Will this be the year that facial filler is cancelled?

What Cox is referring to is what’s known in the aesthetic world as “perception drift”, says Dean Rhobaye, a qualified plastic surgeon who specialises in injectables. “One’s eye becomes accustomed very quickly to the adjustments. This can lead to unnecessary tweaks and, before you know it, you no longer resemble your former self,” he explains.

Rogue injectors: beware 

Shockingly, you don’t have to be a doctor to inject filler and hence there’s endless cowboys about. “You can complete a one day or two day course to become an injector,” reveals Rhobaye. Is it best then to visit a plastic surgeon for injectables, I wonder? “It’s definitely an advantage,” he says. “When I’m injecting a client, I can envisage the musculature underneath the skin because I’ve seen it up close so many times during surgery.” 

Moreover, the interplay between the muscles needs to be understood if you want a believable outcome. For example, says Rhobaye, “the shape of the lips at rest and when smiling is affected by an array of different muscles. In some cases, injecting an adjacent area to the one you’re aiming to correct or enhance can have an indirect effect – for the better, or worse – depending on whether the injector knows what they’re doing or not,” he warns. 

The new vanguard of injectables 

With increasing numbers of high profile faces admitting to fillers gone wrong, there’s a thirst for less invasive treatments, says Dr Ashwin Soni, a GMC registered plastic surgeon whose practice is becoming increasingly non-surgical. Soni tells me he’s doing a lot more bio-stimulating injectables, otherwise known as “skin boosters”, like Nucleadyn, an injectable with polynucleotides (molecules extracted from salmon or trout sperm which closely resemble human DNA, an ingredient that Jennifer Aniston has spoken about trying) that stimulates collagen and elastin. These new smart injectables, Soni explains, work on the body’s own pathways to reverse ageing rather than adding a volumising substance as is the case with fillers.

“Bio-stimulators are proving a great option for patients that aren’t comfortable with filler – and it’s a more affordable option,” he points out. As for plumping lips, aesthetic doctors such as Dr Lizzie Tuckey at Michael Prager’s London clinic, are looking at methods such as PRP (platelet-rich plasma) to regenerate lip tissue. Though it doesn’t have the same inflatable qualities as hyaluronic acid, it will stimulate growth factors for a juicier, more youthful-looking pout. 

The laser facelift alternatives 

The war on overfilling is not won with a shiny new injectable alone. Natural looking results are achieved through a combination approach including energy devices, says Dr Sophie Shotter. “We should be treating the face layer by layer, which is why lasers and skin boosters are now at the forefront because they allow cosmetic practitioners to target the entirety of the face from the quality of the skin’s surface to re-energising the fibroblast cells (the skin’s collagen factory) deep within the dermis.”

Collagen is the body’s main protein responsible for strong cartilage and bones and is what keeps the skin firm and cushiony. Energy devices work by utilising light at different strengths and wavelengths to create a controlled trauma that elicits an emergency uptake in collagen and elastin. The three main types of energy include ultrasound treatments such as HIFU (high-intensity focused ultrasound) or Ultherapy, which are best for firming, IPL (intense pulse light) that targets pigmentation, and radiofrequency which is good for tightening. When combined with microneedling (Morpheus8 and Profound) the results, which take a few months to fully transpire, are intensified. 

When filler makes sense 

Despite technology advancing, filler is a long way from being cancelled, insists Shotter. “It’s still my most popular procedure and can be vital for boosting confidence in patients who’ve lost volume through the ageing process.” Soni agrees: “The results from energy devices are subtle which can leave some patients feeling deflated.”

“In the right candidate, small volumes of filler can be extremely effective at contouring and defining the mid and lower face in particular,” says Soni. A good job, he tells me, is down to using the right viscosity and amount of filler at the correct injection point. The thickest fillers are ideal for creating structure when injected close to the bone. Medium density fillers are suited for lip fullness, whereas barcode (smokers) lines require a very thin density, as does under eyes, bearing in mind there’s no accounting for taste and skill. “It’s not simple, you need experience and an understanding of how the product works within the skin on different areas of the face,” explains Soni. 

And yet. the risks are undeniable 

Ultimately, fillers have become the scapegoat for an industry that lacks regulation and allows the unskilled and unethical to profit from vulnerable clients. What’s not made clear on social media where non-surgical rhinoplasty, for instance, is touted as a safer, quicker alternative to surgery, is that fillers in certain areas of the face, like the nose, carry devastating risks like necrosis (tissue death) and even blindness. These “botched” jobs are at the heart of the complaints the Government is investigating. 

In 2021 it was made illegal for under-18s to be injected, and under the proposed scheme, practitioners and their premises will need to be licensed with age limits and further restrictions for high risk procedures, including those involving injecting filler into intimate areas – the ever popular BBL (Brazilian Butt Lift) has the highest mortality rate of any cosmetic surgery. While the procedure typically involves a fat transfer, filler in the buttocks is gaining popularity, despite being deemed unsafe by both Safe Face in the UK and the FDA (the food and drug administration) in America. 

Victoria Brownlie, chief policy officer of the British Beauty Council, the industry organisation representing the UK’s £24.5bn beauty industry, told The Telegraph: “The problem with the current popularity of dermal fillers is that it’s often marketed as something quick and easy, when in fact the procedure can carry more serious and long-term risks than other aesthetics treatments. Whilst these kinds of procedures are having their ‘time in the spotlight’ as other procedures have done in the past, this mustn’t come at the expense of patient safety.” 

She adds: “For too long there has been a huge disparity in the quality of non-surgical cosmetic procedures like fillers, which has put the public at risk and damaged the reputation of the industry as a whole. It’s time we set a robust standard of competency for anyone wishing to offer these kinds of treatments and a mechanism to ensure anyone proven not to meet this standard cannot operate. We’re confident that, with continued engagement with the Department of Health, we can achieve this and provide that much needed confidence in the services the aesthetics sector offers.”