Every day we are bombarded with photos of celebrities and social media influencers, who are stuffed full of facial fillers and frozen solid with Botox. It’s easy to see why injectable dermal fillers and anti-wrinkle injections have been normalised and have become a part of everyday life. These treatments can be wonderful when administered safely and appropriately, but they are now so common they are regarded as trivial, easy procedures that are no riskier than a manicure or eyebrow wax. This is absolutely not the case.
Kylie Jenner popularised lip-fillers, in particular amongst you girls desperate to look like their idol. As a result, thousands of unscrupulous people intent on capitalising on the booming aesthetics industry and its lack of regulation are flooding the market, endangering everyone they treat.
All aesthetic treatments require a high level of skill and thorough training to administer. Sadly, there are all too many practitioners willing to disregard their patients’ safety and administer treatments that they’re ill-qualified an ill-trained to carry out.
The pressure to look good is immense. This is reflected in the size of the UK cosmetic surgery industry which is estimated to be worth an eye-watering £3.6 billion. Non – surgical treatments such as anti-wrinkle injections and fillers account for £2.75 billion of this figure. ¹
Ironically, it is in the pursuit of looking good that results in many unsuspecting patients being maimed and disfigured by people concerned only with making a quick buck. Dermal fillers and wrinkle-relaxing injections have found their way into the hands of beauticians, hairdressers, and other unsuitably qualified people who often offer treatments at bargain prices, and the public are all the worse because of it.
It’s really important to bear in mind that just because a treatment is popular, it doesn’t mean it’s safe and you must ensure you take all available precautions to make sure your face is in safe hands.
Beware: The aesthetics industry is awash with cowboys
In the UK, the aesthetics industry is unregulated. Essentially this means that anyone can obtain dermal fillers from the internet and inject it into customers, without any training, any qualifications, or any idea at all about what to do should the procedure go wrong. Consequently, there are countless practitioners who are treating patients with fillers, anti-wrinkle injections, and lasers who are unqualified, uninsured, and unsafe.
The situation in the UK is in stark contrast to the US, where just over 20 dermal fillers are approved for use. In the UK there are almost 300 fillers on the market which are classed as medical devices rather than prescription-only medicines and are CE marked as such. https://www.fda.gov/medical-devices/cosmetic-devices/dermal-fillers-approved-center-devices-and-radiological-health
Wrinkle-relaxing injections of botulinum toxin are prescription-only medications. This, in theory, should provide consumers with some protection. The prescriber, such as a doctor, dentist, or nurse with a prescribing qualification, must see the patient face to face before prescribing Botox, and if they’re not administering the toxin themselves, the person that is should administer it under their supervision. Sometimes though, Botox is prescribed remotely by someone who doesn’t see the patient and is administered by someone else, subjecting the recipient to danger.
There is no doubt that our unregulated aesthetics industry puts patients at risk. No aesthetics procedure is risk-free, even when carried out by an impeccably qualified and experienced medical practitioner. But the risk is minimised when the practitioner is a medical professional who is knowledgeable and experienced in dealing with any complications in the unlikely event that they occur.
It’s easy to see how the risk of problems arising increases exponentially when a practitioner isn’t a suitably qualified medical professional though. There are countless examples of practitioners undergoing just one or two – days’ training in an aesthetics procedure. Although this is often all that’s needed to obtain a qualification, it is woefully inadequate to prepare a practitioner for the immense responsibility associated with administering dermal filler and Botox and the dangerous complications that can arise. These training days are often conducted by people who don’t have the expertise to be running training – and some practitioners can be duped into attending in good faith believing they are then fully qualified and equipped to treat patients.
Even more terrifyingly, there are “fake” fillers available on sites such as E-Bay, that anyone, anywhere can purchase. They are frequently shipped in from countries where there are no manufacturing standards.
Currently, the UK is a minefield for those seeking cosmetic non-surgical procedures.
You may think the world of your hairdresser and trust her with your tresses – but she should not be moonlighting as an aesthetics practitioner and injecting fillers into your face or anyone else’s.
At present there is nothing to stop a beautician, nail technician or anyone else from setting up an “aesthetics clinic” and ordering fillers from the internet and injecting anyone that wants it.
What could go wrong?
Unfortunately, a lot. There is an ever-increasing number of patients who’ve been harmed and even permanently disfigured by rogue practitioners masquerading as medical professionals.
The media is awash with horror stories of botched aesthetic procedures, from grotesque lumpy lip fillers to droopy eyelids caused by incorrect administration of Botox. This year saw the horrific case of Rachael Knappier, who made headline news when she suffered vascular occlusion as a result of having her lips injected with filler by an unqualified practitioner. She suffered weeks of pain and disfigurement and narrowly avoided suffering tissue necrosis and permanent damage.
Fillers, anti-wrinkle injections, lasers, etc are not trivial matters – they require skilled administration by medical professionals who’ve been meticulously trained. There is a risk of infection, severe allergic reaction (anaphylaxis), artery occlusion, severe bruising, nerve damage and so on. Fillers injected into the tear troughs (under the eyes) have even caused blindness. There have been 190 reported incidents of this worldwide ².
Anyone who administers dermal filler should always have the reversing agent Hyalase that will dissolve filler if necessary. They must know how and when to use it. Sadly though, some practitioners don’t carry Hyalase, which can lead to catastrophic consequences for their patients.
Permanent disfigurement is a very real possibility when aesthetics procedures are carried out by those not qualified to do so.
Recently, in the Isle of Man, a dental nurse purporting to be a “medically qualified practitioner” was advertising dermal filler and Botox services all over social media. There is a huge difference between the training of a dental nurse and a dentist or a nurse or doctor, and she lacked the knowledge and training required to be providing non-surgical cosmetic treatments. Yet she still thought it acceptable to call herself a medical practioner. This is not only apparent on the island but everywhere else in the UK.
It is irresponsible and reckless to make misleading claims about being medically qualified, but unfortunately, this is a typical example of rogue practitioners operating within the industry.
Social media is hugely influential in the promotion of non-surgical treatments, and possibly explains the boom in procedures carried out on younger women who’ve seen and been influenced by this type of promotion. This seductive advertising, aimed mainly at under 35s, has created a perfect storm of vulnerable customers undergoing cheap, risky procedures carried out by under-qualified personnel, in beauty salons, hairdressers, and other unsuitable premises.
There is good news though
These tales might seem gloomy, but strides are being made to protect consumers. In 2016, Scotland became the first country in the UK to introduce a regulatory framework to ensure patient safety and promote and maintain high standards. This framework is being implemented over a three – year period.
In 2018, the JCCP (The Joint Council for Cosmetic Practitioners) was set-up and now work alongside the CPSA (Cosmetics Standards Practice Authority). The JCCP is a voluntary register, which is Public Service Authority (PSA) registered, that will enable the public to check the credentials of a non-surgical provider.
Both the JCCP and the CPSA were established to increase public protection for those accessing non- surgical cosmetic procedures and aim to improve standards in all who provide cosmetic treatments, regardless of their professional background. In order to join the JCCP register, practitioners must evidence their competence, commitment to public safety and adhere to agreed standards of practice.
How to protect yourself from rogue practitioners
There are numerous steps you can take to ensure your face is in good hands.
When assessing a provider’s suitability to carry out your desired procedure, think the three Ps. PLACE – PERSON – PRODUCT
This should be a medical environment – a clean, clinical environment dedicated to the safe carrying out of medical procedures.
Always remember that there is nothing to stop anyone from setting up a “clinic” displaying fake certificates and calling themselves an aesthetics practitioner. A beauty salon, a hairdressers’, or someone’s home is a red flag that a practitioner might not be who they say they are.
“Medical practitioner” doesn’t necessarily mean anything at all. Look for someone who is a qualified doctor, nurse, or dentist. Check that nurses are registered with the NMC, dentists with the GDC and doctors with the GMC. It is your health and wellbeing that is at stake, so don’t be afraid to ask for their credentials.
Search the GDC
Search the NMC
Search the GMC
The fact that someone is medically qualified doesn’t always make them adequately trained though, so check out their suitability to perform the procedure you’re requesting and that they’re experienced in carrying it out. You can check whether they are registered with the JCCP https://www.jccp.org.uk/
Be aware too that some unscrupulous practitioners think nothing of faking qualification certificates and even training schools in a shameless attempt to dupe patients into believing they’re qualified. Always research the provider and look out for poor grammar and spelling on any certificates that are displayed.
You must find out what product they intend to use and where it was produced and sourced. Ensure that the product is from a licensed manufacturer and supplier. Prominent and reputable brands include Allergan, Merz, Juvederm, Restylane, etc.
The legitimate sounding “Advanced Aesthetics Practitioner” could literally be a beautician who’s purchased fake dermal filler on E- bay. This can and does happen. It’s essential that you know what product is being used and where it was from.
A good reputable practitioner will give you a thorough consultation and allow you to ask all the questions you need to. They will not tell you what procedure you need or pressurise you into having a treatment there and then. They will refuse to carry out an aesthetics procedure that they deem to be inappropriate and they will not carry out a procedure that is contrary to your best interests.
A good practitioner will ALWAYS put patients before profits. They also refuse to carry out procedures on under 18s. Legitimate practitioners will ensure you fill out a consent form and take heed of what is in it, not throw it into a filing cabinet without so much as glancing at it.
Legitimate aesthetics practitioners operate safely and ethically and are experts in facial anatomy, injection techniques, and the products that they use. Happily, there are plenty of them around if you take the time to find them.
It is hoped that unsafe practices will be eradicated in the not too distant future. It is widely recognised that the UK non-surgical cosmetics industry is crying out for more stringent regulation and the tireless work of organisations such as the JCCP and The Safety in Beauty Campaign will soon succeed in their efforts to protect the public from those seeking big profits at the expense of their customers’ health.
In the meantime, be savvy.
Always remember, reputable providers of non-surgical cosmetic treatments invest heavily in their training and professional development in order to continue to deliver treatment of the very highest standard. Bear in mind, that cheap is not a good thing where non-surgical procedures are concerned. Check out the provider, the premises, and the product and leave no stone unturned.
No amount of money is worth risking your health for.
About Tracey Bell
Dr Bell is a qualified dentist, member of the GDC, and respected aesthetics practitioner. She has been a dentist for 25 years and has been carrying out aesthetics treatments to the very highest standard for 16 years. She has treated hundreds of satisfied patients in her clinics in the Isle of Man and Liverpool. Tracey is a trustee of the JCCP has a MA in Dental Law and Ethics and a Graduate Diploma in Law. She provides expert opinions to the legal profession, in aesthetic medicine, dentistry. She is an avid supporter of safety in aesthetic and cosmetic procedures and remains at the forefront of research, technology and education in both dentistry and aesthetic lead. Tracey is a senior lecturer and programme lead in PGCert in non- surgical aesthetics at Salford University .
2 – Chatrath, V, Banerjee, P S, Goodman GJ Rahman, E Soft Tissue Filler – Associated Blindness. A Systematic Review of Case Reports and Case Series. Plastic and Reconstructive Surgery. April 2019, Volume 7, Issue 4
Review of the Regulation of Cosmetic Interventions, Dept of Health, 2013 – https://researchbriefings.files.parliament.uk/documents/POST-PN-444/POST-PN-444.pdf
The Safety in Beauty Campaign: www.safetyinbeauty.com
Save face – https://www.saveface.co.uk/