Fillers have been described as "a complete wild west in the UK" – currently, all you need to administer them is the recipient's consent, and overwhelmingly it's young women whose health is put in danger. MPs were due to discuss this lack of regulation in parliament today, and a coalition of plastic surgeons and dermatologists also called for greater regulation in response to the high number of botched procedures plastic surgeons are seeing and correcting.
At the moment, fillers are classified as 'medical devices' (as opposed to 'medicine'), which means they go through limited trials and are available to buy cheaply and easily on the internet by anyone without qualifications. But steps are finally being taken to better protect patients. Superdrug recently announced it would run enhanced mental health checks on customers seeking fillers following advice from the NHS, and the issue has caught the attention of MPs.
Alberto Costa, MP for South Leicestershire, who was due to lead today's debate, raised it in parliament earlier this month and is lobbying for "proper regulation and protections" to be introduced in the nonsurgical cosmetic industry after his constituent Rachael Knappier was injured by a botched lip filler treatment. Twenty-nine-year-old Knappier was rushed to A&E after being injected by a beautician without medical training, and is now campaigning for aesthetic medical treatments to be performed only by doctors, nurses and dentists. Her petition on the UK government website, which needs at least 10,000 supporters before the government will respond, has garnered more than 3,300 signatures at the time of writing.
The British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS) is leading the charge, with support from the British Association of Aesthetic Plastic Surgeons (BAAPS) and the British Association of Dermatologists (BAD). "It is incredibly easy – and legal – for untrained beauticians or members of the public to purchase cheap dermal filler kits online and carry out procedures themselves," said BAPRAS president Mark Henley, adding that the risk to individuals' safety was evident in the rising number of corrective procedures being required.
There were 934 complaints about nonsurgical procedures carried out by unregistered practitioners in 2018, up from 378 two years earlier, according to a report by Save Face. Of these complaints, 616 were for dermal fillers and in 387 cases patients reported needing corrective procedures to fix the problem, with 11 needing to go to A&E. But the organisation believes that these figures are likely to be the tip of the iceberg.
"We've seen a huge increase in the number of complications as a result of dermal fillers," Save Face director Ashton Collins told Refinery29. "Eighty-three percent of which were administered by non-medics who are not competent to manage and treat complications when they arise. Due to their inability to prescribe the medication needed to treat dermal filler complications, a vast majority of patients are often ignored and left to seek help and redress elsewhere." He recommends that anyone considering dermal fillers should browse its government-approved register for accredited clinics.
One woman who supports the campaign for greater regulation is Chantelle Maughan, 27, a carer from Newcastle upon Tyne. She underwent a botched lip filler procedure in September 2018 after being duped by a woman who had rented a room at a salon in Newcastle.
"I’d had lip fillers once before and loved the result, so I decided to get them done again. I found the woman on Facebook and her page seemed legit – there were lots of pictures of feedback from clients and she was located at a salon in the city centre. (It has since emerged that she'd taken these from someone else’s Instagram and it wasn’t her feedback at all. Having read articles about her, I'm not sure whether she was trained at all.)
I was in excruciating pain and could barely move my mouth.
Chantelle Maughan, 27
I had the procedure and didn’t question anything until later that day when there was no difference at all in the shape or size of my lips, but they were solid. I was in excruciating pain and could barely move my mouth at all. I messaged her and she initially ignored all my messages but then eventually replied and told me to wait two weeks. The pain was the same for days after and it was unbearable to touch them, but she continued to ignore my messages.
I decided to put a post on Facebook explaining what had happened and was shocked at the number of other girls who had also been affected by going to the same woman. She had introduced herself to us under one name, but when a potential client had her deposit transferred back into her bank after cancelling her appointment, a different name came up on her account. I googled that name and surprise surprise, she'd been exposed in the press for having botched fillers at her own salon previously. She'd dyed her hair from brown to blonde and moved to a different city.
I felt betrayed as she came across as really lovely and professional, and I'd wasted £160 on what I thought was going to be 1.5ml of filler. I iced my lips and took paracetamol and it eventually passed after a few days, but my lips are still sometimes tender. The law on this needs to be much stricter. These are young women’s faces people are messing with. These procedures should only be carried out by qualified nurses and doctors."
As today's comments from the coalition of plastic surgeons and dermatologists make clear, it's properly trained professionals who are left to clean up the painful mess made by cowboy practitioners. One such professional is Dr Tijion Esho, founder of the ESHO Clinic, who points out that in the UK, "you have more protection if a handy man messes up your electrics than if a practitioner makes a botched job of your fillers or Botox."
Five years ago, Dr Esho told us he was doing treatments to correct botched lip fillers "once or twice a year," but these days they make up a third of his daily treatments. The most common cases Dr Esho sees are those in which a patient has several lumps in their lips from substandard product placement, usually from an unqualified non-medical practitioner.
"Over the last five years I’ve carried out over 500 corrective filler procedures with 50% of these being specifically for lip augmentation," Dr Esho told Refinery29, with the corrective procedures varying depending on the patient's underlying problem. "It can be sometimes as simple as using a needle to aspirate a lump of filler, injecting Hyalase to dissolve and remove the filler product, or even sometimes incision and drainage to remove abscesses from pus and infection. There is a wide variety of adverse outcomes which each have their dedicated treatment plan."
Would you allow your beauty therapist to operate on you? No.
Dr Ewoma Ukeleghe
Women in their 20s and 30s are most at risk of botched procedures, as they're the demographic most likely to be sucked in by discounted treatments, says Dr Ewoma Ukeleghe, a medical and cosmetic doctor. "The lack of regulation of nonsurgical procedures is very concerning. I frequently come across Instagram pages of 'aesthetic/cosmetic practitioners' (which is code for beauty therapist) with attractive follower counts and an influencer-laden grid to match. However, on further investigation (usually on their website), it's apparent that they are beauty therapists. I have personally seen a therapist advertising that she studied at the 'London School of Medicine', which does not exist."
When doing your research, Dr Ukeleghe says you should be able to confidently answer 'yes' to the following questions before going ahead with a treatment. Firstly, do they have significant experience in nonsurgical treatments? Secondly, do they have in-depth knowledge of the anatomy of the face? Thirdly, is your injector able to identify and deal with complications? And finally, is your injector a medical professional?
"If the answer is no to any of those, you're a botched job waiting to happen," she told Refinery29. "Would you allow your beauty therapist to operate on you? Equally, would you let your surgeon give you a manicure? No, so nonsurgical treatments should not be any different."