Have you had your fill?

If you’ve ever seen a member of the Kardashian-Jenner family pictured, you’ve seen fillers and Botox at work. Like many of us, you might think they look incredibly good for their age, or compared to how they looked five or 10 years ago.

Sure, they’re vaguely featureless. But they’re influencing a whole new generation of people obsessed with looking flawless, wrinkle-free and eternally youthful.

While millionaire status isn’t a prerequisite for well-done ‘work’, education, research and careful selection of a medical practitioner and clinic is key to avoid an overdone look at best, and serious, long-lasting health complications at worst.

For the uninitiated, dermal fillers and Botox are entirely different, although both result in an ‘improved’ appearance. Botox, derived from the neurotoxin botulinum, seeks to paralyse muscles in order to smooth wrinkles in the skin. Also used medically to treat migraines and to help with hyperhidrosis (excessive sweating), its effects stay in the body for between three and six months, depending on the individual.

Dermal fillers, on the other hand, are injected into the skin to restore or create volume in a certain area, reshaping the face or facial features. Collagen used to be a popular filling agent, but nowadays it’s hyaluronic acid that is used most often.

Interestingly, Juvéderm is the world's leading hyaluronic acid facial filler brand, and its parent company, Allergan, is headquartered in Dublin. Is it our proximity that's causing the national obsession? Or is it the influence of social media and celebrity culture that's making thousands of people every year enquire about Botox and fillers?

Injectables are the most popular cosmetic procedures in the world. Brands like Belotero, Juvéderm, Teosyal, Restylane and Radiesse are all becoming recognisable, and the numbers of people using them are ever-increasing in Ireland. Dr Peter Prendergast is the owner of Venus Medical, one of Ireland's leading cosmetic surgery clinics. He says the demand for injectables and the standard of care are inversely proportional.

“In my practice of 15 years performing injectables, I have found an increase in popularity of these treatments each year,” says Dr Prendergast.

‘Poor-quality work’

“Treatments continue to increase in younger patients as well, with the advent and rise of social media. Unfortunately, with this has come an increase in poor-quality work and complications, both of which often require corrective care.”

With such demand, comes more reckless supply. Patients shop around for the cheapest clinic ‘per millilitre’ of filler, in many cases allowing an unqualified, unregulated person (such as a beautician) to perform the complicated treatment. With this comes serious risk, says Dr Tapan Patel, aesthetic physician and director of PHI Clinic on London’s Harley Street.

“As with all procedures, there are some inherent risks,” says Dr Patel. “Serious complications can arise, including blindness and necrosis of tissue. This is why dermal filler treatments should always be conducted by a fully trained, experienced medical professional,” he adds.

Dr Prendergast agrees, saying: “It is inadvisable to shop around for the cheapest filler. The cost of treatment should reflect the consultation and expert advice, the experience, skill, and artistry of the practitioner, and the aftercare.”

You’ll only ever have one face, so taking careless risks with the one you have is not advisable. You can end up with lip droop, asymmetry, lumps, bumps and even infection. However, what happens when you go too far simply because you’ve forgotten what you used to look like?

We’ve all seen cases where someone has gone too far with their cosmetic enhancements, resulting in a look that’s far from natural. Pillow face, as it’s sometimes known, happens when someone has been injected with too much dermal filler. They become used to the new way they look, and feel the need to correct any small loss in volume or shape they detect.

Dr Jonquille Chantrey works with Allergan in the UK, and is an aesthetic surgeon and an international beauty lecturer. She says patients “forget what they looked like originally and choose an exaggerated version of themselves” and that when one doctor suggests stopping or slowing treatment, the person might seek a new doctor willing to continue at pace.

“It is vitally important for doctors to continually assess their patients to ensure that the result is soft and natural,” says Dr Chantrey, “and patients should be discouraged from frequent treatment if their overall facial look is unnatural.

“Any practitioner that does not have the expertise to assess, understand the anatomy and inject the most appropriate filler is likely to produce disastrous results and ultimately an unhappy patient,” she adds.

Dr Chantrey’s advice is echoed by Dr Patel, who says: “In an unregulated industry, it is vital that you do your research and only go to a trusted, respected clinic that focuses on natural outcomes. Unfortunately, the ‘pillow face’ look is the only look that people will see, as good work will often remain undetected,” he adds.

Regulations around Botox

With the clientele of cosmetic surgery clinics getting younger all the time, Minister for Health Simon Harris said recently he’s planning to examine whether the regulations around Botox and dermal fillers are strict enough, and that his department is looking at imposing an age restriction on the treatments.

Dr Patel says that “undergoing a procedure such as this requires a mature attitude”, and says that in his clinic he will not treat patients under 18. Dr Chantrey won’t start cosmetic procedures, apart from on rare occasions, on anyone who’s under 21, and Dr Prendergast’s lower limit for fillers is 22. Late 20s would be his “youngest” when it comes to Botox.

Where will the filler industry move on to? Dr Prendergast sees a possible resurgence in the use of autologous fat for facial enhancement.

“Fat has many attributes for the ideal filler: no risk of allergy, soft and natural, plentiful supply, and potential for lasting effect. It’s rich in mesenchymal stem cells that have regenerative properties,” he says.

To find a reputable clinic, Dr Prendergast has this advice. “Look into the experience of the medical doctor performing the treatments. There is no substitute for experience. Having an aesthetic eye is important, so review before and after photos. A serious cosmetic clinic will have invested heavily in technology in order to offer an array of effective treatments, not just basic injectables.”

If you want to tighten, smooth and revitalise your skin, there are alternative treatments out there. “Treatments such as ultrasound and laser will help to lift and tighten the skin, but the most predictable and popular is injectable dermal fillers and Botox,” says Dr Chantrey.

Dr Patel agrees, saying “laser treatments cannot be used to add volume”, while Dr Prendergast uses fractionated CO2 lasers, the Morpheus8 needling device and micro-focused ultrasound (ultherapy) to lift the face without surgery.

Check, see, know, understand

“Earlier this year, Allergan, makers of Juvéderm, launched a programme to give guidance to those considering facial fillers on how to choose an expert practitioner, and what questions to ask if they were to book a consultation,” says Dr Patel. The guide is as follows:

Check it: When you get to a clinic, check the medical practitioner's qualifications, training and experience;

See it: Ask for as many examples of their work as you need until you're satisfied they can provide the look you want;

Know it: Ask them to tell you which brand of filler they use, and research it before booking a procedure;

Understand it: Feel comfortable that the look you want will be achievable with the treatment they're suggesting you undergo.