Ms Chen found Pu Liu (also known as Mabel Liu) via WeChat, where the alleged unregistered practitioner posted before-and-after photos of cosmetic procedures almost daily. Helena Chen's eyelids have been left scarred and damaged after an alleged unregistered practitioner performed surgery in her bedroom. Credit:Dominic Lorrimer "It felt like she used my eyes for practice," Ms Chen told Fairfax Media. "She said there would be no bruising, no bleeding, no down time. "I thought 'oh that's easy surgery. It must be safe'. I was so excited I didn't think too much."

Ms Chen said she was ushered past two cats in Ms Liu's apartment and towards a single bed in one of the flat's bed rooms. A photo posted to WeChat advertising the services of an allegedly unregistered cosmetic practitioner. "She told me to pay first in cash. I paid $1500. Then she asked me to lie down." Ms Liu allegedly washed her face with water and a cotton cloth, injected an anaesthetic agent around her eyes and started suturing. Ms Chen's eye after the botched surgery.

"Three times she stitched my left eyelid, then pulled [the sutures] out, then re-stitched them. "I screamed at her ... I yelled out I need more pain killer injections." A still from a video posted on WeChat advertising the services of an alleged unregistered practitioner. The surgery lasted eight hours, Ms Chen said. "She'd do a stitch then she'd pick up her phone and open a door and leave the room," Ms Chen said. "Then she'd come back in and start stitching again without washing her hands.

Helena is suffering from a botched plastic surgery. Credit:Dominic Lorrimer "I was so angry. It's painful. It's really painful." When it was over, she told Ms Liu she didn't like the results, but Ms Liu said she would have to come back in a month for another session once the swelling had gone down, Ms Chen said. After seeing three cosmetic physicians, Ms Chen was told she would need to wait six months for her eyes to heal before they could properly assess the damage. "I was stupid to trust her," she said.

Cosmetic doctors are increasingly taking in women who have come away from black market cosmetic "clinics" with scarring, bruising and hard clumps of unknown materials injected into their faces. The unregistered operators, who predominantly target Asian Australians and recent Chinese migrants, allegedly inject clients with imported counterfeit fillers and perform cosmetic surgeries, including double eyelid suturing, nose lifts and liposuction, in their private residences. "They call themselves doctors or nurses but they don't have any qualifications," said Sydney cosmetic surgeon Zion Chan. "People don't know they are visiting unsafe and illegal practices. "It's getting much worse. I would say it is rampant in Sydney. "Every week I see a new patient with a complication. People with product injected into their face that was just a bad mimic [of approved fillers]. It would be lumpy or hard or move around [under the skin]."

Another Sydney-based cosmetic specialist clinician said he saw as many as five complications a week due to the handiwork of unregistered practitioners. "In terms of the really bad cases, like blepharoplasty [eyelid surgery], I'd see every two months … it's incredibly dangerous," said the physician with strong ties to the Chinese community who declined to be named. "They could have been blinded." Individuals found guilty of administering botulinum toxin (botox), hyaluronic acid (dermal fillers) and anaesthetic injections face $1650 in fines or up to six months in jail for each offence under the Poisons and Therapeutics Goods Act. For some prescription-only medications, the penalties can be up to $2200 or up to two years imprisonment. But some home clinics flout Australian laws and post videos of their procedures and before-and-after photos on the China-based social media platform WeChat.

"They can be quite blatant with their advertising," said Sydney CBD-based cosmetic physician Anthony Yap. "But the really clever operators are more subtle, just posting after photos and groups of girls sitting around living rooms having a good time." . Footage seen by Fairfax posted on WeChat shows cosmetic procedures carried out in carpeted living rooms on beds and couches. One video shows a cat passing behind a woman as she works on a client. Several WeChat posts show residential apartments full of young women who appear to be waiting their turn. "It's incredibly dangerous," said another cosmetic physician after watching footage of one operator using a syringe to pierce a woman's forehead. Separate vision shows a syringe pierce a woman at the temple. "There's a risk of haemorrhage … severe skin necrosis, and at worst blindness," he said. "There is no duty of care to the people they are treating."

Many alleged unregistered practitioners charge the same rates as legitimate clinics. "It's part of their strategy," the physician said. "They don't want people to suspect they're not real doctors. "Their clients' English is often very limited ... they won't be as vocal when things go wrong. They won't go to the authorities. They just want it fixed." Health authorities are investigating Ms Liu after raiding her Five Dock premises last week. Fairfax Media has attempted to contact Ms Liu. The apartment she allegedly worked from has been put on the market.

Backyard procedures are becoming increasingly common and the NSW Health Care Complaints Commission has issued a public warning and reported a rise in the number of complaints about cosmetic procedures being performed in residential properties by practitioners unqualified or unregistered in Australia. But once an in-home clinic is raided, some operators have simply moved to new locations, posting notices on WeChat informing their clients they will reopen in weeks, according to patients and WeChat posts. "The commission recognises the issue of displacement, hence its decision to issue a public warning on this matter," a spokesman for the HCCC said in a statement. NSW Health's director of health protection Jeremy McAnulty said the public should "absolutely avoid these places". "Infection control is our major concern," Dr McAnulty said.

"There's a risk of blood-borne viruses and other infections being transmitted from the environment, or from the person performing the operation, or between clients when equipment and vials are being reused. "Then there's the botched jobs. If something goes wrong – which can happen at the best of times with experienced surgeons – you can permanently have a deformed face. "Our message to the public is don't undertake these treatments lightly. Talk to your GP about being referred to an experienced clinician and, if you've had a botched procedure, report it to the HCCC and or [the Australian Health Practitioner Regulation Agency]," he said. Individuals can check if a practitioner is registered in Australia via the AHPRA website. The NSW government recently introduced tougher laws regulating the cosmetic surgery industry to provide greater safeguards for patients.

The regulation means any private health facility that carries out cosmetic surgery procedures, including breast enlargement, tummy tucks, liposuction and facial implants, will be subject to strict licensing standards. Do you know more? kate.aubusson@fairfaxmedia.com.au