The scene is bloody and grotesque. A nurse films cosmetic surgeon Dr Ryan Wells as he pushes and squeezes fat and fluids out of a woman’s legs that have been freshly operated on.

The doctor, wearing runners, seems impervious to the blood and lumps of fat spraying against the walls, medical equipment and his body.

Professor Mark Ashton reacting to footage of a cosmetic procedure discovered in Adele Ferguson’s investigation. Credit:60 Minutes

It’s a scene reminiscent of a horror movie: booming electro house music and the stifled groans of a conscious patient whose face is covered from the bloody scene around her.

It’s footage, says professor of surgery at Melbourne University Mark Ashton, that “borders on barbaric”.

“Lack of sterility, lack of infection control, biohazards… There are so many things wrong with this scene. I just do not know where to begin,” Ashton says. “Unbelievable. Where did you get that from?”

Former registered nurse-turned whistleblower Justin Nixon says looks more like “an abattoir”.

The video, taken in October last year, is one of thousands of internal videos and communications seen by a joint Sydney Morning Herald, The Age and 60 Minutes investigation which show what really happens behind the closed doors of leading cosmetic surgeon Wells, an associate of controversial celebrity cosmetic surgeon Daniel Lanzer until he publicly distanced himself after a media expose in October last year.

The chat group, set up by Wells in May 2020, show a starkly different business to the one he has been spruiking publicly.

“Excellence is, and always has been our standard … I want to reiterate… my complete dissociation from Dr Lanzer and his company,” he told his followers on Instagram on November 7, 2021.

The damage control ramped up when he emailed this masthead on October 30, 2021, stating he ran the Brisbane practice independently and that Lanzer’s involvement had not been in a clinical, procedural or operational capacity for a year.

Social media post showing Dr Daniel Lanzer and Dr Ryan Wells.

“Within the [Brisbane] unit, no compromises have ever been taken with regards to patient safety,” Wells said.

He added that “the alleged conduct seen in recent media coverage is not consistent with the care offered at the Brisbane practice.”

But behind the scenes, the spin was different. “I think [the media coverage] was weak. Danny [Lanzer] might cop some shit but feel we didn’t even get a show up here. It’ll all be okay,” he told his nurses.

Lanzer surrendered his medical registration in early December amid an investigation by the health regulator and headed overseas.

Other doctors he employed had conditions placed on their medical registration by the regulator, including Daniel Aronov who was accused of inappropriately filming surgeries and unsanitary practices and was subsequently banned from doing all cosmetic or surgical procedures, including minor surgery, and ordered to remove his social media posts, and Daniel Darbyshire had his licence suspended after being charged by police over an alleged attack on an elderly man. Darbyshire is expected to defend the charge and is out on bail and the next court hearing is scheduled for July 26.

Wells has managed to avoid scrutiny – until now.

Our investigation has uncovered some disturbing practices in the Queensland facilities, including potentially historic illegal surgeries, serious hygiene and safety issues and an internal culture that has referred to some patients as “red flags,” a “nutcase” ” a mole” and “crazy”, and staff backdating critical paperwork ahead of regulatory audits and “hiding” certain equipment and chemicals in the attic, or as the nurses refer to it the “creepy attic.”

Nurses Justin Nixon and Lauren Hewish say they worked on hundreds of procedures and patient consultations with Wells in Sydney, Melbourne and Queensland and say the culture at all clinics was similar. They did not have access or have seen the Wells’ chat group.

They say they both received a phone call from Wells after they resigned, asking them to keep quiet about what they had seen.

“He said, ‘Be careful who you talk to because it’s our lives at stake,” Hewish recalls of the phone call she received. “Don’t say anything about your experience at the clinic because if it comes out, we’re all done for.”

The leaked work chat reveals how Wells dealt with unhappy patients.

Whistleblowers Justin Nixon and Lauren Hewish.Credit:SImon Schluter

In a message from June 2020, a patient who has complained that her surgery has been moved and she had taken time off work is described by Wells as a “big red flag.” He says he wants a nurse in the room and “may even have to record it.”

Then comes the punchline: “Anyone of sane mind wouldn’t act like this to someone who’s about to operate on them . She’s crazy haha.”

It is the latest scandal to hit the billion dollar cosmetic surgery industry, following a media investigation last year that uncovered safety and hygiene issues at Lanzer’s clinics and inadequate regulations that fail to protect patients.

Under the current law, anyone with an ordinary medical degree and little surgical training can call themselves a cosmetic surgeon, even though they aren’t registered specialist surgeons with more than six years of postgraduate surgical training.

Social media posts featuring Dr Ryan Wells and his partner.

Wells joined Lanzer clinics in 2018, after working for another cosmetic surgeon. He graduated with a medical degree from the University of Notre Dame in 2013.

Within months of working for Lanzer he was earning the big bucks and was on social media – often alongside Lanzer – spruiking and performing major procedures such as mega liposuction, tummy tucks and mini facelifts.

“He was the person doing the bulk of the work at the Lanzer Clinic. He was Dr Lanzer’s workhorse,” says registered nurse, Justin Nixon, who worked with Wells between October 2018 to July 2020.

From the start Wells was part of a fly-in, fly-out team in Queensland, performing surgeries on the first floor of a commercial office building in Spring Hills, Brisbane. It was an unlicensed facility, which under Queensland law, prohibits certain procedures being undertaken, including some types of breast reduction.

It was cramped and according to Nixon, who would also fly in and fly out on a regular basis from Melbourne, it wasn’t fit for purpose.

“The rooms were never actually up to speed,” he said. “There’d be globules of fat from the surgeries previously. It was just an office space where we would open up the sterile sheets and commence operating on a table. It’s hard to find the words… like something out of a horror movie.”

He said the equipment would be transported in dirty suitcases, which he said was concerning “because the sterility of the instruments is already questionable by the time it’s arrived here, long before we’ve even commenced operating.”

The unlicensed Spring Hills clinic closed in early 2020 when Lanzer opened a day hospital in March that year and a clinic in Broadbeach.

Nixon said the Sydney clinic, fly-in fly-out facility for Wells and other doctors, was similar in terms of poor hygiene.

Clockwise from left: In a still from a video, Dr Ryan Wells chases a fly during a procedure; an unhappy patient shows the results of liposuction; Dr Wells removes fat from a patient; and body fluid and fat collected during procedures.

He was shown a video of a storeroom in Lanzer’s Sydney practice including surgical instruments and medical supplies sitting among the doctor’s clothes in a suitcase on the floor. In the same room tumescent fluids and various medications administered to patients were drawn from unsanitary conditions. Nixon identified Wells’ bag in the video.

At least one video posted on social media in late 2019 shows Wells excising breast glands and tissue from an incision under the nipple of a male patient in the Spring Hills unlicensed facility. “So I’ve done both sides,” he tells his followers. “We’ve made the cut and the incision under the nipples. Let’s take out these glands. There’s one, not huge. And we’ve got another one here.”

According to Dr Margaret Faux, who has spent 40 years working and researching the health system, the procedure shown in the video was a partial breast reduction. She says given it was performed in the Spring Hills clinic, which was not a day hospital, it was potentially illegal.

Queensland Health said some procedures of gynecomastia can be classified as breast reduction, which must be performed in a licensed venue. It said gynecomastia can also occur using liposuction only, which can be performed in an unlicensed venue, which is managed by the Office of the Health Ombudsman (OHO).

When OHO was asked if an unlicensed facility in Queensland was allowed to undertake gynecomastia including an incision with a scalpel to remove breast glands, it said OHO “does not have powers to manage unlicensed premises or set rules in terms of what may constitute legal and illegal behaviour.”

For professor Ashton it is a highly doctored video and “deceptive trick” for prospective patients.

“What this video does is it trivialises the significant surgical procedure in a way to make it look straightforward and easy, as if there’s no risk.”

Social media is the key marketing tool for the cosmetic surgery industry to attract patients. With lax regulations, many run amok, posting cleverly staged before and after photos and using influencers to promote procedures without declaring they have received a discount or payment.

Leaked internal chats between Wells and his nurses give an insight into the veracity of before and after surgery photos posted on Instagram.

In one chat from last September, Wells and nurses discuss a post-surgery photo posted by a patient on Instagram and how they might leverage it.

“Hopefully she looks bad in her before pics,” Wells says. “Not bad but with the shit lighting and no tan compared to that one could work great,” the nurse replies.

It seems the patient has edited the photo to make her waist look smaller, which sparks a laughing hilariously emoji by Wells followed by, “Let’s not say because of the tan and lighting though, or post op editing. Let’s agree it was the surgical skill,” he says, adding, “the followers love a patient post op selfie.”

Internal videos paint a picture of a practice that has little respect for compliance and procedures – and patients.

In one video, captured by a nurse in March 2021, shortly after an audit, Wells is flapping about with a blanket in the theatre room trying to kill a fly as a patient lies naked and unconscious after surgery.

He swings the blanket so hard the light fitting becomes unsteady.

Wells posted the video on the Whatsapp group, prompting replies of laughing emojis from nurses working for him. But for qualified surgeons like Mark Ashton, it is no laughing matter.

“The fact that there is a fly in the operating theatre means that that system has broken down. Either the fly got in from the outside or something has happened within the operating theatre that has allowed the fly to grow within that environment. In any case, it’s an absolute litmus test that there is something majorly wrong within this operating theatre.”

He is also horrified that the patient was left naked while under anaesthetic. “We have known in the last 10 to 15 years that one of the most important, critically adjustable factors in preventing infection after surgery is keeping a patient warm … this is not an acceptable standard of practice. It’s not an acceptable standard of care.”

Other allegations of questionable conduct uncovered by the investigation include:

The removal of 12 litres of fat and fluids from a liposuction patient in one procedure, which is considered dangerous and twice the amount considered safe.

• Nurses writing scripts, including in September 2020, when Wells reminds the nurses that one of them had written a script for a patient with the wrong dosage and tells them of the correct dosage: “Answer is it only comes in 200 or 100mg. Someone wrote 500mg the other day as well. Always ask me if not 100% on doses team.”
• A nurse smacking the buttocks of a naked patient and Dr Wells posting the video on Whatsapp to share with the other nurses.
• A message sent by a nurse: “For any photos underwear and bras needs [sic] to be off completely especially for tummy tucks/thighs etc. -RW [Ryan Wells]
• The internal chats also show videos and photos of Wells and his nurses scraping Daniel Lanzer’s name from the clinic window. In an effort to publicly distance himself from the controversial doctor, last month Dr Wells renamed the Queensland facilities to the Institute of Aesthetics.

Wells’ lawyer responded to the allegations, saying he “doesn’t hold any concerns with the standard of hygiene and safety practices at his clinics.” The lawyer said Wells “does not provide nurses with unsigned blank scripts nor does he pre-sign scripts.” He said Wells performs liposuction “in accordance with industry standards.” He said Wells “does not consider his social media posts or activities trivialise surgery,” adding that posts “ensure that prospective patients have a realistic expectation of cosmetic procedures including recovery times [and] inherent risks.” Wells denied through his lawyer ever instructing nurses to move items ahead of an audit. He also denied any knowledge of hygiene and safety issues at Lanzer’s Sydney practice.

Property and company searches reveal that the two are still in business together. The renamed Broadbeach cosmetic clinic sits on a property jointly owned by Lanzer and Wells, while the Brisbane day hospital is owned by Lanzer and Wells’ company rents the premises from Lanzer.

“As much as Dr Wells says he has separated himself and has better standards and that the [Queensland] clinics run completely differently, I think that’s a joke,” Hewish says.

Nixon describes the public disassociation as shameless.

It is a message that worries patient Kathy Hubble, who had two surgeries in the Sydney office in 2018, liposuction of the legs with Lanzer and liposuction of her abdomen with Wells.

“This man is absolutely dangerous to the public … he was directly responsible for the procedure on my abdomen, which has now left me with chronic pain and a tissue that is hard and rubbery and loss of feeling in those areas as well,” she says.

Hubble ended up in Gosford Hospital for almost a week after developing a serious infection, cellulitis, shortly after her second procedure in November 2018.

Former patient Kathy Hubble says she was left in agony after a procedure.

She says the clinic in Sydney was filthy and while she was in hospital recovering, Lanzer tried to pull her out and treat her in the Sydney clinic, saying he was better equipped to deal with the issue. “Dr Wells actually sent me a text message saying he would come and help me down to the clinic,” she recalls. “Back to the dirty environment.”

Kathy Hubble was diagnosed with cellulitis shortly after liposuction.

Some patients can’t speak publicly about their experiences after signing a gag order in return for a refund, while others are too embarrassed to reveal their identity publicly.

One woman, who asked for confidentiality for privacy reasons, spent $39,000 on a series of procedures including mega liposuction with Wells in November 2020.

The patient had the surgery for relief as she suffers from lipedema, a painful condition that causes excess fat to accumulate in the buttocks, legs and arms.

She ended up with excess skin on her legs which she says impacts her lymphatic system. Her arms still have pockets of painful fat. When she told Wells he said if he did revision surgery it would cost her half price.

“I am now deformed. It affects my whole life. It affects my relationship, it affects everything,” she says.

Other patients have joined a class action being run by Maddens Lawyers for any patients of Lanzer, Wells, Aronov, Darbyshire and Fallahi, alleging they engaged in misleading and deceptive conduct. It also alleges that cosmetic surgeries were not undertaken with an appropriate level of care and skill.

The class action has attracted more than 300 patients of the various doctors who underwent a range of procedures including Brazilian Butt Lifts, treatments for lipedema, ear pinning, facelifts and mega liposuction.

But when it comes to protection of patients, a series of inquiries are on foot, but little seems to be little appetite for change.

Social media experts Michael Fraser and Maddison Johnstone, who have captured tens of thousands of videos and posts of cosmetic surgeons and see multiple breaches every day, say more needs to be done.

“This is advertising that must meet the advertising guidelines. It’s not just people having fun on social media. They are medical professionals doing medical advertising, and it must be responsible,” Johnstone says.

Regulatory health expert Margaret Faux says the health system is a mess. For patients, it’s a situation of buyer beware. “You’re on your own.”

It means the cosmetic surgery industry can continue to thrive. “There are just plenty of ways to circumvent current regulation. Unlimited, really… No one can see what you’re doing, basically. And for patients, they are not safe,” she says.

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