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Old 26-10-2016, 05:10 PM
Newton Newton is offline
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Join Date: Oct 2016
Posts: 2
Default Are nurses allowed to inject botox and dermal fillers?

Hi guys,

What exactly are the rules on who can inject botox?

I've been getting injected by a nurse for years and she's really good. But I came across this article on the ABC website recently and now I'm not quite so sure? Has it changed recently? Seems pretty silly as I've been going for 5 years and neither myself nor any of my girlfriends have ever had any problems.

Cosmetic surgery crackdown: Cooling off period for patients among tough new industry guidelines

Australia's booming cosmetic surgery industry will undergo a major crackdown, with the Medical Board introducing tough new guidelines for doctors.
ted of them and we hope they will modify their practices."

Under the shake-up, all doctors will have to provide:

- Mandatory consultations either in person or via Skype for patients considering prescription-only injectables like Botox and fillers;
- A seven-day cooling off period for all patients considering a major procedure
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Old 31-10-2016, 11:25 PM
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doctornev doctornev is offline
Join Date: May 2006
Posts: 182

Hi Newton,

This is a good question. I can only offer up my opinion on the state of the law in Australia and some of this mightn't apply to other countries.

But thanks to a number of well publicised and unfortunately tragic outcomes the law in Australia has recently changed. As of the 1st of October 2016 Doctors must consult the patient personally before every cosmetic procedure including all botox, dermal filler and cosmetic injectable procedure. The botox or dermal filler can still be legally administered by a trained nurse but only if the patient has been first seen personally by a qualified Doctor who prescribes the botox/dermal filler before each and every cosmetic procedure.

As of the 1st of October 2016 a nurse-only cosmetic consultation for any dermal filler, botox or injectable procedure is illegal.

Ultimately, the safety, care and responsibility for the patient remains with the prescribing Doctor, not the injecting nurse.

The history of this new ruling is very interesting and the matter has only recently become clarified thanks to a number of high profile legal cases involving nurses and their supervising doctors.

In Australia all of the medications and products used for cosmetic medicine are generally classed as schedule 4 drugs a defined by the Therapeutic Goods Act (1989). This includes all commonly used injectables, dermal fillers and anti-wrinkle injections such as botox, dysport, restylane, radiesse, juvederm, emerval and xeomin. Under the TGA these schedule 4 drugs can only be prescribed by a Doctor recognised by the Australian Medical Board. Like many drugs, after the prescription is issued by a doctor, anyone with certification for drug delivery (such as a nurse or dermal therapist) can administer the dermal filler/anti-wrinkle injection.

In Australia the definition of the section under the TGA was thought to be non-specific. In the past many nurse injectors would administer botox or dermal fillers with very limited oversight by the "prescribing" Doctor. Typically the botox or dermal filler was “prescribed” by a doctor on an indefinite ongoing basis either prospectively (eg the prescription was good for years) or sometimes retrospectively (eg the doctor “prescribes” all of the botox/dermal fillers every month for every patient who was treated).

In 2015 and 2016 there were a number of well publicised and tragic cosmetic outcomes in Australia (Nurse suspended for injecting Botox: www.smh.com.au). In response to this the Australian Medical Board has clarified schedule 4 of the TGA. New guidelines have come into force on the 1st of October 2016. By law patients can only be treated with dermal fillers or anti-wrinkle injections if they have first seen a doctor immediately preceding the use of the injectables. The consultation must take place in person or via Skype conferencing. (Australian Medical Board Guidelines for Cosmetic Procedures)

Now you must understand these regulations do not say the majority of nurse injectors in Australia aren't skilled nor capable. Personally, some of the most skilled and dextrous people I have ever trained have been cosmetic nurses of lengthy experience. They are excellent. But unfortunately due to the actions of a few unscrupulous and unqualified nurse injectors the Medical Board has decided to act to place patient safety at the centre of Australian cosmetic medical care.

Ultimately, the prescribing doctor has always been responsible for any administration of any medication. The Medical Board has merely clarified this responsibility extends to personally talking to the patient before each and every procedure.
Dr Neville Lee See MBBS BSc LLb
Cosmetic Physician
Melbourne, Australia

Last edited by doctornev : 02-11-2016 at 12:57 PM.
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Old 02-11-2016, 12:53 PM
Newton Newton is offline
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Join Date: Oct 2016
Posts: 2

OK, thanks for clearing that up for me doctornev.

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