The immortal words of Cher in her hit song “If I could turn back time” are pertinent not just to affairs of the heart but also to those of aesthetic medicine – namely Hyaluronic Acid based dermal fillers.

No longer do patients have to wait for natural progression to rid them of fillers they regret having or no longer desire. A medical injection of a prescription only product called Hyalase 1500 I.U.

Hyalase can reverse the process with minimal downtime and a good success rate. An injectable enzyme acts making tissues sells more permeable. Thus, allowing injected substances to be rapidly dispersed and absorbed by the body. A wonder treatment – it is easy to see why; the results are very effective and the adverse effects minimal.

Cohen BE, Bashey S, Wysong A. in their work – The Use of Hyaluronidase in Cosmetic Dermatology: A Review of the Literature (published in the Journal of Clinical Investigative Dermatology 2015;3(2): 7.) Found that out of 13 studies using Hyalase for a variety of aesthetic corrections – 8 cases had no adverse affects at all – and 3 observed only very mild swelling as a result.

This is great news for Aesthetic Practitioners who can treat and correct their own (and other practitioner’s work) should a patient not be satisfied with the results. The product must be prescribed for the patient therefore, only those with prescribing rights and the relevant qualification may prescribe this product.

The more natural look is currently trending, with high profile figures turning their back on the “done” lip look and opting for a more natural appearance. Kylie Jenner (a leading social media influencer on all things lips) hit the headlines in July 2018, when she shockingly tweeted “I got rid of all my filler” (Kylie Jenner Twitter; July 2018).

This prompted her numerous followers to do the same and led to positive reactions, complimenting the star on the more natural look, general acceptance and relief of having ‘the old Kylie” back.

Dr Tracey Bell (Tracey Bell Clinic Liverpool) BDS Dentistry embraces the trend for the natural looking fillers and has noticed a dramatic increase in its use from patients who have had complications, post-operative unsatisfactory outcomes or simple don’t like the result.

The Tracey Bell clinics were started providing aesthetics in 2002. The basic treatments originally provided were Botox and fillers. As Tracey explained there were only two or three fillers available the demographic of the patient was certainly different. The average age of patients was mid 40s and the products available then were expensive “luxury goods” and the patient would attend annually mainly due to cost and desire.

Botox and fillers in 2002, were new and inconspicuous. Between 2015-2018, the demographics changed entirely.

Tracey said the complications she sees are mainly from younger women mid 20s 30 who have had several fillers, normally at 6 monthly intervals. Here lies the problem, unregulated fillers, multiple injections and reactions. There has been an increase in lip fillers in younger patients this has created problems. In the Isle of Man during 2018, there were 26 cases of complications from fillers, placed at other practices some treated by other practices on island, some had travelled to Manchester and Liverpool for a quick fix or birthday treat.

Rebecca was one of these patients, she went to Manchester for a Birthday treat, at a cost £500.00 and had her lips and cheeks done.

The next 48 hours involved trips to A & E in both Liverpool and Isle of Man and a lot of tears, with occlusion blood flow stopped in lower lip and edema in her cheeks.

Tracey removed these fillers and after a traumatic week the patient returned to normal. The patient thought that she had been treated by a nurse going by her profile on Instagram, the woman in fact had no qualifications. The filler had been of the internet. When Rebecca tried to complain she was said tough and told to go elsewhere. These patients feel embarrassed, afraid and quite often end up in A&E, or simply telling no-one.

So, have we had our fill of fillers?

Tracey says no but as education grows and people begin to realise that fillers are not regulated complications will continue.

Regulation needs to be statutory, that is made in law. Tracey is a trustee of The JCCP will continue to lobby for change, whilst giving advice and putting provisions in place for proper regulation.

Filler complications will continue to increase, unless the product, the premises and the person placing the fillers place become regulated.

Anyone considering treatment should don’t be afraid to ask!

About the filler, what is it and has it been prescribed?

What is qualification the injector has, in our experience only medically trained people should provide treatment, they are medical procedures which carry risks. Treatment should not be provided in hair salons or a kitchen. You need the right environment to carry out medical procedures, they should have a medical emergency kit, at hand should it ever be needed.

Know your stuff!

Be educated, facial fillers are here to stay, but there is only room for those who are trained, licensed and have safe environments for patient provision.