Huang’s death shows risk in fly-in, fly-out cosmetic surgeons

We have all heard of fly-in, fly-out workers. They are a vital part of the national economy, whether working at mines or building sites, and come from as far away as New Zealand. In remote regions, fly-in, fly-out doctors are common. These people provide valuable services. But fly-in, fly-out cosmetic surgeons from China?

The first many of us heard about this phenomenon was after the death of Jean Huang in inner Sydney last month. The 35-year-old was undergoing a procedure in a cosmetic clinic of which she was the part owner. Two women have been charged with manslaughter over the death.

Huang died after being injected with three substances including a sedative and hyaluronic acid, a restricted substance. This is a lip filler, among other things, that is sometimes used in breast augmentation. The woman who performed the procedure was a fly-in, fly-out Chinese national on a tourist visa who reportedly has a Chinese medical qualification and a dermatology qualification from Britain. She was not a registered medical practitioner in Australia.

Huang’s death comes amid persistent attempts to review the practices of cosmetic clinics and a class action instigated by clients of Sydney’s The Cosmetic Institute. This business, they claim, has been the scene of several “near misses”, allegedly caused by problems associated with anaesthesia, despite its status as a regulated and ­licensed cosmetic clinic.

Australians spend more per head of any country in the world on cosmetic surgery and treatments are widely advertised online and in the press. How can this happen in a country in which the products of the smallest delicatessen or takeaway food shop are regularly inspected for health and safety? How can it occur when the administration of anaesthesia and toxic substances is regulated by myriad rules and legislation?

The problem with cosmetic procedures — invasive and superficial — is that they overlap with medical procedures. Even the term cosmetic surgeon is vague and open to interpretation. In fact, there is no speciality of cosmetic surgery.

Mary Dingley is a spokeswoman for (and former president of) the cosmetic surgeons association and has been working in the field in Queensland for 30 years. She explains that her organisation represents general physicians working in cosmetic procedures. Most, like her, do not perform invasive surgery. This is left to plastic surgeons, who undertake years of complex surgical training.

Cosmetic surgeons inject fillers and Botox, perform laser skin treatments, can guarantee the safety of the products they use and are fully qualified to administer local anaesthetics.

Lately there have been reports of patients coming to cosmetic surgeons to fix things that have been botched by amateurs who have started cosmetic clinics with no training. A Canberra-based cosmetic surgeon tells me she has treated scarring that required skin grafts, as well as a young girl who had been left with stripes on her neck after a friend had used a laser on her.

Dingley says there is a growing market for illicit Botox obtained from South Korea or Pakistan. Botulin toxin type A is a dangerous substance, but the supply “cold chain” from these places cannot be guaranteed.

Cosmetic clinics are often registered medical practices with a doctor or nurse present, although the level of expertise varies. Some clinics employ mobile nurses, and the advent of telemedicine means some places use a doctor only on Skype. Other clinics attract fly-in, fly-out practitioners who are not subject to medical discipline in Australia.

Another problematic layer consists of everyday beauty salons that use the word clinic in their name and give personnel, usually beauticians, medical-style titles such as nurse, complete with white coat. Staff members in such salons are not supervised by the Australian Health Practitioner Regulation Agency.

A significant area of concern for Dingley and other doctors working in this area is advertising. There are rules about advertising for medical services. Some cosmetic salons with fly-in, fly-out workers cater specifically to the ethnic markets and advertise in the ethnic press.

For example, the Chinese press is full of advertisements for cosmetic eyelid surgery. Unless the advertisements can be regulated, it is hard to see how this business can be stopped. This is one area where governments can step in to offer a practical solution.

It is time governments stopped using the excuse that this is a complex area. Yes, on the one hand, this would seem to be a medical issue and in the provenance of medical oversight; on the other, it seems to be a straightforward case of buyer beware.

However, as I discovered, this is not necessarily true because if someone is not a doctor, or even in the best-case scenario is a poorly trained doctor, how does the average consumer judge the situation without the oversight of government regulation?