Forty-nine-year-old Jennei Hart is at a crossroads.
The mother of two lost nearly 200 kilograms between 2004 and 2006. She’s kept off the weight since then, and undergone procedures to remove excess skin — a by-product of significant weight loss.
But there’s another side effect she’s still grappling with.
“When you lose so much weight … it’s so sad, you become quite gaunt looking,” she says. “[My] cheeks, they’ve all dropped down.”
Although she’s a “newbie” to the realm of cosmetic services, Jennei has been researching, and seriously considering, getting enhancements done.
“I just want to be able to smile like I used to and be happy within my own skin,” she says.
But after the Therapeutic Goods Administration (TGA) tightened its guidelines earlier this year, much of the information Jennei is searching for — including whether a clinic offers specific services — now constitutes “illegal advertising”.
“We’ve always been taught to do the research, you know, find out what’s going in your body,” Jennei says.
“Now … this whole area, to me, feels like it’s blanketed and I’m back at square one.”
Australians collectively spend more than one billion dollars a year on non-surgical cosmetic procedures. The TGA says their guidelines are designed to improve public safety and address the “increasing vulnerability of young Australians influenced by advertising in the cosmetic space”.
But industry practitioners warn the crackdown could cost prospective patients time and money, and fuel international ‘cosmetic tourism’, which carries significant risk.
Cosmetic crackdowns
Under the Therapeutic Goods Act 1989, the promotion of prescription-only medicines, such as botox or dermal fillers, has never been permitted.
Most cosmetic injectables contain substances that are listed in the poisons register and cannot be advertised to the public.
Until recently, the TGA allowed generic references to prescription-only goods — such as the phrase ‘wrinkle-reducing injections’ — in advertisements.
In March, the TGA told the ABC it previously considered this to be a “pragmatic approach” that allowed cosmetic clinics offering prescription-only goods (such as botox) to differentiate themselves from those that did not.
But the agency says service providers were promoting the benefits of therapeutic goods, instead of just the availability.
As a result, the rules have changed.
Now, providers are banned from directly or indirectly referencing prescription-only medicines, including trade names, colloquial names and abbreviations, in all advertising and business names.
While compliance is voluntary, the TGA adds that any future action will be consistent with its regulatory framework. This means, while there is very much an incremental approach to policing compliance, non-compliance could mean charges.
“People do get criminally charged in the Federal Court because … the Therapeutic Goods Act is a Commonwealth Act,” law professor Christopher Rudge says.
The current spotlight on non-surgical procedures follows a crackdown on the cosmetic surgery industry, led by the Australian Health Practitioner Regulation Agency (AHPRA).
The agency received hundreds of complaints from patients and launched investigations into dozens of health practitioners. Fourteen doctors are no longer practising cosmetic surgery or face significant restrictions.
Vapes, Ozempic and botox
Dr Rudge is a law lecturer at the University of Sydney, whose research focuses on the regulation of therapeutic goods and the legal oversight of medical practice.
He says the TGA tolerated indirect references to injectables, like botox, for many years.
“Arguably, it was quite hard — and it will remain quite hard — for a health practitioner … to convey to customers that they provide botox without breaching the guidance,” he says.
Yet, he finds it “quite unusual” that the TGA is indirectly conceding that such advertising has been unlawful the whole time.
He explains there are two key reasons behind the guideline update and its timing.
“One [reason] is overall reform and the so-called crackdown on cosmetic surgery and procedures that has happened on the health practitioner side,” Dr Rudge says.
The other reason is a bit less obvious.
The TGA is responsible for regulating therapeutic goods, including prescription medicines, vaccines, sunscreens, vitamins and minerals, medical devices, blood and blood products.
In recent years, nicotine vaping products, medicinal cannabis and weight loss injections, such as Ozempic, have become key areas of concern.
Like botox or dermal fillers, these are prescription-only drugs, which means their advertising is prohibited.
Yet, usage is rising.
According to Dr Rudge, the TGA’s push to control the promotion of vaping, medicinal cannabis and Ozempic has — consequently — brought attention to cosmetic injectables.
“[The TGA] can no longer artificially exclude cosmetic procedure practitioners, and say, ‘Oh, you’re not counted as people who we’re going to enforce the law [on]’,” says Dr Rudge.
In a statement to the ABC, the TGA said it wished to resolve any inconsistency across all industry areas and to ensure consumers engage in consultation with health professionals, rather than be influenced by commercial advertising.
Information or advertising?
In December 2023, the TGA met with representatives of the cosmetic industry to inform them that it intended to change its position on previously allowed general references to cosmetic injectables in health service advertising.
But not everyone was invited.
Stefanie Milla is the chief executive of the Aesthetic Beauty Industry Council (ABIC), the largest organisation representing the industry, with 1,200 members. She says her organisation was not asked to participate.
According to Ms Milla, cosmetic practitioners, like those who are part of her group, are largely in favour of regulation that benefits the patient.
But she questions whether the updated guidelines will in fact limit a patient’s choice of practitioner. This could also end up costing clients thousands of dollars more.
“Previously, if a client wanted to improve, say, the appearance of certain facial aspects — for example, [the] under-eye area — they were able to access and research so many practitioners online … that specialise in that particular area,” she says.
“They were able to view results and then make their choices about who they want[ed] to go and consult with.”
Under the updated guidelines, Ms Milla says prospective patients will have to guess who provides a particular specialty, instead of being able to access such information online for free.
“Then [patients will] need to book in several consultations, each possibly costing over $200,” she says.
Jennei Hart worries this could be an expensive and mentally exhausting process.
“There are a lot of emotions that go into these procedures for me,” she says.
She says she’s reluctant to “bear my soul” and “expose my flaws” to dozens of practitioners and spend the money reserved for procedures on initial consultations.
Dr Rudge says the TGA’s updated guidelines bring the cosmetic sector back in line with similar medicalised industries.
“In Australia, you can advertise services, but you cannot advertise prescription drugs,” he points out.
“That’s why psychiatrists don’t [state] on their windows or their websites, ‘We will provide depression-reducing consumables.’
“They say, ‘We offer psychiatric services’. Then, if you have the consultation, people generally understand that one of the treatments that may be given is a psychiatric drug.”
Code words and promotional pictures
Under the Therapeutic Goods Act 1989, advertisers are not permitted to share testimonials, claims about goods, price lists, or before and after photos.
But given the TGA’s historically pragmatic approach to policing, many cosmetic practitioners and clinics were in the habit of sharing such material online.
Jennei says she found case study photos particularly useful.
“Because I’m a visual person,” she says, “That’s a little bit easy for me to see, ‘OK, so she had the problem like I had [and] that’s possible’.”
Yet, Dr Rudge understands why they can be problematic.
Even if these photos don’t explicitly state what work has been done — or what goods have been administered — there’s an indirect reference to the product, he says.
Such images, however, could be shared within a consultation, Dr Rudge adds.
ABIC chief executive Ms Milla says practitioners are concerned that the TGA crackdown will drive Australians overseas for procedures.
“It’s not anecdotal … We know that patients have gone, as they’ve informed us,” she says.
Experts warn cosmetic tourism comes with significant risk, as there is no guarantee to the standard of care or product being used. Australians who travel overseas for procedures risk being “botched”, suffering a medical complication or worse.
Since the TGA updated its guidelines, Ms Milla has seen some practitioners use code words to surreptitiously advertise cosmetic products.
“If you are removing this common language … you’re going to have practitioners … get creative about the language that they use,” she says.
“We’re actually seeing, now, practitioners referring to the products and services as ‘magic potions’ or other terms.
“Is that the type of communication that we want to foster? Don’t we want to foster clear, transparent, informed, controlled education?”
Right now, Jennei Hart is weighing up her next steps.
“I need to be responsible for my body and I need to know what’s going in and what your ‘magic potions’ or ‘magic pills’ are,” she says. “I don’t want to be doing this guessing work.”
She hopes this isn’t the end of her self-enhancement journey.
“It’s not about getting the big lips or getting totally wrinkle-free,” Jennei says.
“It’s about finding me again. Just that little glimmer of who I used to be and who I can be.”
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