Get injectables at safe clinics

Advances in non-surgical treatments, such as Botox and fillers, have led to a surge in demand. But, as Leah Hardy reports, this has also created problems

Facelifts and liposuction may grab the headlines, but the real boom in aesthetic medicine is in treatments that don’t involve scalpels and stitches.

These non-surgical procedures include lasers, hair removal, peels, micro-needling, fat loss, and skin tightening via heat, sound and light waves.

But by far the biggest demand is for injectables. These beauty-in-a-syringe treatments feature wrinkle-relaxing injections, such as Botox, and fillers to replace volume in ageing faces and to plump lips.

The UK aesthetic market was worth £2.3 billion in 2010 and is estimated to rise to £3.6 billion by 2015. Of this, non-surgical treatments account for 90 per cent of procedures and 75 per cent of the market value.

A new report from Sk:n, a national chain of specialist non-surgical clinics, says 1.5 million cosmetic injectables are conducted each year in the UK with a 14 per cent increase in the past year.

Why? Dr Mica Engel, an aesthetic doctor at London’s Waterhouse Young clinic, explains: “Non-surgical treatments can dramatically improve appearance, without the costs, risks and downtime of surgery.”

Non-surgical treatments account for 90 per cent of procedures and 75 per cent of the market value

In studies, most people treated with Botox feel they look years younger, between 65 and 90 per cent of Botox patients are satisfied with their treatments, and the more they combined Botox with other non-surgical treatments, the happier they were.

“Technology and techniques have improved dramatically in just the last five years,” Dr Engel adds. “For example, we can use needles to deliver radiofrequency energy to stimulate collagen and improve the quality of the skin, something surgery cannot do. But Botox is still my number one treatment. Done well, it’s like a magic wand.”

Dr Sean Lanigan, chairman of Sk:n clinic’s medical standards committee, says: “Patients can now expect to see the same anti-ageing effect from next generation injectables as they could get from a surgical nip and tuck ten years ago. Fillers have become more bespoke, designed to be used in specific parts of the face, depending on their thickness, and come with anaesthetic for a painless procedure.”

Surgeon Geoffrey Mullan, of London’s Medicetics clinic, says combinations of treatments are particularly effective. “The sagging jawline is the new area of attack via skin tightening treatments,” he says. “These can be combined with fillers to volumise the midface, plus Botox for the forehead.”

Celebrities who have admitted to non-surgical treatments include Jennifer Aniston, Gwyneth Paltrow and Simon Cowell. Non-surgicals have been further normalised by shows such as The Only Way Is Essex, which feature on-screen Botox parties and stars with obvious facial and lip fillers.

This development dismays plastic surgeon Rajiv Grover, president of the British Association of Aesthetic Plastic Surgeons (BAAPS). He says “You shouldn’t start non-surgicals too young; people under 35 do not need Botox.”

And while trout pouts and pillow faces have faded from fashion for older women, Dr Engel says: “I have to turn away increasing numbers of young women who want to look fake with overplumped lips.” And Mr Grover warns: “Some celebrities are on the payroll of companies linked to clinics and there is a shameless lack of disclosure about this.”

But this is far from the only dark side to the boom. A government review published this year and led by NHS medical director Professor Sir Bruce Keogh, says: “We were surprised to discover that non-surgical interventions, which can have major and irreversible adverse impacts on health and wellbeing, are almost entirely unregulated.”

You shouldn’t start non-surgicals too young; people under 35 do not need Botox

Last month leading dermatologist Professor Nick Lowe revealed that complications from fillers used around the eyes had led to 50 known cases of permanent blindness.

Yet while Botox can only be legally administered by a doctor, nurse or dentist, fillers or lasers can be used by anyone, even if they have no medical background or training. One-day courses claim to teach literally anyone how to wield a syringe.

A BAAPS survey found that a third of providers of non-surgical treatments did not specify who administered treatments and a quarter did not mention qualifications. Treatments are offered in shopping centres, gyms and even during at-home parties.

To save money, some injectors have been re-using syringes on different women, which carries the risk of infection, even HIV. Other risks include burns and scarring from lasers and IPL [intense pulsed light].

Dr Engels says: “Any treatment that punctures the skin carries a risk of infection and anything put into the body carries the risk of an allergic reaction, including anaphalaxis, which can be fatal without treatment. You wouldn’t have dental work at home, so why have an aesthetic medical treatment there? It makes no sense.”

Cosmetic specialist Dr Mervyn Patterson adds: “I often treat women with complications from non-surgical treatments and believe they are much more common than people realise. If filler cuts off the blood supply to an area, the skin can start to die. Anyone can have a complication, but not everyone can recognise and treat it. That’s why choosing the right practitioner really matters.”

Dr Patterson says not all treatments are equal. “Many are unproven and ridiculously overhyped. Don’t rush to have the latest wonder treatment. If it works, it will still be around, better and safer, in a year or more.”


So how can you stay safe and get good results? Mr Grover advises:

• Have Botox or fillers in a proper medical environment and ensure your practitioner is able to deal with any rare but extreme complications.

• Never have a permanent or semi-permanent filler. Opt for temporary hyaluronic acid fillers, for example restylane or juvederm, and ask to see the box if you are not shown it.

• The best qualified practitioners have an artistic eye. The best way to judge that is to go by personal recommendation. Remember less is more.

Find a trained, qualified practitioner in your area by contacting BAAPS or logging on to or (for cosmetic doctors) or




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