Warning: this article contains some disturbing images
When 58-year-old Angela* booked an appointment to get anti-wrinkle filler injected in her chin two months ago, it didn’t cross her mind that the procedure could go wrong.
“It was a spontaneous thing,” she tells me when we speak over the phone. “A friend of mine was having something done, and I was like ‘do you think she’ll have time to do my fine lines too?’ I didn’t really think twice about it – all of my friends have had stuff done.”
Angela had previously had other non-surgical cosmetic “tweakments” done in the past, but this time was visiting a new practitioner. Immediately, alarm bells started ringing.
“It was in the back room of this hair salon,” Angela says. “She put some numbing cream on the area, but it was immediately really painful. My friend even said she could see I was in agony throughout. As soon as I left, it was bruised straight away.”
The bruising on Angela’s chin quickly swelled into large, red, puss-filled boils right across the lower half of her face.
“I texted her [the practitioner], and she kept saying ‘don’t worry, it will be fine’”, Angela says. “But the boils just weren’t going away. I was going on holiday to Spain for my daughter’s best friend’s wedding a couple of weeks later, and I was so embarrassed getting on the plane.
“In the end, I and I didn’t even go to the wedding – I couldn’t face leaving the hotel. I was terrified – I thought it would never go away.”
After getting back from Spain, Angela contacted Harley Street’s Dr Ed Robinson, who put her on antibiotics.
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“He [the doctor] said it could have been a dirty needle that she used, or that the filler could have gone out of date,” Angela says.
While Angela’s experience is disturbing, she believes she got off lucky. Despite being marketed as non-invasive and low-risk compared to surgery, injectable procedures come with a host of potential dangers.
Last month, Alice Webb, a 33-year-old mother of five, died at Gloucestershire Royal Hospital hours after reportedly undergoing a non-surgical liquid Brazilian butt lift. She is thought to be the first person to die in the UK after having the procedure, which is a cheaper, supposedly non-invasive version of the traditional butt lift, and which sees hyaluronic acid dermal fillers injected into the buttocks. Two people have since been arrested on suspicion of manslaughter.
A serious concern with liquid BBLs is that the injection can cause a blockage in a blood vessel, which can lead to a blood clot travelling to the lungs – a pulmonary embolism – which can be lethal.
Liquid BBLs are just one part of the booming “non-invasive” cosmetic procedures market, which has seen a staggering rise in popularity in the last decade. An estimated 11 per cent of the UK population underwent an aesthetic treatment in 2023, according to Policy Bee, and almost half of millennial women polled by the BBC in 2019 said they believed that having a cosmetic procedure was akin to having a haircut. In a 2022 audit, the British Association of Aesthetic Plastic Surgeons (BAAPs) found that demand for Botox treatments rose 124 per cent compared to the previous year.
But despite their rapid normalisation, in the UK, there is currently no legal framework on who can administer “non-invasive” aesthetic treatments such as BBLs and injectables. This means that non-medically qualified people are legally allowed to buy the equipment and perform injectable treatments on members of the public.
At best, a botched tweakment can leave you with burst lips, a frozen forehead or an infection. If things go badly wrong, though, vascular occlusion can occur — when filler blocks or puts pressure on blood vessels, stopping blood from passing through – which can cause permanent blindness.
Seven weeks after her filler appointment, Angela’s boils have finally begun to fade after getting them dissolved, but she has still been left with scabbing and scarring.
“There’s this feeling of shame – it’s embarrassing because you’ve done it yourself, you put yourself in that position,” she tells me. “I feel totally embarrassed walking around the street with my boils – I was thinking I’d rather have the fine lines back.
“It’s just not worth it – and if you’re going to do it, you really need to go to someone who’s qualified, a doctor or a nurse.”
The pressure to be more beautiful is hardly a novel one, particularly for women. So what is behind this recent dramatic spike in non-invasive cosmetic procedures?
Social media, and the barrage of images showing increasingly unattainable beauty standards is certainly one factor. There is also the fact it has become far easier to access non-surgical procedures: they are more affordable, prolific and widely advertised. Where once you might have to seek out a specialist, now it seems every high street has a medi-spa, or a hair salon with a private room, where these procedures are available for as cheap as £50.
“Accessibility, social media, celebrities, fashion, people living longer and wanting to look 'good for their age' and simply fact that perhaps your friends are having tweakments and therefore you think, 'why not me',” says Amish Patel, aesthetics practitioner at Intrigue Cosmetic Clinic.
Patel also believes that the spike is due to the reduction of the stigma that used to surround cosmetic work – since 2015, posts on RealSelf, a plastic surgery review site, have more than doubled, with users posting before and after pictures of themselves.
“Ten years ago, most people wouldn't talk about having had treatments, but these days, especially with the younger generation, there is very little, if any, stigma attached to having dermal fillers or Botox,” he says. “It has now become socially acceptable and part of most consumers' beauty routine along with facials, hair cuts or getting their nails done."
The topic is the subject of Coralie Fargeat’s new and already wildly popular feminist body horror film The Substance. When Elisabeth Sparkle (Demi Moore), a 50-year-old actress turned TV fitness instructor, is about to replaced by a network executive who deems her too old, she takes up an offer to inject herself with neon-green substance that lets her live every other week as a flawless, hot 20-something. It is presented as a reckless decision and a Faustian bargain – the origin of the product are unknown and it is administered in a dingy underground basement. Naturally, it doesn’t go to plan – each time, the younger version overstays her welcome and parts of Elisabeth’s body age at extreme rates, leaving a Frankenstein’s monster in its wake.
When 55-year-old Sarah* first started getting injectables in her late twenties, the industry was still nascent.
“I was working in fashion, a very image-conscious industry,” Sarah says. “And like most women, you start to get old and there’s a lot of pressure on you to look younger. I thought ‘oh it’s not surgery, it’s fine’.
“For the most part it was fine, but it’s only when it starts to go wrong that you think ‘oh god, what am I doing to my face?’”
After more than twenty years of getting fillers without any complications, it did go wrong for Sarah, when she booked to get a course of lip filler.
“I didn’t do any research about the practitioner beforehand – it was a friend of a friend, so I just thought ‘I’ll go with them’.
“I had the lines above my lips injected with this product that was new on the market at the time – a Poly-L-lactic synthetic filler. Immediately, it started to form hard lumps on my lips that became very noticeable. I thought they’d just go away with time, but they didn’t. People started saying ‘what’s going on with your face, what have you done to your lips?’.
“I probably left it for about two months, and it kept becoming more and more visible,” she continues. “Finally, I contacted the practitioner to make an appointment to dissolve it, which was incredibly painful. But I was so worried that even if I tried to get it dissolved that it wouldn’t go away. I thought ‘am I going to have to have it cut out?’”
Almost twenty years later, even after having the filler dissolved, Sarah has only just managed to get rid of the lumps around her mouth.
“They haven’t been noticeable for a few years, but I can still feel them,” she says. “Not long afterwards, guidelines came out to say that that product shouldn’t be injected in that area.”
“People don’t ask what they’re getting injected in your face, or who’s injecting it,” she continues. “What are their qualifications? Are they able to deal with an emergency if something goes wrong? Until something happens to you, you don’t think about any of this.”
“Nowadays, when you get fillers, it’s like going to the hairdressers. But I think people don’t realise that this isn’t just like having a hair cut or even going for a facial – it’s is a medical procedure.”
“We get at least one enquiry a week from either a clinic wanting to refer an individual who has approached them for help with a case of botched fillers or directly from someone who has had filler,” says Patel. “The most common botched fillers we see are lips – when done poorly [they] can be overfilled, asymmetric, or stiff unnatural looking 'lilo lips' often caused by the injector using the wrong filler thickness.”
The government is trying to change the UK’s regulatory landscape. The passing of the Health and Care Act in April 2022 gave the Health and Social Care Secretary the power to introduce a licensing regime. Under the proposed scheme, which will be operated by local authorities in England, practitioners will need to be licensed to perform specific procedures, and the premises from which they operate will also need to be licensed.
Save Face – a government approved register of accredited practitioners – received almost 3,000 complaints about botched cosmetic procedures in 2022. While most of the complaints relate to dermal fillers and Botox, last year they also saw a spike in complaints around higher risk procedures such as liquid BBLs and breast augmentations.
“Those complaints were extremely severe – 50 per cent of them had sepsis, and nearly 40 per cent needed corrective surgery,” says Ashton Collins, director of Save Face. “These women have been left unable to walk, unable to work, sit down, care for their children. Many of them were told at the hospital that they may not make it through the night.
“We warned the Government that unless they took urgent action, it would only be a matter of time before somebody would inevitably die as a result of one of these procedures.”
"Other European countries have much stricter regulations,” Patel says. “In fact, it is often limited to doctors. The UK market is full of 'cosmetic cowboys’, making it extremely difficult for consumers to know who or what is safe.
"There are several red flags you should watch out for: cheap prices – how are they undercutting the competition?,” Patel continues. “Probably by using poor quality or even counterfeit dermal fillers, lack of insurance, experience, and training. Look at reviews, ask for client examples and ensure you book a face-to-face consultation with them. If it feels wrong or you feel pressured, then walk away.
"Remember, this is your face. You wear it everyday, so ensure you put it in safe and capable hands."
