Wednesday 21 August 2019

The look of love? The ugly side of 'tweakments' for Generation Botox

No tweak is too much for Generation Botox in pursuit of the 'Love Island' look. But a rise in unqualified practitioners has sparked calls from doctors for tighter regulation of the filler industry. Catherine Healy reports

Rachel Wallace. Picture: David Conachy
Rachel Wallace. Picture: David Conachy
Treatment: Longford-born Love Island contestant Maura Higgins is said to have had her lips filled at a Dublin clinic
Dermatologist: Caitriona Ryan raised concerns about training providers to the health minister
Need for change: Dr Rosemary Coleman at the Blackrock Clinic. Photo: Frank McGrath
Boost: Phillip McGlade, MD of the Thérapie clinic, credits Love Island for a recent surge in clients. Photo by Tony Gavin

Rachel Wallace was 21 when she had Botox for the first time. The clinic that carried out the treatment initially had concerns about her age, but she got the go-ahead after a consultation with a doctor. She had been conscious of a line on her forehead, she says.

A few months later, Wallace had her lips injected with filler. An allergic reaction caused swelling in the top lip for a day or so. "I was convinced it would last forever," she remembers. "I got a lot of slagging from my mam and dad."

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She waited another two years before getting her next lip injection but continued to go for Botox annually.

Wallace, who is 29, went on to have breast augmentation in 2013. She went from a B to a DD cup and chronicled her experience of surgery in a series of video blogs. "My boobs were something I wanted to get done very badly," she says now. "The way I felt about my chest was beginning to really affect my confidence and my relationship." As for the pressure on her as a model? "I did it for me, not anyone else," she insists.

These days, according to Wallace, cosmetic work carries much less stigma than it might have even a decade ago. "It was unheard of in our group of friends when I started," she remembers. "Now I can't think of a single person in my social circle that hasn't had something done."

Boob jobs, Botox, fillers and other treatments have become normalised among the Love Island audience and it's in no small part thanks to social media, where hordes of millennial influencers speak openly about going under the knife or needle. One reality star, Chloe Khan, a 27-year-old Briton with 1.7 million followers on Instagram, faced backlash last week for using the platform to give away £20,000 worth of procedures - butt implants, two Brazilian bum lifts and rhinoplasty (or a nose job).

Testimonials on paper mean little to the modern female consumer, says Ailish Kelly, sales director of the Avoca Clinic in Wicklow, which sponsors Wallace (and which, like similar specialist clinics, employs doctors to lead cosmetic procedures). "People want to see before-and-after photos now. They want to hear about people's journeys."

The clinic is regularly approached by influencers wanting to collaborate but remains cautious about who it works with, Kelly explains. "We're doing a girl next week who's having an unusual operation - a particular kind of tummy tuck. She struggled to find information on it anywhere so that will be an educational opportunity for us."

'Getting work fixed'

No reliable figures exist for the number of cosmetic procedures and treatments carried out in Ireland every year. Anecdotal evidence suggests strongly, however, that the total is growing.

Kelly says there has been a "constant rise" in appointment requests at Avoca, with 60 breast augmentations now being carried out in an average month. While women aged between 25 and 40 are the largest demographic for augmentations, plenty of older patients are coming in too, she adds. Women in their 50s and over are increasingly deciding to "put the few bob into themselves", as she puts it, instead of an apartment in Bulgaria.

Need for change: Dr Rosemary Coleman at the Blackrock Clinic. Photo: Frank McGrath
Need for change: Dr Rosemary Coleman at the Blackrock Clinic. Photo: Frank McGrath

Others turn to the clinic after getting cheap procedures abroad: Kelly says about two to three people ring up every week to enquire about getting work fixed.

Phillip McGlade, managing director of aesthetic clinic Thérapie, which operates nationwide, credits Love Island for a recent surge in clients. Several female contestants on the reality show have had cosmetic work done and have gone on to promote salons and clinics after their stints on TV. Thérapie has seen a double-digit growth in business since the current season kicked off at the start of summer, according to McGlade, with enquiries going up by about 200pc.

The biggest increase has been in Botox injections, he says. McGlade stresses, however, that the medical team is told to only treat people who "need it". "Our clients are representing Thérapie when they walk out the door so we have to be honest," he says. "We probably say no to at least 20pc of those who come into us."

Thérapie is not the only clinic to be hitching its wagon to Love Island:  An Irish celebrity news website recently launched a competition in association with a clinic where Longford-born contestant Maura Higgins, according to the promotion, gets her lips filled (Maura Higgins' mother Sharon confirmed to The Longford Leader last month that her daughter had had fillers).

But the boom in non-surgical enhancements has also reaped rewards for plenty of unqualified practitioners.

A particular problem is the availability of cheap fillers which can be administered in salons and private homes across the country by people without any medical training. Fillers are currently categorised as a medical device rather than a drug, meaning providers are subject to little or no regulation. Botox, on the other hand, can only be carried out by a doctor or nurse working within their scope of practice.

Boost: Phillip McGlade, MD of the Thérapie clinic, credits Love Island for a recent surge in clients. Photo by Tony Gavin
Boost: Phillip McGlade, MD of the Thérapie clinic, credits Love Island for a recent surge in clients. Photo by Tony Gavin

Rosemary Coleman, a consultant dermatologist at Blackrock Clinic, stresses the urgent need to change the classification of fillers. "Beauticians, to start with, should not be allowed to inject," she says. "It really is very dangerous - you can go blind or have a blood vessel blocked - and complications are much more likely to happen in the hands of someone who isn't trained to immediately identity and treat the problem."

Éilís Fitzgerald, a consultant plastic, reconstructive and aesthetic surgeon based at Beacon Consultants Clinic in Dublin, provides removal of fillers administered elsewhere as part of her own private practice. She usually sees poor cosmetic results arising from the wrong product being injected into the face or lips, or products being injected into the wrong place. Bumps are easily corrected, she says, but there can also be more adverse consequences like loss of tissue and serious scarring.


The antidote used to dissolve fillers is a prescription-only medication and therefore not permitted to be used by non-medical providers. Fitzgerald is aware anecdotally, however, of beauty therapists who offer clients this same antidote, called hyaluronidase, despite it having a high rate of severe allergic reactions.

"One of the approaches you can take here is to put the onus on consumers to do their research," she says, "but I think the consequences are much too serious for that. It's not like you're buying a knock-off Prada handbag."

There are issues as well with regulations around Botox, according to Fitzgerald.

"Anyone with a medical degree can give it," she says, "but they shouldn't be, in my view. There would be procedures I've done on dummies as a medical student that I'm not qualified to do now."

The proliferation of short training courses in fillers is another major concern. Caitriona Ryan, an associate clinical professor at UCD and consultant dermatologist at Blackrock Clinic, brought attention to her concerns about one particular training provider in a letter last year to Minister for Health Simon Harris, seen by the Irish Independent.

The company in question offers a two-day injecting course costing €4,000 with a promotional tagline predicting a rise of €130,000 in annual salon revenue "with just five treatments per week". It welcomes non-medical applicants with a background in beauty as well as medics.

Like her colleagues, Ryan has seen her own fair share of nightmare cases.

"As a doctor, I feel compelled to treat a young girl with devastating complications on their face," she says, "but some people would be wary of becoming involved."

There has been a particular increase in the number of problems presenting to her in the last year, she adds, with most of those affected having gone to beauticians. The lack of regulation means guarantees cannot even be made about provision at commercial clinics described as being doctor-run, according to Ryan. One particular clinic, she says, posted on a Facebook group for junior doctors looking for people to carry out fillers, saying training would be provided on the day.

Kelly McGlynn from Dublin had lip fillers done for the first time back in April at a supervised training clinic. The injections were administered on site by doctors and nurses who were looking to move into cosmetic work from other areas, she says. McGlynn had seen the academy offer a half a millilitre of filler as a special deal for €100, about €60-80 less than what she had found advertised elsewhere. "Everyone is doing it so I said I would give it a go," she says.

The 32-year-old now plans to never have it done again, having felt very sore in the days that followed. "They say to leave it for 24 hours and then massage it, but for up to a week after I couldn't touch my bottom lip; I'd rather go through childbirth again. Even in the last few years, I've noticed you can see the lump where filler was injected, and I can feel it when I press my lips together."

Sourcing is also a problem within the sector, according to Nicola O'Byrne, who is a dermatology nurse prescriber. Some practitioners are buying products on the internet, she says, without knowing if they're safe or authentic.

"We have a lot of non-medical people and beauty therapists offering treatments that are so cheap that they couldn't possibly be paying the full amount [for legitimate products]. A box of filler could cost €120 plus VAT and delivery, which brings the treatment price up a good bit. If someone is offering treatment for €150, it doesn't add up."

Allergic reaction

O'Byrne remembers refusing to provide extra lip filler to a woman who had came into her for corrective treatment at The Skin Nurse Clinic in Clontarf, feeling that her lips were already quite large.

This same woman then had an allergic reaction after going to a beauty therapist who had injected her with a millilitre of "what looked like cheap filler". She ended up needing medical treatment and having to miss work for three weeks. "The beauty therapist had left her to her own devices and said it would go down eventually," O'Byrne recalls. "She was utterly traumatised."

Some providers have accused doctors of being "territorial" about cosmetic treatments to protect their bottom lines but that is "absolutely not the case", Fitzgerald stresses. "We're all really busy. I don't have an appointment free until October, and there's plenty more busier than me," she says. "It's a patient safety issue."

And yet younger women continue to turn to non-medical practitioners in their droves. Cheaper costs are an obvious factor but as is the greater willingness to provide much bigger lips - "rubber dinghies" - as O'Byrne calls them.

A host of Irish salons and independent injectors regularly share photos of their clients' dramatically enlarged lips on Instagram, bringing in hundreds of likes per post. None of those approached by this newspaper were willing to speak about their services or credentials.

O'Byrne is of the view that certain practitioners tend to appeal to certain patients. "I don't attract the Love Island fan, for instance, because I don't advertise in that way on social media.

"The people you get - if you have a more holistic approach and are genuinely concerned about the patient from A to Z - are those who will pay a medical professional price because they're getting that consultation with return visits. It's not a conveyor belt where people are in and out in 15 minutes."

Ryan agrees that her own cosmetic practice, which mostly sees women in their early 30s to late 60s, is likely to be unrepresentative. Those seeking treatments are, as a whole, getting younger, she says.

"Big lips have become the equivalent of having a Michael Kors bag for girls in their early to mid-20s," as she puts it.

John Curran, a consultant plastic and reconstructive surgeon working out of the Bon Secours Hospital in Tralee, points out that interventions in non-medical environments can seem "less scary" to younger women despite actually being more unsafe.

"They don't make you sign a long consent form for fillers like I do," he says. "Your average beautician who does lots of lip filler may be excellent," Curran adds, "but has he or she ever seen what a dead lip looks like? What it's like on the day you have to cut it off? And five years later when the patient still can't eat without dribbling? That's how we think about it."

It is clear to all, however, that the age profile of women accessing treatments has changed significantly in recent times. When she began working in the sector 16 years ago, O'Byrne says, clients were typically ageing - losing volume in their cheeks, for example - and simply seeking to return to what they once looked like.

Older clients now tell her their teenagers are "begging" for lip fillers. "With social media, it's just gone bananas," she says. "People want the Kim Kardashian chin and everything else. What they're doing is changing their features so they don't look like the same person anymore."

But a ban on under-18s getting Botox and fillers does not a solution make, according to many medical practitioners. "It's hard to be black and white about age," Rosemary Coleman from Blackrock Clinic says. "I would use Botox for acne scarring and after-surgery scars, or for bad hyperhidrosis (excessive sweating)."

Fitzgerald and Curran also point out that consultant plastic surgeons study the ethics of provision as part of their training, including how to analyse a prospective patient. Properly regulating who can carry out cosmetic work is a more appropriate approach, they say. After all, Fitzgerald stresses, Botox is used to treat children for medical as well as legitimate cosmetic reasons. "What about the child who has a weakness on one side of their face because of a condition they had?" as she asks. "Will a ban prevent treatment in that case?"

As for women in their 20s, Caitriona Ryan sees Botox as a sound preventative measure. There is growing evidence from twin studies about the advantages of starting treatment reasonably earlier, she says. She herself first had Botox at 26, and is adamant about the benefits of subtle interventions.

"I'm a big believer in putting your best face forward; if you look better, you feel better. I think us taking ownership of that is a great thing but it needs to be done in a more careful way."

Positive experience

Emma Reilly, who is 30, returned to Botox for a second time this summer after a gap of a year. She had hoped to get a second treatment after six months but couldn't afford it at the time. "I didn't have a huge number of wrinkles starting off but I make a lot of facial expressions when I talk and my forehead would get a lot of lines, It drove me mad," she says.

"The woman in the clinic I go to talked me through the whole thing the first time I went, about a year ago. I asked if it was the right thing to be doing and she said yeah, it's more about prevention, so I ended up getting it done on my forehead, in between my eyebrows, and around my eyes." The results were "incredible", she says. "You know when you go to make that face when you frown? I can't do that now," she laughs.

Sara Mahood has also had a positive experience with cosmetic work. The 27-year-old gets her lips filled by a nurse who works out of a room in her back garden, having had a bad experience four years ago with a commercial clinic.

"I've gone to her probably five times in the last two-and-a-half years, and they've always been really nice," she says. "I wouldn't go anywhere else."

Mahood admits to having been self-conscious of her lips since her teenage years. "I used to overdraw them but I don't need to at all now once I've had them done; I'll just wear a lip balm and I'll feel fine," she says. "I feel so much better when they're big. It gives you a big boost."

She plans to get under-eye fillers next and is certain she will eventually turn to Botox. "I'll probably get everything done when I get older," she says.

In a statement responding to concerns raised here, the Department of Health confirmed it was assessing the need for new regulations covering fillers. "From 2020, certain products used for aesthetic purposes that currently do not fall within the definition of a cosmetic product or a medicine, which includes dermal fillers, may be classified as medical devices under the new EU Medical Devices legislation - Regulation (EU) 2017/745," it said. "The regulation, which becomes fully applicable in May 2020, specifically includes dermal fillers within the remit of the regulatory framework for medical devices.

"The medical device regulations do not specifically address the administration of dermal fillers. However, under the new regulations, member states may make provision for certain devices to be eligible for prescription control. This may represent an opportunity to introduce national legislation restricting the supply or use of dermal filler.

"The Department of Health is working with the Health Products Regulatory Authority (HPRA) to identify the correct use of this provision and how it may be applied to the administration of dermal fillers in Ireland. Work on developing this requirement will continue over the coming months."


Cosmetic ­procedures in ­numbers


Percentage rise in enquiries at Thérapie since this series of Love Island started


The number of breast augmentations carried out in an average month at the Avoca Clinic in Wicklow


The cost of a two-day injecting course with a promotional tagline predicting a rise of €130,000 in annual salon revenue

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