made up in Victorian times of the word vanity. People that come to see us in modern times have stories about relations, divorce, they’ve grown up, “It’s time for me now. I’m feeling a little tired.” People say, “I look angry. I’m not angry, I’m not tired. I’m not upset. I’m not worried. And I’m sick and tired of people asking me how well I am when I feel fine. I want to change that. I want to look better. But I don’t want to look different.”

Trish: Yeah, totally. I’ve seen a lot of those people out there that are the ones that look different. They’re just using too much or whatever it is like we’ve both seen them.

Dr Michael Molton: Absolutely. And it’s a great fear for a lot of people. But the best cases are the ones that you don’t see. And yet they just look more refreshed, but a little bit less angry, less tired, all those sorts of things.

Trish: Yep. Yeah, because it’s true. As we age, we naturally kind of do tend to take on that more … Or as a woman, you take on more that masculine kind of features, and you do kind of look a bit angry. And it’s true, some people they don’t mind. But some people they do. They just want to actually look better and just feel better about themselves and I’ve always been one to say if you don’t care, yep, great. More power to you. But that’s just not me, hey.

Dr Michael Molton: Well, and that’s right. There are other stories that patients come in with like I’m reentering the work force. I need to stay in the work force longer. And I’m in face of the public. I need to put forward a happier disposition, a more relaxed, a less tired, a less angry disposition. Because my job relies on that.” The combination of the socio professional impact of that agent as the population ages and we’re needing to stay in the work force or we’re finding ourselves back in the social scene has a much greater impact than it did years ago.

Dr Michael Molton: Because as you said earlier because of society’s changing.

Trish: And it’s progress. As years go on, like I recently had back surgery. And the discs that were replaced in my back, he used titanium as opposed to what they were using 20 years ago. So things change and things get better and we can do more things that we did 10, 20 years ago. And really aesthetic treatments are part of that whether we like it or not.

Trish: It may not be about having body dysmorphia. It may just be about the fact that, hey I know that I can look a bit better than I look at the moment which is what I want, if I do this. So I will. And that’s okay, too.

Dr Michael Molton: Absolutely, and it’s a very fulfilling process. You see the pleasure in patients when they come back. The pleasure that has come about with treatments. The patient had for years, and those another difference that we could apply to cosmetic medicine versus cosmetic surgery. Patients that come to see us, they don’t come once. They come maybe two or three times a year, some. Some might come once a year. Some might come twice a year, depending on what sorts of … Sorry, every other year or so on and so forth.

But I’ve got patients that have been coming to see me for 10 years. That’s quite different as a general rule to cosmetic surgery where you would have a singly procedure. You’d probably have a follow up and that will probably be it. You may never see that surgeon ever again.

Trish: That’s so true. That’s so true. Whereas in what you do, people will, yeah, they’ll come back and have their treatments on a more regular basis. I guess it’s more of a consumable for want of a better word.

Dr Michael Molton: Yeah, it’s just staying ahead as much as possible of the game. I think it’s very gratifying. It’s certainly gratifying for me to see patients that I haven’t see for two or three years that started off with a series of say treatments or whatever that don’t wear off. They stay with us always in front of what you would have looked like had you not had those sorts of procedures.

Where anti-wrinkle injections and general filler type processes are things that wear off and you go back to where you would have been had you not had the treatment. But there are lots of procedures that keep you and whether you continue on with them or not that keep you ahead of the game with that ageing process.

Trish: Yeah. I totally agree. And from a consumer’s perspective, I’ve actually had a few treatments where I haven’t sort of thought, “Oh, yeah.” And then six months later, I’m like, “Oh my god. I look better.” And I actually do look better than I looked 10 years ago. I’m not younger, but I just look better. I look more refreshed. Mind you I am happier because I look better as well. Do you know what I mean? It all kind of goes hand in hand as well. It’s very much like that.

Dr Michael Molton: It does, and there are a lot of people that talk about how self esteem and self confidence are improved with these sorts of things. I think that is a by-product. I don’t think that is a definition that we would apply to what we do or reason for what we do. It is just about helping people keep their appearance longer and letting them age not gracefully but not disgracefully either in a way that is entirely in line with the sort of ageing process that you would expect. Rather than this premature ageing that we see.

And we see this a lot in the Anglo-Saxon, fair skinned, light eyed patients. These are the victims of ignorance. And earlier years, decades ago when we didn’t understand about sunscreens and so on and so forth. And we see a lot of those patients. And we’re able to turn back the clock on some of those issues and help them look more the appearance of the age that they are.

Trish: Totally. Just lately I’ve become a little bit addicted with watching, and I don’t know how I came across it, but I became addicted with watching people with facial … It is a facial deformity, like where their chin kind of sticks out a heap and their teeth are all mangled. It was actually a Korean TV show that I was watching.

But the one in particular, there was this girl. And her jaw actually stuck out like it was an abnormality. There’s no doubt about it. And her teeth had kind of grown all here and there. And she was her shoulders down, and hunchback. And she spent her whole life in this state of absolute despair and hating herself. And then she applied for this show and got this great transformation. And she turned into someone who looked amazing. Her jaw was fixed, her teeth were fine. But it wasn’t even the way she looked, but the way she carried herself. You could see a complete difference in the way she carried herself just because the way she looked.

Dr Michael Molton: Isn’t that so true, isn’t that so true. And we see that day after day after day with patients. That boost to their confidence and so on and feeling a lot better. That feels really good.

Trish: Yeah. Well, I’ve got to say, I’m really looking forward to the … I love being in this industry. I’m really looking forward to seeing what’s gonna be happening now and what’s gonna be done to protect the public. And just kind of how it all kind of unfolds over the next however long it’s gonna be. And I love the fact that what I’m seeing now, and I am very new to the industry, but what I’m seeing is I’m seeing all these fusions of societies and colleges and everything kind of joining together as well, which is really nice because it’s all about just getting it right everyone isn’t it?

Dr Michael Molton: Well, absolutely. And over the years, it’s a little bit like not talking and then finding out that they’re actually really nice people and they actually carry the same values that we do. And that is the best way I could describe this process is that we’ve just so much discussion that we’ve found. We got so much common ground. And now we’re almost united body with their own mind.

Trish: Yeah. No, that’s so true. That’s so true. We’re all playing in the same playground. Might as well just get it right for everyone, hey.

Dr Michael Molton: Absolutely.

Trish: Awesome. Well thank you so much for your time tonight because I know it’s pretty late at night. Could be relaxing in front of the telly or something, but you’ve chosen to take the time to talk to us, so I really, really, really appreciate that. So can’t thank you enough for that.

Dr Michael Molton: No it’s my absolute pleasure, Trish.

Trish: Lovely. Thank you so much. So listen, if you do find it hard to navigate out there or if you’re trying to work things out or not sure where to go or whatever, or you just want a little bit of extra help with kind of guiding in the right direction, you can always drop us an email to info@plasticsurgeryhub, I could send you a whole list of all the different societies and the colleges and whatever.

Trish: In fact you can even just find them on our website as well. But, yeah, if you need any help just drop us an email. And thank you so much, Dr. Molton. Thank you so much for taking your time.

Dr Michael Molton: You’re welcome, Trish. Thank you.

Trish: Thank you. Bye.

Dr Michael Molton: Bye now.

Trish

Trish is a plastic surgery blogger. She is passionate about wellbeing, health and beauty, and doesn't mind a little bit of 'help' from the amazing cosmetic and beauty procedures that are available today. Trish spends her days talking to women and men who are looking for suggestions and advice on procedures that are available to them. Cutting through the sales pitch and hype, a down-to-earth response on general information is what you will get.

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