The Sunday Times Magazine – Fillers

Face invader

First it was dangerous breast implants. Now the crisis hitting the cosmetic surgery industry is dermal ‘fillers’, as patients report severe disfigurements

Katie Glass Published: 18 November 2012

Are “fillers” safe? Are fillers safe? (Vincent Besnault)

Among the scented candles and a copy of Hello! magazine in the sitting room of an Essex house is a silver-framed photograph of Rachel as she used to look. Dressed up for a friend’s birthday, her dark hair swept back, she grins at the camera with a smile that lights up her hazel eyes. She was 34. Not that you’d guess.

There are no photographs in the house of Rachel as she is now.

“When it happened, I didn’t want to have my picture taken,” she says, lifting the frame. Dressed in jeans and a Breton top, she is not wearing the £200 tinted glasses she had to buy to hide the damage that has been done. “I’m self-conscious about people looking,” she says. “The first place you look at someone when you talk to them is their eyes.” Now her eyes are swollen with red welts. They’ve been like this for 2½ years.

Dermal fillers originated as a treatment for wasting illnesses and deformities caused by injury

Rachel doesn’t tell anyone how this happened. Not her colleagues at the school where she works, nor her family or friends. “I’d be too embarrassed,” she says. “I know this is partly down to my own stupidity.” Some people might think she’s right.

The scarring under her eyes is damage from a dermal filler injection, which she had to give her face a more youthful look. It was done two months after that first picture was taken. Can you feel sympathetic towards someone injured in the pursuit of vanity? And when things go wrong, should the NHS bear the cost?

Dermal fillers originated as a treatment for wasting illnesses and deformities caused by injury. A gel-like substance is injected under the skin, which plumps up an area, filling out grooves.

Cosmetic surgeons quickly realised how useful they were. Unlike Botox, which decreases wrinkles by paralysing muscle movement, fillers add volume to skin thinned by ageing, giving a fuller, youthful effect. Celebrities were hooked. Madonna’s pillow-soft cheeks, Lindsay Lohan’s bee-stung lips, Nicole Kidman’s crease-free smile are all allegedly “filled”.

As the look filtered down to the high street, fillers began to be sold in beauticians, hairdressers, online; discounted on Groupon to just £150 a pop. Now fillers, according to Key Note, a market research company, are as popular as boob jobs; along with Botox they command a market in nonsurgical procedures worth £775m, expected to grow by 8.4% in the next year. Restylane, the world’s leading filler, has been used in 16m treatments worldwide since it was launched 16 years ago.

Yet, as fillers have grown into a mega industry, they have remained almost totally unregulated in Britain. As a result, there are no exact figures as to how many have been sold, how many practitioners are offering them, or how many treatments have been carried out. Classified in Britain as “medical devices” rather than medication, fillers circumvent the robust rules governing prescription drugs. Their only European requirement is a CE quality control mark; to obtain one, a product just has to do what it says on the box. In America, where fillers are regarded as medication, the Food and Drug Administration has licensed only six. In Britain, by contrast, the Medicines and Healthcare Products Regulatory Agency estimates that we have around 160 different types of fillers on the market. They can be bought, sold and administered by anyone, anywhere, no medical training required. The implications of this vast, ungoverned industry are only just becoming apparent.

A survey by the British Association of Aesthetic Plastic Surgeons, out this week, found that almost half (49%) of their surgeons had seen patients who had problems with permanent fillers. Of those patients, 84% required surgery or had developed problems so severe they were deemed untreatable. The study suggests that complications with semipermanent fillers are even more prevalent, but the complications they cause are not long term.

Sally Taber, director of Independent Healthcare Advisory Services (IHAS), fears fillers could cause a healthcare crisis bigger than the global scandal that erupted in 2010 when the French firm Poly Implant Prothèse (PIP) was found to be manufacturing breast implants using substandard, industrial-grade silicone gel; 47,000 British women were affected. “It’s a huge problem. Many more people have had fillers than PIP implants. Unless we get this sorted out, dermal fillers will be the next disaster,” Taber warns.

During the PIP scandal, the Department of Health (DoH) promised to provide NHS care to any women whose providers refused to remove her implants for free. As each operation costs around £3,000, the potential bill to the health service was estimated at £120m. PIP has already reportedly cost the NHS £2m.

It was Rachel’s sister who first suggested fillers …

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