In Microprocessing, columnist Angela Lashbrook aims to improve your relationship with technology every week. Microprocessing goes deep on the little things that define your online life today, to give you a better tomorrow.
“I have been doing this for my lips for over 2 years 😉 ,” writes user “mandapanda” on the beauty forum Essential Daly Spa, which positions itself as “one of the best online sources for luxury skin care cosmetics.”
“Got the [Restylane] from Canada and get numbing cream and sterilize like crazy,” the post continues. “I know it may seem mad and dangerous … 😲 But had it done so many times and know techniques etc… just cheaper when I do it!”
Mandapanda’s post is one of hundreds on the website where people discuss doing their own cosmetic injectables, including lip fillers and neuromodulators like Botox. Posters provide each other with tips, encouragement, and reviews of various sites where people can buy the fillers without a prescription or a medical license. And they warn about sites that they suspect are selling dangerous or counterfeit products — the kind that could kill you.
Unlike older, surgical forms of cosmetic procedures, such as face-lifts and nose jobs, fillers can be done quickly, with short recovery periods. They’re made of naturally-occurring hyaluronic acid, and typically make the skin appear “plumper” — think of Kylie Jenner’s lips, for example. And they’re also exploding in popularity: According to the American Society of Plastic Surgeons, practitioners are administering 200% more “minimally invasive cosmetic procedures,” including fillers, Botox, and laser hair removal, since 2000. Yet they can still be expensive, ranging to about $600 for Botox to $3500 for Sculptra, and many in the medical community think that this cost, combined with fillers’ reputation as a quick and easy beauty fix, has led more people like Mandapanda to attempt their own.
While there’s very little data about how many people are doing their own injectables, several dermatologists and plastic surgeons told me that it seems to be a growing problem. The issue is particularly acute in the United Kingdom, where most fillers, such as Juvéderm, don’t require a prescription to administer. Though a prescription is required in the United States to purchase most facial fillers and Botox, the ease of ordering products, even prescriptions, on the internet and across international lines has many medical professionals afraid that the problem will worsen.
That would be a danger to public health because while the process of injectables — a quick shot of Dysport between the brows, a couple seconds of a syringe under the eye — might seem simple enough, the risks of a badly done job can hardly be overstated. Incorrectly done fillers can cause blindness, tissue necrosis, and even death.
Anjali Mahto, a British dermatologist who recently spoke with me about medical disinformation, says she’s seen cases of people attempting to self-administer their own fillers. “Unfortunately there are websites available where people can easily buy filler due to poor regulation,” she says. “Combine this with easy access to YouTube videos and the potential dangerous result can be self-injecting.”
Mahto’s experience mirrors one described in a 2017 editorial in the British Journal of Oral and Maxillofacial Surgery. “Over the past six months at Homerton University, there has been a noticeable increase of patients presenting with adverse reactions to dermal fillers self-administered,” write the study authors. They describe two such cases, including one in which a 50-year-old woman thought she was injecting herself with hyaluronic acid, the primary ingredient in many temporary dermal fillers such as Juvéderm. In reality, the product was “foreign body material,” the exact nature of which was unknown, which caused large lesions to develop on the woman’s lips.
According to a 2018 study out of Ireland and the United Kingdom, people attempt their own fillers out of a desire to save money. The average cost of Juvéderm injections, for example, is $620, according to the American Society for Aesthetic Plastic Surgery. But the study found self-injections are also driven by distrust of medical practitioners and a sense of self-control and empowerment. In one testimony from the study, a person who was considering doing their own injectables said they’d had a bad experience with their practitioner, and that it was “time to take charge of my body and my money.” Another was even more explicit: “I am all for individual liberty and rights. If you want to inject yourself, more power to you.”
“With fillers in the face, you can have a stroke, you can go blind, you can have tissue necrosis, you can have tissue death, you can have deformities, you could have seizures — I mean, it’s terrible.”
I saw this attitude reflected in many of the forum posts I reviewed for this story. “I’ve been injecting my lips now for about four years (was having them professionally done for 2 years before),” writes user “thinkforms.” “At first I thought you were all crazy! But I’ve saved so much money and I have full control.”
“Lady5space” adopted a rebellious tone in her own plea for advice. “I thought I’d try to find a kindred spirit who also wants to stick things into their face while simultaneously sticking it to the medical man. Anybody have any encouragement/sage advice for a newbie?”
The 2018 study, and my own review of hundreds of forum posts, found that many people who attempt their own injections get their education from YouTube videos and dermal filler “maps,” which mark the areas of the face where fillers are to be injected.
Many of these videos appear to be educational content made by doctors for other doctors, likely with no idea that their work is being used by DIY-ers armed with potentially fake fillers or neuromodulators.
“What’s the expression? ‘When fools go rushing in?’” says Ivona Percec, associate director of cosmetic surgery at Penn Medicine. “The more educated people, the ones who’ve actually studied the anatomy from bone through the soft tissues all the way through the skin, are actually the ones who are the most cautious, because we know exactly what we’re dealing with.” Even physicians and nurses who haven’t studied the deeper anatomy of the face, says Percec, aren’t properly equipped to be doing cosmetic injections — much less a layperson whose only education comes from YouTube.
And even in cases where a medical professional attempts to do fillers or neuromodulators, a lack of proper training can result in disaster. Unfortunately, it happens: There’s a lot of money to be made in cosmetic procedures. Percec says she had a patient who had terrible complications from improper fillers around the eyes, and, because the likely untrained injector didn’t tell her the filler could be fixed, walked around with a botched face for two years.
While having a disfigured face from improperly done injections might seem bad enough, the consequences can be far worse. Boris Paskhover, a plastic surgeon at Rutgers New Jersey Medical School, told me that while he’s never had to treat someone who admitted to doing their own fillers, he knows it happens. “I had to remove the old filler because they had silicone injected by somebody in their house in Florida — some random nurse,” he says. With badly done filler, he says, results can be catastrophic. “With fillers in the face, you can have a stroke, you can go blind, you can have tissue necrosis, you can have tissue death, you can have deformities, you could have seizures — I mean, it’s terrible.”
While facial fillers are more common, an increasing number of men are attempting their own penis fillers, to sometimes disastrous consequences.
Percec told me she’s even seen patients lose the tip of their nose because the filler injection went into a vital blood vessel. Such complications are possible, though rare, when it’s a seasoned plastic surgeon or dermatologist performing the procedures. When it’s a professional not trained in injections, or the patient doing their own, the risk becomes much greater.
Which makes it all the more concerning that in the United Kingdom, the sale of most fillers is unregulated, making it possible for anyone, including civilians with no training, to legally use them. This opens the floodgates for huge websites like Fillerworld, which sells domestically within the U.K. to anyone who can pay (U.S.-based buyers must have a prescription), or others like Foxy Fillers, which is based in the U.K. but sells internationally without a prescription.
“There is no law [in the U.K.] that says you need to have medical training in order to carry out filler procedures,” a spokesperson for the British Association of Plastic Reconstructive and Aesthetic Surgeons says. “I can say with certainty that surgeons are fixing increasing numbers of ‘botched’ filler procedures, often injected by non-medical professionals.” And while facial fillers are more common, an increasing number of men are attempting their own penis fillers, to sometimes disastrous consequences: infections that require removal of part of the penis shaft’s skin.
Other sites that sell injectables, like Anna’s Cosmetics, appear to be based in the United States, though prescriptions are required for most of these products. “Anna,” like many of the posters on beauty forums I reviewed, takes an almost activist stance with her sales. “I believe that access to Aesthetic and Anti-Aging Medicine [sic] should be a right, not a privilege,” she writes on her About page. “That is why I created this shop: I want to give everyone a chance to use the latest developments in aesthetic medicine… Beauty is a fragile gift and it needs to be cared for!” She later advises that buyers consult their doctors, as she is “unable to monitor the online buyers for their skin, health conditions and product compatibility.” (Some sites require Americans to provide a medical license number and/or prescription number to complete a purchase; when I tried to register at the filler shop Medical Spa RX, I received an email requesting a copy of my medical license. So it’s unclear if Anna’s Cosmetics is truly “unable” to monitor its buyers, as it claims.) “Anna” did not respond to a request for comment by press time.
Yunyoung Claire Chang, a dermatologist at Union Square Laser Dermatology in New York, agrees that DIY fillers are a growing problem. Most of the botched jobs she’s had to fix, though, come from patients who got work done at offices offering discounted treatments.
“I can say with certainty that surgeons are fixing increasing numbers of ‘botched’ filler procedures, often injected by non-medical professionals.”
“I have had several patients buy ‘Groupon’ or other discount filler treatments from non-licensed providers who then come in with disfiguring complications, ranging from nodules to vascular occlusion [in which] filler is injected into a blood vessel and causes death of the surrounding skin,” she says.
In the U.K., activists and industry professionals are lobbying for greater regulation. Earlier this year, the British Association of Plastic, Reconstructive, and Aesthetic Surgeons, alongside other organizations, warned the British Parliament that restrictions need to be tightened to protect patients from botched injections. Such regulation would almost certainly cut down on rogue injections, but it likely wouldn’t eliminate the issue entirely; while American regulation on fillers is considerably stricter than British law, people nevertheless attempt their own procedures or go to practitioners who are not fully trained on administering them.
Fillers and Botox are expensive in part because it takes many years for medical students to get the necessary training to administer them with the lowest chance of potentially fatal complications. They’re too risky for discount deals and absolutely too risky to try at home on yourself or on a friend. If you’re interested in trying fillers or other injections like Botox — and don’t want to run the risk of going blind or having your nose fall off — prepare to pay up.