Know the Difference: Interview on Mamamia with Dr Amira Sanki

Dr Amira Sanki

On 8th December 2020, ASAPS Vice President and Chair of Education, Dr Amira Sanki, was interviewed by Mamamia in their podcast The Quicky on a range of cosmetic surgery topics including information on injectables, what each patient needs to know before doing any work on their face, the importance of getting the right advice and doing your research on your surgeon’s training and experience.

You can listen to the podcast here or read the transcript of that interview below.


Claire Murphy: From Mamamia, hi, I’m Claire Murphy. Welcome to The Quicky, getting you up to speed daily. Have you had a little work done?

Speaker 4: I get Botox in two areas on my forehead to target a couple of fine lines that I have. I mostly do it just because it makes me feel a little bit more confident day-to-day.

Speaker 5: I just got to the point where the lines on my forehead and around my eyes were starting to bother me more than they had been previously.

Speaker 6: I have started getting filler in my cheeks and under my eyes. Just want to look the best that I can for my age, and this is just one of those things that makes me happy.

Claire Murphy: Here in Australia, you’re not alone: the demand for cosmetic procedures has soared by up to 300% during 2020 due to what has been coined as the “Zoom effect” due to the increased time we stared at our faces on screens during meetings this year. But as we have clinics popping up in suburbs across Australia, what do we need to know before we start messing with our faces and what could potentially go wrong if we don’t?

Claire Murphy: According to the Australasian College of Cosmetic Surgery, Australians spent more than $1 billion on cosmetic procedures in 2017, and numbers have risen as each year has passed. In fact, we spend more on cosmetic procedures per capita here in Australia than they do in the US. We fork out the most on the anti-wrinkle treatment, Botox – around $350 million a year. Dermal fillers come in a close second, followed by laser and IPL, breast augmentation and reduction, and then liposuction.

Claire Murphy: How much we’ve spent in 2020 on looks is set to break records, with Australia’s demand for these procedures increasing dramatically this year. And it’s not just older Aussies looking for a nip and tuck either. There’s a trend towards younger women and men having Botox and lip fillers, some hitting 18 and heading straight for the cosmetic surgeon’s office. Charlotte Dand says she went in for her first treatment at 23.

Charlotte Dand: I’m actually a dancer, and I always thought about having some work done, but I was thinking in a few years. At that point, I was 21. And I was dancing and a gentleman once said to me, “Oh, you would look better if you didn’t look like you were frowning on stage.” And it was that moment that I thought, “Oh, my God, I need to get this done now.”

Claire Murphy: Did it escalate from there at all, Charlotte, or did you stick with just a bit of Botox?

Charlotte Dand: It did escalate over the course of the next couple of years. I went from having the Botox and then I started looking into fillers. And I did have lip fillers done for a couple of years, but after a while, my family said, “You just don’t look like yourself anymore.” And I started to think, “Okay, maybe I shouldn’t be getting this done.”

Claire Murphy: Was it expensive?

Charlotte Dand: Yes, absolutely. To maintain it, it was really expensive. It cost quite a bit because you have to go back every four to six months.

Claire Murphy: Were you made aware, at any stage whilst getting these procedures, of the dangers potentially associated with them?

Charlotte Dand: They do tell you about it. Obviously, they don’t want to scare you off too much. And when I first got this done, I was reading reviews on different companies and the side effects and what you should be doing after it. But I’ve heard a few horror stories, but luckily, it was no one too close to me. But I think when you’re in that mindset of, “I want to get this done,” and the power of social media and it’s in your face every day, when you’re so hell bent on doing something, I don’t think you think about all of that side of it too much.

Claire Murphy: You said you did a fair bit of research into what potentially might happen, but did you research the qualifications of the people that you ended up seeing to get the procedures done?

Charlotte Dand:Yes, when I first got it done, I actually went to one clinic and I was really unhappy with the consultation. I just felt like they weren’t giving me much information. I was asking them questions that I already knew the answer to, and I just wanted to see whether they were giving the same answer back. And I just wasn’t happy with it. So, I actually left and then I went to another place which I researched a little bit more about, but I know many friends who actually have not done anything, just gone in and got work done.

Claire Murphy: Do you think you’ll keep up some of these procedures as you get older, Charlotte?

Charlotte Dand: Well, I’ve been having the work done now for about six years. I have kept up the Botox, yes. It’s something that makes me feel a little bit more confident. Financially, if I can afford it, then yes, but it is a bit of a luxury. And unfortunately, in these times, it’s pretty difficult right now.

Claire Murphy: Dr. Amira Sanki, who’s on the Board of the Australasian Society of Aesthetic Plastic Surgeons (ASAPS), says young people looking to make changes to their face in their teens and early twenties need to make sure they’re getting the right advice.

Dr. Amira Sanki: A properly qualified and trained injectables practitioner will appropriately steer a person towards the best treatment to maintain their health and beauty. Women in their teens and twenties should really just be looking at photo-ageing and pollution prevention with good lifestyle and good skin care. And I would say that it is probably a bit too young to start surgical and nonsurgical procedures.

Dr. Amira Sanki: While women in their thirties and forties can introduce injectables and peels, and women in their fifties and sixties are starting to look at surgical options – there are no fixed rules. The key is to offer what is most appropriate to the patient.

Claire Murphy: Now, I’ve been reading quite a bit that there has been quite an increase in demand for procedures during 2020. Does COVID have something to do with this? Why are we looking to enhance our looks more this year than ever before?

Dr. Amira Sanki: COVID has been a really interesting introspective time for people, and that introspection has brought them to looking at their own health and how they’re looking and feeling. Interestingly, about 80% of our ASAPS plastic surgery members have noticed an increase in demand for aesthetic work. And 46% of our members have seen increased sensitivity of patients regarding their appearance.

Dr. Amira Sanki: I think people are actively trying to feel better during lockdown, and part of that is plastic surgery because plastic surgery is a way for people to feel more confident and more healthy, and to help people focus on their health, emotional happiness and wellbeing,

Claire Murphy: Is it beneficial or detrimental to start non-invasive cosmetic procedures, like Botox or fillers? If we’re freezing muscles now, later on in life, will that make them less wrinkly or is freezing them and not using them having the opposite effect? Basically, is it better to start younger on certain things like that?

Dr. Amira Sanki: It’s a really common question of patients to know what are the long-term issues, and that is a really intelligent question for patients to ask. We have a really great twin study that shows one of the identical twins having continuous Botox and the other twin did not. And the twin that did have neurotoxin to paralyse the muscles of the face actually looked better in the long term.

Dr. Amira Sanki: I suppose the way to think of it is that if you’re constantly squeezing the fabric of your dress or shorts, then that’s going to put that wrinkle in more permanently, whereas if you’re intermittently ironing out and then wrinkling it again, then it’s going to look less obvious. From a medical point of view, we do have good evidence that repeated botulinum toxin injections actually improve the way your face looks in the long term.

Claire Murphy: But it’s not all Kardashian lips and frozen forehead wrinkles. Along with the trend for the procedure, comes risk. And with demand come those who enter the market for the money without the proper training or qualifications, those who import laser machines from overseas by passing the strict Australian testing requirements, those who may not have proper sterilisation practices. Last year, doctors in Australia reported an increase in requests to fix cosmetic procedures that had gone wrong, something Eleanor knows all about.

Eleanor: I got fillers last year in June because I was excited to try them out. And I thought, “Why not?” I would try everything once. So, I got about one mil in my lips. I was really happy with the results. At first, they weren’t too obvious or fake looking, which I really liked. I really wanted a natural look. I was told that they would last about three to six months max. And it was December when I realised that they were a bit too big. So, that’s over a year later and they hadn’t gone down at all.

Eleanor: I raised the alarm with my nurse, and she said that it was super unusual and that I should get them removed. She didn’t know why they had still stayed for over a year, but we decided to go forward with the removal and we dissolved my lip fillers. What had actually happened is some of the filler in my upper lip had migrated above my lip. It gave me that look of a duck lip, flipped up a bit. Overall, I just wasn’t happy with what it looked like. Along with it not dissolving for over a year, it also had changed the appearance of my lips entirely. And so, we dissolved them, and yeah, everything’s been good ever since.

Claire Murphy: Filler accidentally injected into an artery on a woman’s cheek caused swelling, ulceration, and left a scar. Lip filler left lumps all over a patient’s mouth. There were facial burns from an ultrasound machine that had been illegally imported. A woman was permanently blinded after filler was accidentally injected into a blood vessel near her eye. And these are just some of the incidents that were reported in the past couple of years.

Claire Murphy: A Victorian beautician was shut down completely after it was revealed that she may have exposed her clients to serious infections, including HIV. Dr. Sanki, how do we know if someone is properly qualified in this area? I read that any medical doctor, regardless of what their specialty is, can call themselves a cosmetic surgeon.

Dr. Amira Sanki: Every plastic surgeon would see, on a weekly basis, someone who has been “botched” by a non-qualified doctor calling themselves a surgeon when they are not. And that also extends into the non-surgical space as well. People who weren’t properly informed. To give you an example, I had a very dear friend of mine, she’s very slim, she’s a runner, she’s a really intelligent woman, she wanted to have the bags under her eyes filled up.

She felt that she made a rush decision to have fillers done to her lower eyelids, which is a notoriously tricky area, and then suffered a lot of bruising and visible filler, which was really unsightly. And she was an incredibly intelligent woman, an investment banker. So, she felt silly to have been rushed into this decision. Fortunately, she was able to have that filler dissolved, and often, there are some good solutions to these problems, but really the best solution is to just make an informed decision from the start.

Dr. Amira Sanki:

Within the surgical space, 90% of cosmetic surgery patients would choose a non-accredited surgeon because they feel that they’re going to pay less and it’s less expensive. But when they look back in hindsight, 80% of Australians would say that the title of cosmetic surgeon implies that a doctor is a registered specialist. And if they had known better that that person wasn’t properly qualified, they wouldn’t have gone ahead with the procedure.

Claire Murphy: How, Amira, do we then find out who is qualified? If we’re going to, we presume, to a doctor’s office associated with a hospital, we would presume that that is someone who is qualified. What about all these places that we’re seeing now, these clinics that are popping up in suburbia, who are not linked to a hospital, in shopping centres. How do we find out if those people are qualified or not?

Dr. Amira Sanki: That is a really simple thing to look for. A plastic surgeon has the five letters after the name, F-R-A-C-S, specifically in plastic surgery. The FRACS is the diploma that’s awarded by the Royal Australasian College of Surgeons that actually says you’re a surgeon. And it is a protected title. It is the only title recognised by the medical board of Australia.

Claire Murphy: Could we ever find out, if those “cosmetic surgeons” have had complaints against them, do we have a way of knowing, of finding out? Is there a record of that anywhere?

Dr. Amira Sanki: The Australian system is actually very transparent, and the way that people can research their doctor is to look up on the AHPRA website, which is the Medical Board of Australia. And every medical practitioner and nurse, and even paramedical practitioners are listed there. And then, you enter that person’s name and you will have not only their qualifications, but also any endorsements and also any complaints that have been made against them, and any conditions on their registration.

Claire Murphy: Now, there’s going to be a bunch of people who say, “But I’ve had my lip fillers done at the beautician and it’s been fine. And it’s way cheaper than going to see a qualified plastic surgeon.” What do you say to those people who might be potentially putting themselves at risk?

Dr. Amira Sanki: Look, there are actually many highly qualified and experienced injectors working in beauty salons and clinics. But the important message here though is for patients to understand that they are having a medical procedure. They’re not clients, they’re patients. And the best way to have this procedure safely is to know the difference between a non-surgical sweatshop that is pumping through patients, and a proper medical practitioner, who has been trained in injectables, has good experience, taken a full history and examination, explained the expectations, risks, and alternatives to the procedure.

Dr. Amira Sanki: I think the way of looking at your injectables practitioner, whether they’re a nurse or a doctor, is that they really shouldn’t be something that you’d just pop into. They should be just like that campaign, your GP for life, they should be your injector for life, and you should really have a solid long-term relationship with your injectables provider.

Claire Murphy: The AHPRA website that Dr. Sanki mentioned, the Australian Health Practitioner Regulation Agency, does include those surgeons who are registered, but as was exposed by a Four Corners investigation in 2018, it doesn’t keep a list of all the sanctions that doctors may have been under any time they may have had a case go badly. So, whether you get cosmetic procedures or not is your choice. At what age you choose to start is also a choice that is yours to make. And as we heard Dr. Sanki say, there are some long-term beauty benefits from starting younger.

Claire Murphy: But if you do, there’s a mantra we learned in the making of this episode. If it’s cheap, check twice, because it’s a medical procedure, you are a patient, and you need to make sure you’re not putting yourself in the hands of someone who could risk your face, your sight, maybe even your life. That’s The Quicky for today. This episode was produced by myself, Claire Murphy, with audio production by Ian Camilleri, and guest booking by Mel Zower.

Claire Murphy: This episode of The Quicky was brought to you by Qoin, Q-O-I-N. Start your digital currency journey today.




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