When is it safe to go under the needle?

A growing number of under-35s are having Botox or fillers, but a quick fix can carry significant risks, discovers Rosie Taylor

While the prospect of undergoing a breast or nose job has always been cause for lengthy consideration, for many, having fillers or Botox has become as normal as getting a manicure.

Reality TV shows such as

Love Island have “normalised” nonsurgical cosmetic procedures, and the desire to look good in selfies is driving more under-35s to have them, according to the American Academy of Facial Plastic and Reconstructive Surgery.

Last month, NHS criticism about how the procedures were fuelling mental health problems triggered Superdrug, the high street health and beauty retailer, to bring in tougher mental health checks for customers in search of a quick filler fix.

The procedures also carry physical risks – including severe reactions and facial disfigurement – and are not fully regulated in the UK. So how do you know what is safe? And who can you trust with your face?

What can go wrong with Botox?

“Botox” is a brand name for botulinum toxin, which is produced by bacteria and relaxes muscles when injected by blocking signals from nerves that tell the muscles to contract.

When injected into the face it can help soften hard lines caused by facial muscles contracting, so is commonly used to help minimise the appearance of forehead lines and crow’s feet, with the effects lasting around three to six months.

As botulinum toxin is a prescribed medicine in the UK, by law it can only be used if the patient has been seen by a prescriber, such as a registered doctor.

The reality is that this happens infrequently. Some unscrupulous injectors will order the toxin over the internet, while others may simply ask patients to speak to a doctor over the phone or on a video-calling service such as Skype.

Last year, Save Face, a governmentapproved register of practitioners, helped 934 patients who had been damaged by cosmetic procedures. Eight out of ten cases involved beauticians, hairdressers or members of the public with no official healthcare qualifications.

Save Face found more than two thirds of people whose Botox had gone wrong did not have a face-to-face consultation with a prescriber, while nearly four in ten had no consultation at all.

The main risk with injectable toxins is that they can make the face appear lopsided if not administered correctly.

David Gateley, a consultant plastic surgeon and owner of nakedhealth Medispa, a clinic in south-west London, says: “Too much injected into the face can change the way the jaw moves, making you look like a robot or unable to smile or frown. Problems injecting into the forehead can cause your eyebrows to sit at different heights or one eyelid to droop.

“In all these cases, the only thing to do is wait for around three months until the effects have worn off.”

He warns that rarer, but more serious, risks include infections, blurred vision and allergic reactions – particularly if the toxin has been ordered online. Botox is also not suitable for pregnant women, because the effect on unborn babies is unknown, or for people with myasthenia gravis, an immune condition that causes muscle weakness.

What risks are involved with fillers?

Fillers involve injecting a substance that “plumps up” the face. It is mainly used to make lips bigger and cheeks more pronounced, but can also be used to smooth wrinkles by filling under lines and creases, with effects lasting from four months to a year.

Fillers can be made from different substances, but the most common is naturally occurring hyaluronic acid. Synthetic fillers, including those made from silicon, and collagen fillers are also used.

As with Botox, fillers injected incorrectly can cause facial features to appear wonky or swollen – “trout pout” or lumpy lips are common complaints – or make skin appear red or bumpy.

The effects can last for months and “permanent” synthetic fillers can be very difficult to remove if things go wrong, Gateley warns.

There are serious potential health risks from fillers, according to a review of evidence published in the Journal of Dermatology and Dermatologic Surgery in 2016.

The most dangerous is vascular occlusion, which happens when filler is accidentally injected into or close to an artery, stopping blood flow.

A lack of blood flow to the face can quickly cause the flesh to begin to die off – a condition called necrosis. If this happens near the eyes it can cause blindness and, in severe cases, the filler can travel through the arteries to the brain, causing a stroke.

While these cases are relatively rare, Save Face helped 616 people who had bad experiences with fillers last year. Of these, 25 per cent had lumps or nodules on their face and four per cent had infections. It recorded six cases of vascular occlusion, or where doctors had to act quickly to stop necrosis.

When is it safe to get work done?

The law says anyone can perform these procedures – and that really does mean anyone. As Ashton Collins, the co-director of Save Face, explains: “Anyone can get hold of some Botox, watch a few Youtube videos on how to inject and start promoting their own mobile salon or ‘Botox parties’ on social media.

“There’s no address linked to these people and often the phone number is a throwaway pay-as-you-go sim card. If there are complaints, they close down their site and disappear, only to open under a new name a short time later.”

Two thirds of complainants to Save Face found their practitioner on social media. Collins recommends only getting Botox or fillers from a medical professional, such as a doctor or nurse, who has appropriate training in cosmetic procedures and is under supervision by an experienced cosmetic doctor.

However, it can be hard to know where to find a reliable practitioner.

There is no single official register of approved cosmetic practitioners in the UK, although there are a number of government-approved organisations which inspect practices and check qualifications and training standards are met.

These include Save Face and the Joint Council for Cosmetic Practitioners (JCCP). When it launched earlier this year, the JCCP initially said it would consider allowing non-medical professionals to register to perform filler and toxin injections.

It has since scrapped the idea, however, with Prof David Sines, the chairman, pointing to the absence of a training programme for beauticians to ensure they are equipped to the high standard required to carry out risky procedures.

The JCCP is calling on the Government to create strict laws around who can inject toxins and fillers, but this could be a long way off. For now, Prof Sines says: “It is totally reasonable to ask who the prescriber is [for Botox] and whether the practitioner has the training required.”

You can check whether someone is a registered doctor or nurse using the websites of the General Medical Council (GMC) and Registered Council of Nurses (RCN).

Registered doctors or nurses can be struck off or banned if they are found to have harmed patients. Many beauticians claim they are safe to perform cosmetic procedures, but are split over injectables.

“Current evidence suggests client safety is determined at the level of an individual provider on the basis of their skills and personal standards and not on the basis of their professional background,” says Lesley Blair, the chairman of the British Association of Beauty Therapy and Cosmetology.

But she says the body does not insure therapists for carrying out Botox and fillers because there are at present no approved qualifications available to train therapists adequately.

“Until such time as a qualification is made available, we will continue to recommend that therapists do not carry out these treatments,” she adds.