PRP And Skin Rejuvenation: Trends, challenges and the impact of the new guidelines

In the lead up to the National Cosmetic Medicine Summit, we were delighted to be able to have a word with Dr Herbert Hooi, who is both Chairing and speaking at the Summit. Dr Hooi gives us a sneak peek at his specialty areas, what’s trending right now, and the likely impact of the new guidelines.

1. Tell us a little bit about your background.

I’ve been performing cosmetic medical procedures for 10 years and am now in full-time cosmetic medicine.

Prior to that, I was a busy emergency physician and for a number of years practised as a lawyer and medical administrator. I became interested in cosmetic medicine in my junior medical officer days but there was no formal training nor career pathway 25 years ago. Over 10 years ago I underwent further study and training in cosmetic medicine and was elected as a Foundation Fellow of the Australasian College of Aesthetic Medicine in 2009.

2. What have been some of the highlights of your career in cosmetic practice?

I’ve been fortunate to have a number of highlights so far in my cosmetic medicine career and hopefully there’ll be many more to come!

The biggest honour I’ve had so far is to be asked to speak on the Australian experience with PRP in Venice at the Biobridge in 2013 and to be subsequently asked again to speak in the following years. In 2013, I followed a number of European and South American speakers and I can say that, at least with our clinical practice and results, Australia acquits itself very well when compared with the rest of the world.

I would also include amongst the highlights being elected to Foundation Fellow of the Australian College of Aesthetic Medicine and being fortunate enough to be able to speak about and train other doctors and nurses on PRP.

But the biggest highlights really come in everyday practice when you have changed someone’s life with what you do.

To have a patient start crying with joy because you’ve made such a positive change to their appearance and self-esteem is extremely gratifying. This is even more so for my migraine sufferers who can often get their lives back with a simple series of ‘anti-wrinkle’ injections.

3. You are speaking on PRP and skin rejuvenation. Without giving too much away about your upcoming presentation, how is PRP being used in cosmetic practice and what are the advantages or disadvantages over other methods of skin rejuvenation?

Platelet rich plasma is one of those treatments that really stood out for me when it first came to market. Long before it was used for cosmetic purposes, it was utilised in surgery and dentistry to help wound healing and to stimulate the growth of bone in bone grafts.

About 10 years ago, someone conceived the idea to start injecting it into normal skin and discovered it had a rejuvenating effect. In addition, it also seemed to help stimulate hair growth. PRP is currently widely accepted and is being used for skin rejuvenation, male pattern baldness and as an adjunctive treatment for accelerating wound healing after other procedures such as laser skin resurfacing throughout Europe and Asia. More recently, it has started to become used in gynaecology to ameliorate vaginal ageing and to help erectile dysfunction.

It has an advantage over most other cosmetic injectable treatments because it is entirely natural, using the patient’s own blood. This appeals to many patients as nothing ‘foreign’ is being injected. It also has relatively little downtime compared with laser resurfacing or dermal fillers for example. The changes in appearance are gradual and alleviates embarrassment to the patient by avoiding more dramatic changes such as with dermal fillers or with surgery. The risk of looking ‘overdone” with PRP is likely to be almost zero.

Being a natural treatment is also a disadvantage. When stimulating a natural physiological process, there will always be a variation in response amongst any randomly selected group of people. So not everyone will see a benefit from PRP treatment. As it is an injectable treatment, the occasional development of bruising can lead to some social downtime, similar to other injectable treatments.

4. You will be chairing the regulation and best practice stream, and you have an honours law degree and are admitted to practice as a solicitor.
What are some of the key regulatory changes facing the cosmetic industry in Australia and how will this impact those working in the industry?

The Medical Board of Australia introduced National Guidelines for Medical Practitioners practising Cosmetic Medicine and Surgery late last year. These long awaited Guidelines followed on from developments overseas such as the United Kingdom’s 2013 Keogh Review.

Some of the key recommendations included:

• Providing that medical practitioners offering cosmetic surgery should obtain appropriate training
• Instituting mandatory ‘cooling off’ periods for all procedures other than minor medical procedures
• Guidelines for providing cosmetic surgery for patients under 18
• Mandating face to face or video consultations with a medical practitioner prior to the performance of cosmetic injectables
• Guidelines for having formal arrangements for post-procedure care and managing complications, whether provided by the medical practitioner or someone else
• Guidelines that provide for the performance of a procedure in a facility that is appropriate to the level of risk involved
• Restrictions on financial arrangements that were commonplace prior to October 2016 such as third party financing schemes

For many clinics, the Guidelines represented ‘business as usual’ and therefore did not have much, if any, impact on their practice. For others, it provided a baseline and an incentive from which they could incorporate current best practice into their businesses.

Many, but not all, registered nurses, perform cosmetic medical procedures under the supervision of a medical practitioner and the Guidelines would have a direct effect on their practice. However, the practical impact of the Guidelines on ‘independent nurse prescribers’ providing cosmetic injectable treatments remains unclear. As they are not medical practitioners, it would appear that the Guidelines do not apply to them, considering the Medical Board of Australia does not have legal jurisdiction over the practice of registered nurses or any other person (who is not a medical practitioner).

I am aware that the Nursing Board has a Position Statement on nurses and cosmetic procedures. This is more of a general statement of expectation rather than a more detailed guideline.