A pretty design is not everything

Beautiful photos on Instagram. A marble counter, dried flowers, a scented candle, a soft sofa. It looks like a salon from an interiors magazine.

And that is exactly the moment to ask one uncomfortable question: who is actually going to perform the treatment, and are they allowed to?

Because the number of places where you can improve your looks is growing at a headlong pace in Poland. And a pretty interior says nothing about whether the treatment will be safe.

Two kinds of saving, one price

Not every establishment follows the rules. It happens that instead of common sense the decision is made by arithmetic — the patient wants to save, the owner wants to earn. The bill for that comes later, and it is always the first party who pays it.

I have seen how painful and costly the consequences of a treatment with hyaluronic acid, another filler or threads, carried out in a beauty salon, can be.

Abscesses and skin infections are only the beginning of the list of complications. In the worst cases it came to irreversible disfigurement and even to necrosis.

How it works with us

At Dr Kuschill MEDESTETIS clinics the rule is one and very simple: all treatments that breach the continuity of tissue are performed exclusively by doctors.

• Cosmetologists — after five years of study and specialist practice — Laser procedures, peels, operating advanced treatment devices.
• Aesthetic medicine doctors — after medical studies, courses, postgraduate studies and practice under the eye of professors — All injectable treatments.

This division is, first, compliant with the law, and second — it is what guarantees patients the standard of care the brochures talk about.

Aesthetic medicine: a name anyone may use

Here we come to the heart of the problem.

For years doctors have been drawing attention to treatments performed by unauthorised people. The demands in this matter are also supported by the Chief Sanitary Inspectorate, which runs an educational campaign, “Do not pay with your health for your looks”. Its aim is to promote beauty salons, hairdressers and manicure studios in which the treatments are performed by competent, educated people and the premises themselves meet sanitary requirements. Safe studios are marked in this initiative with a special symbol.

There is no mention there of injecting botulinum toxin alongside a manicure.

The problem is that the Inspectorate's initiative does not cover aesthetic medicine establishments. And the name “aesthetic medicine” may today be used by practically anyone — including someone with no medical education. That misleads patients very effectively.

If we are talking about medicine, then doctors should be the ones practising it. It seems obvious. In practice it is not.

Why a treatment room should not look like a salon

Many patients assume that a fashionable place that photographs well on social media is a guarantee of professionalism.

The opposite thought occurs more rarely: that a treatment room that looks like a lounge may simply not meet sanitary requirements.

The rules here are hard. All surfaces in a treatment room have to be easy to clean, and treatments are performed on a medical couch or in a medical chair.

That is why I immediately rule out “home visit” services. A mobile treatment room cannot be sterilised. That is a straight road to complications — and non-sterile instruments are one of the most common causes of infection with hepatitis B, and even C.

There is also a second argument, which is mentioned less often. A person who comes to a patient's home has no way of reacting when a complication appears.

The kit nobody wants to see in use

The first criterion of choice is competence, not the price list. We look at the price list only at the end.

If not a single doctor works in an aesthetic medicine practice — I advise against it.

Why? Because a doctor knows the risk of every treatment and knows how to react when something goes wrong. A treatment room has to contain a resuscitation kit and adrenaline, which is administered in anaphylactic shock. There also have to be preparations that neutralise the substances used — needed, for instance, when filling wrinkles with hyaluronic acid, if symptoms of ischaemia appear in the area supplied by a particular artery, or an allergic reaction.

It is equipment whose existence nobody wants to check in practice. But its absence at a critical moment changes everything.

Where does a beauty salon get botulinum toxin from

I ask myself that question every time.

Botulinum toxin is a medicine. As a medicine it may be bought and administered exclusively by doctors. That is why all injections should be performed only in medical practices — first, because only there are they done by people authorised to do so, and second, because only there are the preparations verified and properly stored.

The preparations administered in beauty salons most often come from uncertain sources. In the worst case they are bought over the internet on foreign auction sites. They meet no standards at all and are simply dangerous.

Besides the origin, storage matters. Most preparations require refrigerated conditions. If a practice does not have a suitable refrigerator — that is reason enough not to use its services.

How to check before you book

The first source of information is usually the internet. You just need to know what to look for in it.

• Has this person actually completed medical studies? You can check that in the Central Register of Physicians. It takes a moment, and few patients do it.
• Are the reviews you are reading worth anything? Popular sites treat aesthetic medicine doctors on a par with cosmetologists, beauticians and enigmatic “natural medicine specialists”. Those are not comparable categories.
• How the doctor looks. That is not a joke. An aesthetic medicine doctor is the best calling card of the place where they work. If they are well groomed and look natural, they are unlikely to let a patient leave with caricaturally enlarged lips or an immobile forehead.

Quite a few patients come to me on a recommendation. For a doctor there is no greater compliment. For a patient it is concrete information: that a given specialist's taste matches her expectations.

Diagnosis, the difference you cannot see in a price list

There is one more argument for a medical practice — the possibility of a diagnosis.

Before I propose a treatment plan, I take into account:

• the precise condition of the skin,
• general health,
• the kind of work done,
• allergies,
• lifestyle,
• the patient's expectations.

Only from that does a treatment plan emerge — one that does not take the patient out of her life and best emphasises her natural beauty.

A patient who ends up with an incompetent person has in practice to diagnose herself. And when the person performing the treatment makes a mistake — she is left alone with it.

And that closes the circle. The saving that pushed her towards a random establishment ends in an expense far greater than a visit to a doctor. Plus time, which nobody will give back.

A pretty design is not everything. It is in fact the least important thing on the list.

This article was prepared by Joanna Kuschill-Dziurda MD PhD — specialist in allergology and internal medicine, physician in aesthetic medicine.