Statement from The Aesthetic Physician Association of Malta (APAM)

On behalf of all APAM (Aesthetic Physician Association of Malta) members, we, would like to issue the following statement on Aesthetic Surgeries done abroad.

Though Aesthetic Surgeries do not fall under our remit, we have, in the past few months, been inundated with queries from our patients about doing Aesthetic surgeries abroad, were many times the prices are extremely attractive.

We would like to make it clear, that we are neither here nor there on this issue, but having the patients’ best interest at heart, we would like our patients to reflect on the following points before going ahead and booking such an important life event.

1. Price

Price is, and always will be an issue. However, one has to keep in mind that if at times the price is too good to be true, it usually is.

Always ask why the price is cheaper. What is being compromised.

If one is convinced that nothing is being compromised, go ahead, everybody loves a good price.

1. Licencing

Always check that the doctor/hospital doing the surgery have all the necessary licences. This can very easily be checked by a simple Google search.

Same should be done to any doctor practising in Malta. Always check they are registered with The Medical Council, thus ensuring the highest possible care and standards possible.

1. Standards

Always check that the doctor/hospital doing the surgery adheres to high standards. Feedback and criticism from past patients are extremely helpful.

1. Aftercare

Aftercare is of the utmost importance, especially in major surgeries. Always check that you will receive the best aftercare especially when going abroad. If need be, prolong the stay abroad, so that any problems that may arise after surgery, will be given adequate time to be taken care of.

1. Complications

Always be aware, that even the best of the best DO have complications. The difference between a good doctor and an excellent one lies in the way one deals with complications. Always check the complication rates and the way that doctor deals with complications.

And here lies the problem of doing major surgeries abroad. In the case of complications occurring after one returns to Malta, the doctor who did the surgery, cannot be reached.

Thus, to all our patients, please think carefully before you book any surgery. This is an important decision. Choose wisely and always inform yourself properly.

Dr. Jason Debono - President

Dr. Joanna Delia - General Secretary

Dr. Charlene Scicluna - Treasurer

Dr. Tyron Pillow

Dr. Anna Maria Fenech Magrin

Dr. David Grech

Inflammation in Dermal Fillers site after COVID Vaccine.

Trials in the development of SARS-COVID vaccines have indicated that people with dermal fillers may experience mild side-effects.

Here are some Frequently asked questions which Dr. Jason Debono MD - Aesthetic Physician and President of the Aesthetic Physicians’ association of Malta has kindly answered.

Q. What are the side-effects related to fillers mentioned in the news?

In the Moderna mRNA-1273 trial, 3 reactions were possibly related to dermal fillers out of 15,184 vaccine recipients. The ‘side-effect’ was a mild to moderate swelling, around the area of the dermal filler, due to a delayed hypersensitivity reaction.

Q. Is this related only to Moderna vaccine or to all other COVID vaccines?

Millions of COVID vaccines have been administered to date, under many different brands. This swelling has only occurred with the Moderna vaccine till now, and might I add, is a very rare event.

Q. Do these side-effects happen with any particular brand of fillers?

No. It can happen with all Hyaluronic acid filler brands. Keeping this in mind, it is always very important for patients to ask and keep tabs on what dermal filler brand has been injected. This so as to help Aesthetic Physicians make a better decision on how to treat the patient in the eventuality of any complication.

Q. Is the swelling temporary? And can it be treated?

Though the swelling often resolves without any treatment, doctors can also require the use of pharmacological treatments such as oral corticosteroids and/or hyaluronidase to treat the swelling. The swelling usually goes down after a few days.

Q. Does this side-effect happen only with vaccines?

No. Interestingly enough an article was published on the 25th April 2019 - Delayed hypersensitivity reaction to hyaluronic acid dermal filler following influenza-like illness (by Mohammed G Turkmani, Koenraad De Boulle, Wolfgang G Philipp-Dormston)- showing increasing evidence that implicates influenza and influenza-like illnesses in the pathogenesis of late onset filler reaction. They also concluded that although the risk of late onset adverse reaction with hyaluronic acid fillers is extremely rare, injecting physicians must be aware of the possible filler reaction following the influenza infection.

Q. Should patients be discouraged from injecting Dermal Fillers?

Not at all. Hyaluronic acid Dermal fillers licensed for use in Europe have been shown to be an extremely safe intervention. However, doctors and even patients must be aware of these rare events, and be assured that these can very easily be treated and are mostly completely reversible. Patients should also not be discouraged from taking vaccines. On the contrary, seeing that these side-effects can also be due to any influenza-like illness, patients should be encouraged to take vaccines. Also patients who have had vaccines should not be precluded from receiving dermal fillers in the future.

Q. What is your advice in view of this information to any patient who wishes to do Dermal Fillers?

It is extremely important for the patient to ensure that these treatments are done by a fully qualified and experienced Aesthetic Physician, who are experts in both the injection of dermal fillers and management of complications arising from them. Doctors and even patients should keep tabs on the medical history and treatments done, taking note on the brand of the dermal filler, date of injection and also amount used in each treatment.

BOtulinum TOXin and Fillers are two of the most sought after cosmetic medical treatments locally. They have become more accessible and the general public has a better understanding of what the treatments entail. Whilst such treatments are seen to ‘beautify’ and ‘enhance’ one’s appearance, lines are sometimes blurred in the public’s perception of what is considered as a beauty treatment and what is really a medical treatment, albeit one designed to enhance personal appearance. The second this happens, a pandora’s box full of complications, risks and mistrust in Aesthetic Medicine is opened.

Why does it have to be a Doctor to inject some filler in my lip? Why does it have to be a Doctor to plump up my cheeks? Answer - Because it is not just about plumping a bit of volume or shaping here and there ! It is so much more than that. In the face and scalp, there are 27 artery and vein structures, 42 muscles and nerves supplying the whole system. Whilst you may just see a pair of gorgeous lips, the Doctor injecting your filler is making a mental note of all the structures which are invisible to the naked eye. The Doctor is using his extensive knowledge of anatomy to avoid dangerous structures and avoid serious complications. The Doctor is keeping in mind how the muscles work in order to avoid creating drooping and excessive weakening of such structures causing unwanted complications.

Another important fact that one should keep in mind is that not everyone has textbook anatomical structures. The phrase ‘we are all unique’ does not apply just for the outer appearance, it also applies to what’s underneath. Whilst the risks of undergoing such treatments in the hand of experienced Doctors is minimal, on rare occasions, one may experience a complication which needs to be treated. Such complications sometimes require swift medical treatment in the form of injected and/or oral medication and also close review of other symptoms that may arise. That moment is when one would have wished to not just look at a cheaper cost, but at proper qualifications and experience.

It is the knowledge that is ingrained in a Medical Doctor that will manage a complication from becoming very serious and not a ‘one-day seminar’ that awards one a certificate of attendance. Aesthetic Medicine treatments are not beauty treatments. They are safe treatments aimed to improve one’s appearance only when administered by qualified Doctors.

Would you visit someone claiming to be a dental expert just because he/she has attended some short seminar claiming to have taught them how to fill a tooth, or a properly qualified dentist who has invested years of his/her life to become a proper expert in their field?

Never risk your health for a bargain. Choose a fully qualified, registered and properly trained Medical Doctor for your cosmetic treatments.

In September 2017, the European Committee for Standardization, CEN, launched the European Standard for Aesthetic Medicine and non-surgical medical treatments, including all injectables and regulating equipment such as Lasers used in dermatological and cosmetic medical treatments and the implementation of these standards in European Union member states has been obligatory since December 2017.

The Aesthetic Physician Association of Malta (APAM) have committed to these standards. The Board and its founding members strongly and unanimously believe that the European Standard document provides the most comprehensive recommendations for all aspects of the provision of medical aesthetic non-surgical treatments. Following these recommendations is paramount for the safe provision of treatments to the public.

All Aesthetic Medical Doctors should follow these principles and in doing so the right ethical framework is created.

‘This European Standard (EN16844:2017+A1:2018 (E)) is designed to bring the following advantages to those that adopt it:

- Improvement in aesthetic medicine services which can enhance patient safety and reduce the risk of complications

- To promote consistently high standards for aesthetic medicine service providers across Europe

- Enhance patient satisfaction’

The Aesthetic Physician Association of Malta is aware that untrained, or unlicensed persons not registered in the Malta Medical Council register are advertising and providing treatments and it is a concern that this can lead to numerous complications which are not seen to correctly. As experts in this field they encourage the public to do their research in the most thorough of ways. It is particularly important that when a client trusts the Doctor to perform the treatment, they make sure the person is fully qualified. It is the right of the client to request proof that shows the Doctor is fully trained and registered.

The European Standard (EN 16844:2017+A1:2018 (E)) states that:

3.1.5 – The practitioner shall be a medical doctor authorized by national competent authority to practice medicine autonomously. Medical doctors authorized by the national competent authority are entitled to perform aesthetic medical treatments provided they are trained to these treatments. Assistants shall be medical doctors, who are in a recognized post-graduate training scheme, or authorized healthcare professionals who shall be working under the practitioner’s direct supervision (direct supervision means to be physically present in the facility and able to respond and act according to the level of risk of the procedure)

3.1.7 – Treatments with the use of lasers (class 2 and higher), light – (IPL, and LED) and other energy based devices shall only be applied by qualified medical practitioners or by authorized healthcare professionals under practitioner’s direct supervision.

In 2016, the Ministry of Health set up a board of experts who met specifically on this regard – to evaluate the Standard and give their recommendations. The members of this board agreed that the European Standards should be implemented in Malta in their entirety. With that in mind the Aesthetic Physician Association of Malta will ensure to support the Maltese authorities in the implementation of these standards. The association encourages the Public to seek advice and reach out to the Association when they meet unprofessional and unethical practitioners. This will serve to safeguard any future clients and ensure safe enjoyment of these procedures.

For the full (EN 16844:2017+A1:2018 (E)) document please visit our Resources page where a copy is attached!

Officially Launching

The Aesthetic Physician Association of Malta (APAM)
November 2020

Dr Jason Debono, President, together with general secretary Dr Joanna Delia, treasurer Dr Charlene Scicluna, and founding members Dr David Grech, Dr Tyron Pillow, and Dr Anna Maria Fenech Magrin, are proud to announce the official launch of the Aesthetic Physician Association of Malta (APAM).

Membership of the association is open to medical doctors who are licensed in Malta and practice aesthetic medicine full-time. Associate membership is also available for licensed medical Doctors who practice aesthetic medicine part-time. APAM has been set up to promote and advance the effective, safe, and ethical practice of Aesthetic Medicine for the benefit of medical practitioners and members of the public.

“The Board will do so through leadership, information, education, support, professional development and maintenance of the highest professional standards among its members and within aesthetic medicine circles,” says Dr Debono.

The association was born as a response to the increasing interest in, and the fast development of, the aesthetic medical world, and the need for up-to-date information and education about treatments required for the public to make the right choices. Aesthetic medical treatments are the realm of Medical Doctors and should be carried out by the appropriate licensed professionals and are regulated by the Malta Medical Council by laws and the Health Standards Authority and other Ministry of Health bodies.

By virtue of standards UNE – EN 168844:2018+A1, the EU regulates this field and the members of this Association take these standards very seriously and expect the Maltese Authorities to do the same.  The Association will therefore maintain the highest professional standards in practice of aesthetic medicine in relation to clinical practice and patient care. The Association will promote the health of the general public by setting, upholding, enforcing standards which are inspired on international practice, in compliance with Applicable Law and which create a standard which has legal value.

The European Standard UNE – EN 168844:2018+A1 states that with regards to Aesthetic Medical Treatments:

3.1.5 – The practitioner shall be a medical doctor authorized by national competent authority to practice medicine autonomously. Medical doctors authorized by the national competent authority are entitled to perform aesthetic medical treatments provided they are trained to these treatments. Assistants shall be medical doctors, who are in a recognized post-graduate training scheme, or authorized healthcare professionals who shall be working under the practitioner’s direct supervision (direct supervision means to be physically present in the facility and able to respond and act according to the level of risk of the procedure)

3.1.7 – Treatments with the use of lasers (class 2 and higher), light – (IPL, and LED) and other energy based devices shall only be applied by qualified medical practitioners or by professionals under a practitioner’s direct supervision.

“The values of the Association are those embraced by the modern medical profession and which are professed in the Applicable Law,” says Dr Delia. “The Association shall promote public safety by supporting public authorities, in particular health authorities, in the dissemination of information and making standards available to everyone in the industry, collaborating with authorities who conduct check and audits and report hazardous operations to the relevant authorities.”

For the full (UNE – EN 168844:2018+A1) document please visit www.apam.care

For more information visit:

W: www.apam.care

E: info@apam.care

F: https://www.facebook.com/Aesthetic-Physician-Association-of-Malta-111048300267829