South Africa: As cosmetic procedures become more popular in South Africa, reports of complications and “failed” results are becoming more common. In my view, the most important issue is not the procedures themselves, but who is performing them and why patients are seeking them.
A plastic surgeon’s guide to avoiding cosmetic mishaps
One of the biggest dangers I see now is the use of unqualified doctors. In South Africa anyone can identify themselves as ‘cosmetic doctorhowever, I have observed how a lack of anatomical knowledge and poor sterile techniques can lead to serious complications that require complex reconstruction.
Technology, and social media in particular, plays an important role here, not only in creating unrealistic expectations, but also in reinforcing a dangerous environment. Nowadays, patients are more aware and critical of their appearance due to selfies, video calls and filters.
But surgery can’t replicate FaceApp or Instagram filters, but I continue to see influencers promoting clinics and practitioners without credentialing and often using edited “before and after” images.
The issue is compounded by widespread title confusion in South Africa. There is no understanding of who is actually qualified to perform various cosmetic procedures.
Inspection of injection material
For injections like Botox and fillers, I advise patients to see a plastic surgeon or dermatologist. A doctor may be acceptable if they have properly accredited aesthetic training, but I advise patients to be wary of practitioners who have trained through short courses or “weekends”. Currently, hair transplants should only be performed by doctors specially trained in hair restoration surgery – often plastic surgeons or dermatologists with this expertise.
Opening surgery
When it comes to surgical procedures such as breast augmentation or liposuction, only a plastic and reconstructive surgeon registered with the Health Professionals Council of South Africa (HPCSA) and the Association of Plastic, Reconstructive and Aesthetic Surgeons of South Africa (APRASSA) can perform these surgical procedures. This is impossible.
When the wrong provider performs the wrong procedure, the risk of complications increases dramatically—and the adverse effects are often more difficult to correct and carry the risk of permanent damage.
These are not uncommon scenarios. They are problems I see regularly in clinical practice, often related to poor physician selection, poor treatment choices, or excessive intervention.
Common examples include overfilled faces resulting in distorted proportions, bad Brazilian liposuction or Brazilian Lift (BBL) leading to asymmetry or in severe cases fat embolism, and poor breast surgery resulting in capsular contracture or implant misalignment.
What products to use
Uncontrolled product use is another issue – one that is growing. Botox and fake fillers are very dangerous. In some cases, complications include tissue necrosis (skin death), long-lasting granulomas (hard lumps), and permanent damage.
Regulatory approval of products used in cosmetic procedures is black and white. If the product is not approved by the South African Medical Products Regulatory Authority (SAHPRA), should not be used.
Credential check
Credentialing is the most important step to make sure that the professional you are using is fully qualified and everything is above board. Patients should check HPCSA registration and APRASSA membership before inquiring about training and experience. And finally, insist on a proper consultation that includes a complete medical history and risk discussion.
In terms of warning signs, rush orders and extremely low prices should raise immediate alarms. If a practitioner is doing a one-day consultation with a push for procedures, that’s a red flag, and if the prices seem too good to be true, they probably are.
Aftercare is also important. If your provider disappears after the procedure, this is a serious warning sign.
Take away
Cosmetic procedures – even “afternoon treatments” – are still medical procedures and carry risks. However, when done correctly, cosmetic work can be safe and beneficial. But if done badly, it can have serious consequences.
Who is the author?
Dr. Nombulelo Metuse
Dr. Nombulelo Metuse is a plastic and reconstructive surgeon born in Welkom, Free State and raised in King Williams Town, Eastern Cape. He received his MBChB from the University of Limpopo (MEDUNSA) and his Masters (MMed) in Plastic Surgery from the University of Pretoria (UP). He is the first black plastic and reconstructive surgeon to qualify from UP. He has more than 12 years of service in the public sector and 5 years in the private sector.
Specializing in cosmetic plastic surgery, aesthetics, and craniofacial surgery, Dr. Metuse is passionate about education and believes that an informed patient is the best fit, so he spends more time educating patients.
