Cosmetic fillers – what you can do if it goes wrong

Posted by Ruth Powell on
Cosmetic fillers

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The UK cosmetic surgery industry is booming with more patients than ever opting to undergo procedures such as breast augmentations, facelifts, liposuction and fillers.

The latest figures estimate the value of the industry at a staggering £3.6bn, a figure which many feel is fuelled by increasing pressure, particularly on women, to enhance their appearance. The British Association of Aesthetic and Plastic Surgeons (BAAPS) estimated that in 2015, more than 51,000 Britons underwent some form of cosmetic surgery.

The vast majority of those were women, who account for around 91 per cent of cosmetic procedures in the UK – but the number of men seeking procedures is thought to have doubled over the last decade.

Surgical procedures such as breast augmentations, facelifts and liposuction are regulated by the Care Quality Commission and carefully monitored by organisations such as BAAPS, so while mistakes can be made, patients are able to undergo these operations with some degree of confidence and knowledge that the clinician treating them is working within a code of conduct and is accountable to an external body.

However, there are many cosmetic procedures that do not involve surgery – dermal fillers being one of the most popular. Used to plump out wrinkles, lines and reduce the signs of ageing, they are injected directly beneath the skin.

These are big business – it is reported that fillers, laser hair removal and Botox account for nine in 10 procedures, and approximately 75 per cent of the market in terms of money spent. There is a widely held view that this market is partly driven by pressure to look good from TV, magazines and social media – particularly the “selfie culture”. It is perhaps not surprising that people are tempted by advertising for a quick fix to their wrinkles after seeing perfectly-posed pictures of smooth-skinned celebrities on Facebook, Snapchat or Instagram.

Most of those people would be shocked to discover that dermal fillers are only subject to the same level of regulation in the UK as ballpoint pens and toothbrushes. When it comes to those who carry out filler procedures it’s rather like the Wild West out there – pretty much anybody can do it.

With the industry worth so much money and still growing, it’s perhaps not surprising that alongside the many responsible and competent practitioners, there has emerged a troubling number who cause concern. At best inexperienced and at worst unscrupulous, these individuals can be found around the UK in hair salons, nail bars and even working from their homes.

They do not have to register with anyone. They do not have to prove that they are competent. And often they are uninsured – so if anything does go wrong, those who are often left devastated by poor or even dangerous treatment can sometimes find themselves without remedy.

As somebody who has seen first-hand the horrific consequences of these procedures going wrong, I believe this situation is unacceptable and must not be allowed to continue.


Surely fillers must be regulated in some way?

It’s shocking, but they are not – at least not beyond the everyday regulations which apply to purchases such as pens and toothbrushes. Fillers can be bought over the internet without a licence. There are no rules about which substances can be used.

To put this in context, let’s compare the UK to the USA, where cosmetic procedures are regulated by the FDA. In the UK, it is estimated that around 150 different kinds of fillers are in use. In the USA, just 15 are approved. As someone who specialises in cosmetic surgery claims, I have heard some real horror stories. In one case, a bathroom sealant had been used, with devastating consequences for the patient.

What can go wrong?

Fillers are injected directly underneath the skin and, in theory, safely break down in the body, remaining visibly effective for up to a year.

When it goes wrong, the effects can be devastating – both cosmetically and medically. Several high-profile celebrities – among them Khloe Kardashian and the actress Leslie Ash, have spoken about their own problems. The infamous “trout pout” is an obvious effect of fillers being injected without appropriate skill. In most cases these effects fade over time, but sometimes there can be more permanent scarring or cosmetic consequences.

In the most severe cases the effects can go beyond the cosmetic. There have been cases where fillers or fat from the patient’s own body can be mistakenly injected into a blood vessel that supplies the eye, causing temporary or permanent blindness. I know of one case where filler moved around under the skin after being implanted, putting pressure on the patient’s optic nerve. There have also been reports of substances finding their way to the brain, causing stroke.

What can I do if a procedure goes wrong?

Currently, there is no ombudsman to complain to, no register for rogue practitioners to be struck off, and no formal body to complain to.


What about practitioners –  they must need to be licensed?

Cosmetic surgeons who carry out surgical procedures must be licensed. Practitioners who administer botulinum toxin, commonly known as Botox, are also required to have a licence – but when it comes to fillers, there are no rules. No medical qualifications are required at all, and "practitioners" are not even required to demonstrate that they have undergone any training. This is a bizarre and very troubling situation for a procedure that represents around a third of non-cosmetic procedures carried out in Britain.

Another issue is that practitioners are often either inadequately insured or not insured at all. Proper regulation such as a national register could require that insurance is in place, further protecting patients if things go wrong. As it stands, even claimants who have a good case can find it hard to receive any compensation because of the insurance position. In the worst cases, a practitioner subject to a legal claim will simply close a company and then re-emerge under a different name.


Isn’t a prescription required for substances used in cosmetic procedures?

The problem lies in the fact that dermal fillers are classified as implants rather than drugs. As such there is no requirement for a prescription, to the extent that they can be freely bought over the internet.

The prescription point is a very good one, because reclassifying fillers so that they require a prescription before they can be purchased would go a long way towards resolving some of the problems around them.

A review of the industry in 2014 by the medical director of the NHS in England, Sir Bruce Keogh, referred to fillers as a crisis waiting to happen, and recommended that they become prescription only.

As the BBC reports here, doing so would have effectively controlled their marketing and sale, regulated who can perform the injections and automatically banned them being advertised. All these measures would be major steps towards a system that benefits consumers rather than unscrupulous practitioners. So far, the Keogh recommendations have been widely discussed but not implemented.


So what was the Keogh report, and what did it recommend?

Professor Sir Bruce Keogh, then medical director at the NHS, was commissioned by the government to help guide a review of procedures and care guidelines within the cosmetic treatment industry. This came amid rising concern that there was no industry-wide standard of care and little accountability or protection for patients.

When the review was published in April 2013, its author summed the situation up by saying: “The most striking thing is that anybody, anywhere, any time can give a filler to anybody else, and that is bizarre,” His review made several recommendations – the most significant being that dermal fillers be made prescription-only.

It also made several other recommendations, including the appointment of an ombudsman to oversee all private care and restricting or banning advertising, competitions and discount offers for cosmetic procedures. The recommendations were welcomed by many, including the British Association of Aesthetic Surgeons (BAAPS), which has long campaigned about the dangers of untested procedures and fillers.


Why have the recommendations of this report not been implemented?

The government’s response to the Keogh review was far less proactive than many had hoped. Rather than adopt the recommendations, the government merely said it “intended” to improve the standards or training and qualification of cosmetic practices, and that it agreed there was a “need to look at how products are used in practice and how they can be further controlled, including the need for regulation.”

Many inside and outside the industry, including BAAPS, considered this to be an underwhelming response. The president of BAAPS, Rajiv Grover, himself a cosmetic surgeon, said the organisation was “appalled” at the lack of action. At the time he said the response “represents yet another thoroughly wasted opportunity to ensure patient safety” and that “choosing not to reclassify fillers as medicines with immediate effect or setting up any kind of register beggars believe….It’s business as usual in the Wild West”.

Many commentators, myself included, believe that the government is unwilling to go through the expense and bureaucracy of regulating anything that it doesn’t actually have to. It seems to prefer that the industry regulates itself – something which it has so far shown no signs of being willing to do.


So what is being done?

In September 2016 there was some fanfare when the Royal College of Surgeons made an announcement that it was taking steps to address concerns over patient safety.

It sounded like a good step forward, but in reality its effect is limited. It really amounts to the organisation posting a checklist on its website for patients to fill out when considering a procedure. It asks whether the patient understands important facts such as the level of the practitioner’s skill and the possible risks and complications involved. It also recommends a two-week “cooling off” period between consultation and procedure.

These checks are all sensible and having them all in one place will undoubtedly help patients think carefully before undergoing a procedure. However, they don’t really address the patient’s most important question – how do I know my surgeon is competent and that the procedure is safe?


If you believe there has been negligence on the part of a practitioner and that has resulted in disfigurement, loss of earnings or trauma, your best hope of redress may be able to make a legal claim for personal injury.

Ruth Powell is a personal injury claims specialist at BL Claims Solicitors and a specialist in cosmetic surgery claims. 

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About the Author

Ruth is a Senior Associate and leader of our London Clinical Negligence team. She has over 20 years experience of clinical negligence litigation and is a member of the AvMA specialist clinical negligence panel.

Ruth Powell
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