Marisa Batti grew up during what she calls "the Kylie Jenner boom", when lips were big, skin was smooth and facial symmetry was within reach for those who could afford it.
She booked for dermal filler injections as soon as she turned 18.
"I was really insecure at the time and thought I needed to have big lips to feel and look beautiful," Ms Batti said.
She's now 26. After years of moving between different cosmetic clinics throughout Sydney, Ms Batti has learned the importance of knowing what can go wrong.
About one year ago she suffered a vascular occlusion, meaning filler blocked a blood vessel.
It's rare and can happen at the hands of even experienced injectors. But left untreated, it can lead to necrosis, the death of affected skin tissue.
"There are complications that do come along with these procedures," Ms Batti said.
"That's why you should always walk into a clinic very aware that these things can happen, and you have to put a lot of thought in before actually doing these procedures."
Registered nurse and cosmetic injector Laurisa Dannoun resolved Ms Batti's occlusion — which happened at another clinic — by dissolving the filler.
She's worried not enough injectors have the training and knowledge to identify and resolve complications.
"There's a lot of junior injectors coming through now who are not very interested in the scary side of things, they just want the glamorous injectable training and the trips and the conferences," Ms Dannoun said.
"I think over time [awareness will] increase, but at the moment, it's not at the level it should be."
Ms Batti and Ms Dannoun are among many patients and injectors who have told 7.30 it's time for Australia's booming cosmetic injectables sector to get real about the risks.
'You will not see that in the advertising'
Injectables like botox, which relaxes muscles, and filler, which adds volume to areas like the lips and jaw, have become so common that the procedures are now available at many suburban shopping centres.
Maddison Johnstone's business analyses and monitors cosmetic advertising. She said consumers rarely get the full picture.
"Those who advertise regulated health services are actually obliged to not under-represent the risks and not minimise the risks," Ms Johnstone said.
"If used incorrectly … injectables can cause skin damage, blindness and even death. You will not see that in the advertising."
The Therapeutic Goods Administration told 7.30 it has received 12 reports of blindness related to dermal filler in more than a decade. Only three patients fully recovered their eyesight.
Twenty-five patients reported necrosis.
"I'm so heartbroken for those people," Ms Johnstone said.
After intense media scrutiny, the Australian Health Practitioner Regulation Agency (AHPRA) has cracked down on cosmetic surgery in the past 18 months.
Chief executive Martin Fletcher told 7.30 the agency was now "increasingly turning our focus" to cosmetic procedures.
Cosmetic surgery involves more invasive procedures, while cosmetic procedures can be performed without anaesthetic.
AHPRA registers and investigates individual health practitioners. Mr Fletcher said the agency was investigating more than 250 complaints related to 88 practitioners involved in both cosmetic surgery and procedures.
"There are certainly many legitimate people involved in this industry and legitimate businesses," Mr Fletcher said.
"But there are also examples of businesses where we believe people appear to be putting profit over patient safety.
"So those people … should be on notice that we are keeping a very close eye on this, and we won't hesitate to act if we think the public has been put at risk."
There is no legal requirement for cosmetic injectors to report adverse outcomes to the Therapeutic Goods Administration, which regulates the drugs used, but it is mandatory for pharmaceutical companies.
'I was absolutely unrecognisable'
Radiologist Mobin Master consults with patients seeking to have their filler dissolved – and believes the available figures under represent the problems.
"I think it's under-reported, if anything," Dr Master said.
"So we can't give data to patients. It's very difficult to give them hard figures as to, 'This is the percentage risk of a vascular occlusion, this is the percentage risk of blindness in this country,' for example."
When 7.30 visited Dr Master's clinic, he was treating patient Lisa Grove. She had travelled from the US to Melbourne to have her filler dissolved after a "catastrophic" injection below her eyes almost one year ago.
Ms Grove started getting cosmetic injections after cancer reconstruction surgery left her face uneven.
"While I was still in [the nurse's] chair … my face exploded out in all directions," Ms Grove said.
"I was absolutely unrecognisable, even to myself. The right eye was visually in a nasty way, disgusting way, protruding until roughly about three weeks ago."
The treatment left her in pain and hearing crunching noises when she blinked.
Using MRI and ultrasound, Dr Master found and dissolved filler underneath Ms Grove's eyes and eyelid.
"I think she's suffered one of the worst symptoms I've seen," Dr Master said.
About half of Dr Master's work is reversing patients' past procedures for complaints ranging from cosmetic to chronic, and he has found up to 15 years' worth of filler built up in some people's faces.
"I think the important thing is for this to be understood as a medical treatment. It is not getting your nails done," Dr Master said.
"It still has its risks, it still has its complications."
It's a sentiment echoed by western Sydney injector Dr Imaan Joshi: "Consumers are sold the lie that it's no big deal."
Dr Joshi trained and worked in general practice before moving into cosmetic injections in 2015.
In Australia, doctors, nurses and dentists are allowed to provide cosmetic injections without specific training, which Dr Joshi said was a concern.
"I feel in many ways that there is a mentoring and a supervision and even an apprentice-like model that is being bypassed for the most part in the aesthetics industry," Dr Joshi said.
"Just about anyone with basic qualifications, that is they're an AHPRA-registered nurse, doctor or dentist, can do a day or two days or a week-long boot camp and then essentially set up shop."
Mitch Greer is a social media influencer who has also been getting cosmetic injections since the age of 18.
Ms Greer started with filler in her lips, and now gets it in her cheeks, under her eyes and in her chin. She also gets botox to slim her face and lift her eyebrows.
As a regular consumer, she encouraged others to do their research.
"It's not Coles you know," she said.
"You need to spend money if you want to look good, and you need to be safe."
Watch 7.30, Mondays to Thursdays 7.30pm on ABC iview and ABC TV
