For many people, having access to cosmetic procedures is empowering and “a comfort”, giving them more control over how they look and feel.

The ‘Zoom boom’ has meant a surge in demand but lack of regulation means untrained non-medics are providing treatments with potentially ‘catastrophic’ results, including blindness, writes Liz Dunphy

People with no medical training are injecting dermal filler into clients’ faces at the back of nail bars throughout the country with potentially “catastrophic” results including blindness, a doctor has warned.

Dr Brian Cotter, of SISU aesthetic medicine clinics, said that anyone can now easily buy substandard product from websites like AliBaba and advertise their services as injectors.

Although he stressed that dermal filler is safe when in the hands of a professional, someone with no medical or anatomical training could easily inject filler into a blood vessel and not notice, resulting in blocked oxygen supply which will eventually lead to the permanent death of that tissue if not recognised and treated with prescription medication.

Blindness is also a concern around non-medically trained practitioners injecting potentially substandard product around the sensitive eye area.

“It’s a ticking time bomb,” said Dr Cotter.

“The outcomes are catastrophic, potentially. It’s a huge issue. It’s down primarily to the total lack of regulation around things like dermal fillers.

“Botox is quite well-regulated, it’s a prescription drug, it has to be prescribed and administered by one of two people in the Republic of Ireland, either a medical doctor or a dentist.

But dermal filler is technically classified as a medical device, which means that anyone could get their hands on a dermal filler without any formal training or medical education and legally inject that into someone’s face.

“It’s really scary when you think about it.

“The majority of medical clinics will be using large pharmaceutical companies with extremely tight regulatory aspects in terms of their production of product, and their safety and efficacy.

“And pharmaceutical companies will primarily only deal with medical clinics, with formally educated medical practitioners.”

Medically untrained injectors are instead buying unregulated dermal filler from websites like AliBaba, bringing in products from outside the EU, he said.

“You will have a patient cohort who want that over-the-top effect, they’re more price-conscious, they’re looking for cheaper,” he said. “They’re young enough and are maybe not thinking about the risks.

“But when someone runs into an issue, there’s no recourse for that patient.

“Complications can arise. But medically trained injectors have the expertise to identify that situation and treat it.

“For example, if someone with no medical training does a treatment, occludes a blood vessel, has no idea they did it, and then that patient runs into massive issues.

“If someone has a vascular occlusion, they get tissue loss. You see very frightening stories in tabloidesque newspapers about that thing, and it gives filler a bad reputation. But it’s non-trained, non-medics providing those treatments.

“Any medical clinic which performs these treatments will stock a product called hyaluronidase, that’s an enzyme we use that immediately reverses dermal filler, it dissolves it and breaks it down. But hyaluronidase, or hyalase, is a prescription drug, so often you’ll have people who are non-medics doing dermal filler and they won’t have the skillset or means to deal with a problem.”

Dr Cotter said that he has been pushing for better regulation of the sector, but has been told that it requires legislation.

“It’s probably not something that’s massively on people’s radars with everything that’s happening at the moment,” he said.

“But it is a huge problem.

“We have people who come in for Botox treatment and say, sheepishly, that they had their lips done by a girl in the back of X nail bar when they were 19.

“That’s widespread. It’s happening in Cork where we have a clinic, it’s in Limerick City where we have a clinic. In Dublin there are numerous non-medically trained providers doing these treatments.

“It’s a ticking time bomb.”

Lack of regulation and the ease of internet and social media advertising is making it easy for these businesses to spread quickly, he said.

“You can do a one-day course online in injecting filler that gives you a ‘certificate’,” he said.

“That person views it as additional income, like it’s a beauty treatment, like getting your nails done. But the outcome can be catastrophic, potentially.

“Sometimes these people will end up in the emergency department, which is difficult as well because if the doctors in there may not have massive exposure to dermal filler because it is an evolving aspect of medicine.

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“And the proliferation of non-medical people, particularly in relation to dermal fillers, is probably increasing at a faster pace than say, for example, the more internally regulated medical providers, because the infrastructure requirements are totally different.

"Some people are operating in a very grey zone and their focus is not on the patient — it’s on money and profit. That’s a dangerous situation to be in because you have no one regulating an industry.

“You can get your lips done in Dublin for €80. We can’t buy the product for that price. So what does that product cost? Is there insurance? If it’s too cheap, then ask why. What’s missing in that process?”

Medically trained injectors have also seen a ‘Zoom Boom’ throughout the pandemic with interest soaring in cosmetic procedures.

Demand for Botox and filler treatments jumped by as much as 150%, non-surgical nose jobs jumped by 50%, and male clients increased by 50% in some Irish clinics since the pandemic.

“We’re at about 120% growth above where our projections were for the year and it’s now July,” said Dr Cotter. “That’s a huge increase for us. It also says that there’s a huge increase outside of us as well.”

The hike in demand is largely due to people staring at digitised images of themselves in computers while sitting through virtual meetings, medics believe.

“People are staring at a digitised, inverted version of themselves, and they’re beginning to notice things that they never noticed before,” he said.

Digitised images also show an opposite reflection to what people see in the mirror, he said.

“Left is right and right is left, and people are not used to seeing themselves like that,” said Dr Cotter.

A psychological phenomenon known as the mere-exposure effect has found that people tend to develop a preference for things just because they’re familiar with them.

“So when people see a different image of themselves, any asymmetries seem more pronounced because it’s not how you’re used to seeing yourself,” explained Dr Cotter.

“And digital lenses tend to be short-angle lenses which makes everything look wider. They say the camera adds 10 pounds, and it does make people look different.”

While demand for Botox and filler has increased by some 150% in his clinics over the past year to 16 months, demand has also increased for SISU Slim, a treatment which uses a fat-dissolving drug to remove excess fat.

It has been particularly popular in targeting fat under the chin.

“A lot of people are getting that treatment because when they’re on video calls, if your laptop is on your desk it’s angled up probably 15-20 degrees, and people are just staring at it,” he said.

Male clients now make up some 25% of SISU client base, with a 45-50% increase in male patients, over the last year to 16 months.

“Even outside the pandemic, we’re seeing a paradigm shift where male patients are moving more into the space, particularly for the preventative aspect.

“We have builders, mechanics, MDs, finance, a lot of doctors. Most people that come in say that they just want to look less tired.

There’s a misconception that people get these treatments because they want to look younger, but they actually want to stay the same or just look a little bit better.

Dr Cotter believes that treatments like Profhilo, a ‘tissue modulator’ where hyaluronic acid is injected to improve the overall quality of the skin without actually changing the structure of the face, are the much more efficacious facials of tomorrow.

“What these things do and what people used to think they do are different.” he said. “Now, these treatments can be very soft and subtle and not radically altering.”

He has also seen demand for non-surgical rhinoplasty rise by 50%-60%.

“People are working from home, probably spending more time seeing digitised versions of themselves, and they’re seeing a contour they don’t like or a nose that was broken before. Having a surgical rhinoplasty is a big decision.

“But a dermal filler treatment can get the effect you want without the radical downtime of a surgical treatment,” said Dr Cotter.

“All of this comes back to how we’re viewing our face. I’ve used more Zoom over the past year than ever in life. I look at it, and my left eye is smaller than my right eye, and on a Zoom call, I just stare at it. It’s human nature.

“It definitely has changed since the pandemic — the Zoom Boom is a real thing.”

Dr Emma Sheenan, founder of Eden Medical which now has seven clinics nationwide with another two in the pipeline, said that the surge in demand is “definitely” due to the increase in video calls.

That, and an increase in disposable income as restaurants and pubs closed over successive lockdowns and holidays abroad were cancelled.

“The Zoom calls we’re all doing are showing us a reflection we’re not used to,” she said.

Demand for non-surgical nose alterations has also increased since the pandemic, she said.

“Recently, we’ve seen an increase in non-surgical rhinoplasty or nose filler. If a patient has a concern about their nose, it’s very satisfying to have that concern rectified within minutes, and it saves them going down the surgical route of a rhinoplasty.”

Injectable cosmetic treatments will remain popular, she believes.

“I think it’s here to stay,” she said. “When people get these treatments done, it can make their confidence soar. It’s really all about how they make you feel rather than how you look.

“And attitudes are definitely changing.

“When I started Eden Medical five years ago, a lot of people were keeping it under wraps, they wouldn’t even tell their partner or their parent.

“But now it’s widely talked about, it’s accepted. Now people are encouraging their husbands to get it done too.

“And there’s so much knowledge about it now.

“So people know about it, and they know it’s very safe when it’s done in the right hands.”

Beauty journalist and influencer Mary-Jane O’Regan said that it’s important to normalise conversations about aesthetic medicine.

Education and open conversations will protect people from ending up in dodgy back-street clinics, she believes.

She first had botox and lip filler seven years ago at the age of 35, and has continued with both treatments since.

“Men [on Twitter] seem to be under this illusion that women should be natural and shouldn’t be doing all this to themselves,” said Ms O’Regan.

“But confidence is what’s attractive, and this builds people’s confidence.”

As a beauty journalist, editor, and social media influencer whose @GlamityJane Instagram page has more than 13,000 followers, she believes it is important to be honest about any work she has done.

“If I was being disingenuous and not admitting I had Botox, that is so damaging and wrong. If I was to just say: ‘It’s this cream or serum’, that’s putting an unrealistic expectation into somebody’s mind.

“I think people in the public arena have a duty of care to be a bit more honest about what they do.”

Her love of makeup first prompted her to have cosmetic procedures.

Read MoreFresh support for UK ban on children getting Botox and cosmetic fillers

With naturally thin lips ‘that were almost inverted’ she felt excluded from wearing the lipsticks she sold to people while working in a department store because they “didn’t sit right”.

“I used to say I had a lip like an envelope,” she said. “I was so envious selling this luxurious lipstick to other people. One of my memories as a child was watching my mother put on lipstick. So my desire for bigger lips was purely because I loved makeup so much. It’s such a big part of my identity and self-care routine.

“The botox gives me a bit of a brow lift, I have naturally heavy brows.

“I had a bit of non-surgical rhinoplasty done two years ago. And I haven’t had to have that redone yet, but I will. I had a little dip on my nose that I didn’t like.

“But I have no desire to overdo anything. That’s down to having a good doctor as well.

“Getting cosmetic procedures is so I can wear makeup better. It’s not from a desire to look younger than 42 because you’ll always look your age in some ways.

“I could pick myself apart, my neck could be better, my hands are ageing. But it’s not a chase for eternal youth, I’m very open about what age I am.

It’s about feeling good in myself. And I feel better when I have a little brow lift, a little bit more volume in my lips. It’s nothing sinister, I don’t not want to look like myself.

“But I do want to be more confident. If my lips are not the way I want them or my botox wears off, I don’t feel as confident. For some people, confidence is in a self-help book — for some, it’s Botox.”

Attitudes to cosmetic procedures are changing, she said, with people becoming increasingly open about having ‘tweakments’.

“When I initially came out and said I was getting Botox people were shocked, but now it’s much more common,” she said. “So many girls have said ‘thanks’ for being so open about what I’ve had done.”

She said that having access to these cosmetic procedures is empowering and “a comfort” to many people, giving them more control over how they look and feel.

“I remember growing up with someone who hated her nose, it really dented her confidence.

“I was always confident in who I am, but I didn’t always love how I looked, and now I’m more comfortable with how I look, there’s more balance now. And I do think that’s really important,” Ms O’Regan said.

“You see people crying [from happiness] after procedures because they’ve always hated their nose or had tiny lips.

“It’s such a comfort to have that. No one wants to be like Benjamin Button or the Bride of Wildenstein, but it can give you an extra kick of confidence. It’s not chasing eternal youth, but preserving what you have and feeling good about yourself.”

Social media can spark cosmetic trends, like when Kylie Jenner had her lips augmented, she said.

Although extreme cosmetic work, often popularised through digital images on social media, is still visible on shows like Love Island , that look is falling out of fashion, she believes.

“There’s this Love Island scenario where people are getting extreme work done, but that’s tailing off now. That pillow face, big lips, big cheeks look was big for a while, but they’re going back to a more natural look.”

“I don’t think people should feel pressure to have Botox or filler, but I don’t think they should feel ashamed of it either,” she said.

Read More'Zoom boom' creates a 150% surge in cosmetic nips and tucks

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