A plastic surgeon’s guide to avoid cosmetic mishaps

As cosmetic procedures continue to gain widespread popularity in South Africa, reports of complications and “botched” results are becoming increasingly common. 

According to Dr Nombulelo Metuse , a Plastic and Reconstructive Surgeon at Mediclinic Muelmed, the biggest issue is not the procedures themselves, but rather who is performing them and why patients seek them.

“One of the single biggest risks right now is the use of unqualified practitioners,” she says. “In South Africa, anyone can market themselves as a ‘cosmetic doctor’, but we’re seeing how a lack of anatomical knowledge and poor sterile techniques can result in serious complications requiring complex revision.”

Dr Metuse believes that technology, and social media in particular, has played a major role here – not only in creating unrealistic expectations, but also in fostering a risky environment. “Patients today are more aware and often more critical of their appearance because of selfies, video calls and filters.

“Surgery, however, cannot replicate FaceApp or Instagram filters,” she cautions. “Yet we continue to see influencers promoting clinics and practitioners without verifying credentials, often using edited ‘before and after’ images.”

The issue is compounded in South Africa by widespread title confusion. “There is a lack of understanding around who is actually qualified to perform different cosmetic procedures,” says Dr Metuse.

For injectables such as Botox and fillers, she advises patients to consult a plastic surgeon or dermatologist. “A GP may be acceptable if they have properly accredited aesthetic training but be cautious of practitioners trained through short or ‘weekend’ courses. Hair transplants, meanwhile, should only be performed by doctors specifically trained in hair restoration surgery – often plastic surgeons or dermatologists with this expertise.”

When it comes to surgical procedures such as facelifts, breast surgery or liposuction, Dr Metuse is unequivocal. “Only a specialist plastic and reconstructive surgeon registered with both the Health Professions Council of South Africa (HPCSA) and the Association of Plastic, Reconstructive & Aesthetic Surgeons of Southern Africa (APRASSA) can perform these surgical procedures. This is non‑negotiable.”

When the wrong provider performs the wrong procedure, the risk of complications increases substantially – and poor outcomes are often far harder to correct, risking permanent damage.

“These are not rare scenarios,” says Dr Metuse. “They are complications we see regularly in clinical practice, often linked to poor practitioner selection, inappropriate treatment choices, or excessive intervention.”

Common examples include overfilled faces resulting in distorted proportions, poorly performed liposuction or Brazilian Butt Lift (BBL) procedures leading to asymmetry or, in severe cases, fat embolism, and poorly done breast surgery causing capsular contracture or implant malposition.

The use of unregulated products is another issue – one that Dr Metuse warns is escalating. Counterfeit Botox and fillers pose significant risks. In some cases, complications have included tissue necrosis (skin death), long‑term granulomas (hard lumps) and permanent disfigurement.”

The regulatory approval around products used in cosmetic procedures is black and white. “If a product is not approved by the South African Health Products Regulatory Authority (SAHPRA), it should not be used,” says Dr Metuse.

To ensure the practitioner used is fully qualified and everything is above board, she says verifying credentials is the most important step. “Patients should check registration with the HPCSA and membership with APRASSA, before also asking about training and experience. And finally, insist on a proper consultation that includes a full medical history and risk discussion.”

In terms of warning signs, a rushed procedure and extremely low prices should raise immediate alarms. “If a practitioner does a same-day consultation with a procedure push, that’s a red flag,” says Dr Metuse. “And if prices seem too good to be true, they probably are.”

Aftercare, she adds, is equally critical. “If your provider disappears after the procedure, that’s a serious warning sign.

“Cosmetic procedures – even ‘lunchtime treatments’ – are still medical procedures and carry risks,” Dr Metuse concludes. “When done correctly, cosmetic work can be safe and rewarding. But if done poorly, it can have serious consequences.”