Once only divulged to close friends and spoken about in hushed tones, injectables are no longer a shocking topic for discussion. You can bet that plenty of your favourite celebrities or influencers have had at least some kind of work done (whether that's lip plumping or smoothing out forehead lines). But with clinics popping up left, right and centre, it isn't solely famous faces who live by the needle.
From lips to noses and even under-eyes, research shows that for lots of people, booking filler injections is akin to a fortnightly manicure appointment or a haircut. Though injectables like filler may seem commonplace, it's not unusual to come across the odd horror story. On TikTok and Instagram, oozing cysts, painful infections and bad DIY jobs are just a handful of them, which makes you wonder: what exactly do the experts themselves have to contend with day in, day out?
Ahead, an anonymous lip filler doctor gets honest with R29. This story was originally published on Refinery29 UK.
"On London's Harley Street, it's quite easy for an injector to make over £100k a year. In my job, I get to see some weird shit. Sometimes I think, what the fuck are people doing to themselves? Once, I put a small needle into an infected lip to try and aspirate it. The patient was in severe pain and the infection was draining from the cheek area, so this whole mass of infected filler was trapped in her face right down to the lip. As I applied the needle, it popped and exploded. It literally burst onto my top and a bit went on the corner on my chin, luckily away from my mouth. It was disgusting because it was pus mixed with old filler, so it was this white, paste-like material. The odour that came out was like rotten fish. Actually, like nothing I'd ever smelt before. The patient was so happy, though, because they felt instant relief.
"The worst thing I've seen was when I was treating a guy who had used Vaseline to inject into his penis. He said, 'Look this is really embarrassing but I looked it up on the internet and I was trying to find a way of increasing the size of my penis and I saw that injecting Vaseline could work'. I was like, 'Where? In which medical journal did you see this because no medical journal I know says this!' Obviously, he had to show me the deal and I saw all of these lumps. The skin had expanded where the actual Vaseline had been sitting in the tissue and reacting in there. It was just an absolute state. Part of it was infected and part of it was necrosed, so it was dying. I think he thought the skin tissue was bruised but it was dying. Again there was an odour coming from the area. I had to send him to the hospital straight away.
"I've also seen people injecting their own lips with filler. This is so common because there are private Facebook groups where people teach each other how to inject themselves with counterfeit products. They are quite open about it. I've gone onto the forums with a fake Facebook profile and people are using different instructions about where to inject. People say, 'This is fine, I usually inject here and use ice to numb my skin because I can't get access to local anaesthetic. A little bleeding is okay.' They are literally coaching each other. Particularly in my line of work, where we're doing a lot of reconstructive treatment, a lot of people's stories are linked to some form of mental health issue. One girl had been diagnosed and struggled with body dysmorphia for years. She was trying to treat herself because no-one else would help her achieve the look she wanted. She'd injected Radiesse, which is a non-permanent filler and a crystallized form of powder. This is usually injected into hard areas like the jawline or nose, but she had injected that into her lips. She had these hard lumps and a reaction, which without surgery, could not be removed. We talked about it and she realized she had made a mistake. It took months for her to visit me because she was ashamed, but she just wanted my help. Her lips looked a lot better, but we couldn't remove the tissue damage without surgery and that would probably cause more disfiguration. As a medical professional, you try not to be judgemental. When this happens, I try and stay objective because I know everyone has a story. But the online forums are a free for all and aesthetics is in such a bad state, particularly in the UK with no rules and regulations.
"Things like body dysmorphia are obvious to me when we take the consultation. Some patients don't understand why we do a consultation, especially if they know what they want or have had the treatment before. It's about making sure they're safe and whether we should be doing the treatment in the first place. We're looking for different flags, for example someone who has a previous history of mental illness or someone who has been to many different practitioners and has never been happy with the results. There are also non-verbal cues, for instance when someone says they can't look at themselves in the mirror. It can be hard to explain to someone when you say you don't want to treat them, or hope they listen when you refer them for counselling. Many times, they'll find someone that will do it for them. For everyone who says no, someone will say yes because they're thinking about the money.
"I turn people away a lot. The most common one is lots of lip filler, sometimes requested by adult entertainers, who want that fully 'done' look. There was a girl that wanted me to take away her Cupid's bow. She wanted her top lip so full, that it was round like a sausage or like a blow up doll. I said, 'No I'm not going to do that. It goes against what I do and I'm not the person to do that for you'. Filler is an injectable implant in many ways. The tissue can stretch and become traumatized so much, that it loses its elasticity. This happens when you dissolve filler using Hyalase. The tissue can be quite saggy so this happens to people that go for the exaggerated, overt looks. There's not much you can do to reverse that other than surgery and using excess tissue from somewhere to repair it.
"A girl also wanted me to bleach her anus, then use a bit of filler to make it look more even. I was like, 'What?!' She had photos and we were swiping through pictures of her anus on her phone. She'd taken screenshots of different anuses and which colours she wanted to achieve. I'm sure there's someone that does this, but I'm not that person. There are downsides to filler because it's a medical treatment and there are always going to be medical risks. Unfortunately, social media trivializes it and people think you can remove it if you don't like it, but there are plenty of things that can go wrong before then. Unfortunately, they can be permanent.
"Infections can lead onto the formation of abscesses and pus, for example, or necrosis of the tissue where you could lose your lip. There's vision loss when injecting into the nose and then you've got stroke as a result of vascular occlusion [cutting off the supply of a blood vessel]. In the right, medically trained hands and in a medical environment, these things are put to a limit. But some people are getting everyone and anyone to do it with no form of medical training and think that these risks aren't going to be elevated. Lewis Hamilton is the world's best driver, right? But even he has crashed before. The same goes for medical professionals. We are highly trained, but things can go wrong in the right hands.
"Some people don't take well to needles. Once, a girl was having filler done and I saw her starting to go pale. She said she was going to be sick. I was like, 'Crap!' We didn't have a sick bowl so we got the bin, sick was on the chair. We got her some water, she seemed fine and she settled. She was about to walk out of the door and then she collapsed. Half of her fainted outside and half inside, and the hallway was where the waiting room was. Everyone waiting for an appointment saw her passed out and slowly her being dragged back into the room because that's all we could do. I had to pop my head out and tell everyone that we had everything under control. Every patient was like what the fuck was that? I was traumatized by it.
"Sometimes I treat celebrities. Once, someone's agent contacted us saying that this person would love to come to see me — and that their fee is £8,000 ($13,633). I had to read it again. They actually said that we had to pay them for the benefit of treating this person. As a team, we laughed and ignored the email. Two weeks later the celebrity emailed themselves saying that they love our work and want to come to have filler free of charge. I told my assistant to turn them away. The less famous, the bigger the diva. People who are uber famous don't do anything like this. Everything is pre-paid, they're in and out quickly and they even send you Christmas cards.
"Unfortunately, I know quite a few injectors who will treat under 18s, and I know this because I've had patients challenge me about why I won't treat them when XYZ person has said yes. I've had parents messaging me about their daughters, asking that if they give consent, can they book their daughters in for lip filler. I advised one woman why this shouldn't be the case and she got quite defensive. She came back quite angry at me and notified me of places that had agreed and she told me to reflect on my policies. Some people compromise on quality. Some use counterfeit or fake and cheap products. That goes for Botox as well as dermal filler. Many of them share the products, so they use part of the syringe on someone and change the needle. Some even keep the same needle and use it on someone else. The sharing of syringes and needles happens a lot. Sometimes, you get people who aren't actually using anything. I knew about a nurse in Newcastle who was just using saline, so she was injecting water into the lips making patients think that they were having product. When the prices are that cheap it because that's probably happening.
"The amount of times I saw sex in exchange for treatments on Harley Street is the thing that has shocked me the most. Lots of people in the adult industry tend to be big on filler. I was propositioned myself. I was about to start a treatment and the person asked whether they were paying for it. They asked if there was any other way to pay. I was thinking, Paypal? They said that with their last injector, they came to an understanding. I couldn't believe it. But I don't cross those kinds of lines. Another thing that shocked me was the amount of drugs in the industry. I drink but I am anti-drugs. I'm not judgemental, but as a medical professional, if you're doing that and coming to clinic high and treating patients, that's wild. Some take drugs with their patients on nights out. A lot of people get lost in the money, sex and drugs, and they're not happy people. If you're not a happy person treating unhappy patients, what type of cycle is that? I stay away from all of that. It disappoints me. No wonder [the industry] is in a mess like this.
Overall, I just hope that the industry gets better, but we have to look at ourselves as medical professionals, too. We talk a lot about non-medical professionals being the reason why there's a downfall in not keeping to regulations, but these non-medical professionals are getting their hands on these materials because a medic somewhere is prescribing it to them. We are part of the reason things are the way it is, and we need to regulate ourselves before we can regulate the industry."
If you’re interested in getting filler or any other injectables, be sure to visit a trained doctor or nurse.