Would you let a beautician, hairdresser or even a friend give you Botox or fillers? A shocking 83 % of injectables are given by non-medics, according to one survey. We ask the aesthetic doctors who are left to pick up the pieces, how to be sure you're in safe hands

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Cosmetic injectables are on the rise, and with it the number of botched Botox injections and fillers. Anyone watched Dr Michael Mosley's  current BBC series The Truth About Cosmetic Surgery won't be surprised to know that the industry is still largely unregulated. Social media is fuelling the rise, according to facial aesthetician Dr Nina Bal , who is often left to pick up the pieces. “I've definitely seen an increased demand for procedures like Botox and fillers due to social media, but with that, there have also been a lot more botched results coming through my clinic door,” she says. “I am typically called upon to rectify one to two unsuccessful treatments every week.”

The government last year was set to launch a campaign to warn people of the dangers of using unqualified practitioners or even administering the injections themselves at home. Health officials told the BBC’s Victoria Derbyshire  programme that the campaign aimed to educate and inform as well as tackling the toll that botched procedures can take not only on mental health but also the NHS, as doctors are called in to repair the damage.

A huge percentage of people admitted to finding their practitioner on social media and cited that cheap prices and celebrity affiliations as being the key reason for making the decision

According to Save Face , a government-approved register of accredited cosmetic practitioners, the number of problems related to treatments such as these has almost trebled in the space of 12 months with 83 per cent of procedures administered by non-medics. “We've seen a huge rise in complaints –  last year we had 934 in comparison to 378 the previous year, with lip fillers being the most common complaint,” says its director Ashton Collins. “The nature of the complications ranged from unsightly lumps to infections and vascular occlusions, where the artery becomes blocked and it can lead to compromise of the tissue and permanent scarring.

“Our study showed that 83 per cent of injectables were performed by beauticians, hairdressers or laypeople,” explains Collins. “A huge percentage of people admitted to finding their practitioner on social media and cited that cheap prices and celebrity affiliations as being the key reason for making the decision.”

Significantly more lenient than our transatlantic neighbours, the UK has approved 160 dermal fillers for use compared to just 10 in the United States. Unlike Botox, which is a prescription medicine, fillers are woefully unregulated, meaning anyone can get hold of them. “Dermal fillers in this country aren’t seen as a medical device which is crazy,” says Dr Esho, Founder of The Esho Clinic . “Clients need to be in the hands of a medical professional who can prescribe and act independently. As medics, we’re accountable – if I do something wrong the patient can contact the GMC (General Medical Council) and I could lose my licence, but as a non-medic, there’s no governing body or trading standards.”

Dubbed 'the Kardashian effect', 'selfie mania' the search for that razor-sharp jawline and sculpted cheeks similar to those of successful reality stars, has led to a 41 per cent rise in non-surgical treatments such as fillers and Botox since 2016 leading to an industry worth £2.75 billion in the UK according to BBC’s Watchdog.

Dr Esho coined the term 'Snapchat dysmorphia' after seeing the rise in people asking for procedures to look like their filtered online selves. “We are already seeing an increase in vulnerability of the new generation with the phenomenon I’ve described as 'Snapchat Dysmorphia'. My fear is that something really bad will happen before people take note, which is why I’ll always be fighting for legislation. The UK is at the forefront of so much medical innovation that we should be leading by example.”

Where Kylie Jenner has led when it comes to lip fillers, a plethora of reality personalities have followed. “We're finding that there's a big problem with social media culture as celebrities are offered free treatments in exchange for promotional posts which leads to their followers wanting the same treatments without doing the necessary research first,” Collins tells us. “This has then led to the treatments themselves being so trivialised that they are now thought of as beauty treatments and not medical procedures that can cause serious complications when administered incorrectly. What we're also finding is that when things do go wrong, the patient is blocked from contacting the brand or individual and is left to seek redress elsewhere.”

When procedures go awry, it’s usually due to poorly administered lip fillers or tear trough fillers, says Dr Bal. “These two areas, in particular, are unforgiving of even a small amount injected in the wrong tissue plane or anatomical place. This could be due to poor technique, not enough medical and anatomical knowledge or not enough post-injection massage to avoid lumps giving an unnatural result.”

More severely, if a blood vessel is injected it can cause necrosis (permanent tissue damage). “Those injectors don’t recognise the signs and symptoms of it and don’t have the medical equipment and knowledge to resolve it,” she cautions.

While the government’s executive agency, Healthcare Products Regulatory Agency (MHRA) has declined to make injectables prescription-only for now, campaigners are desperate for stricter guidelines on who administers the treatments. “The government's decision not to make fillers prescription-only puts the public at risk,” Ashton says. “These are dangerous procedures and non-prescribing practitioners who administer them are often not competent to recognise and manage the complications effectively.”

Although the government have enlisted the Joint Council for Cosmetic Practitioners (JCCP) to come up with stricter guidelines, they are merely advisory for now.

"The Government have acted to improve the regulation and registration of those performing cosmetic interventions, but we clearly need to make much more rapid and substantial progress if we to protect consumers properly,” says Jackie Doyle-Price, Parliamentary Under-Secretary of State for Health and Social Care. “We need to work closely with the JCCP to develop hallmarks that people who wish to undergo these procedures can look for so that they can be sure they are obtaining treatment from a regulated practitioner.”

The JCCP itself wants to make fillers prescription only and is calling for a change in the law. “The JCCP has submitted evidence to both the DHSC and to the MHRA that it is essential to make such devices prescription only in order to protect the public and to promote patient safety," says the JCCP’s Professor David Sines.

So far, so promising, but like the rest of us in the UK, the future of this initiative all depends on another factor too - the outcome of Brexit. “Legislation hasn’t been passed, but it’s still on the agenda for the future,” says Dr Charles Spence, president of the British College of Aesthetic Medicine (BCAM) and campaigner for legislation. “With Brexit negotiations ongoing, something like this isn’t a priority for the government right now. BCAM is continuing with the campaign for stricter regulation on dermal fillers and legislation for injectable products to protect the public.”

Dr Esho is also calling for tougher government action. “Lobbying, public awareness and practitioners being ethical is a key part in how we can put a stop to this, but the government has to input a model that will help control things."

There's no denying that the ‘Jennerfication’ of our beauty standards may have done for cosmetics what Cara Delevingne did for eyebrows, but the quest for perfection has crossed into dangerous territory. Until regulation is approved, fillers need to be approached with care.

Dr Nina Bal's checklist for safe injectables

1. "Check whether the person who injects is medically qualified – not just aesthetical procedures but medical ones first of all. Go only to a doctor, dentist or nurse prescriber."

2. "Check the before and after photos to see if the results and style of injection are aligned with what you want."

3. "Ask if the products used are FDA approved, which brands they use and if they have EpiPens in case of allergic reactions, as well as hyalase, an enzyme which dissolves the filler, in case something goes wrong. Check that a cannula is used for tear trough under eye fillers done, as using a needle in that area can cause blindness."

4. "Check if your injector is registered with of Save Face,  the government-approved register of reputable practitioners

5. "Make sure you have a face-to-face consultation beforehand to talk through the results you want to achieve and answer any questions you have."

Images Dr Nina Bal. Follow Dr Esho  @drtijionesho  Nina Bal on Instagram  @drninafacialsculpting.