Sunday 9 November 2014

Why dermal filler injuries and corrective procedures are on the increase in UK

Injuries from dermal fillers and corrective procedures - are they on the increase in UK?

Expert medical aesthetics practitioner Helen Bowes explores the notion that corrective dermal filler procedures resulting from injuries and bad practice are on the increase. We look at two case studies from UK doctors who misplaced injections causing the client trauma and discomfort.


Client 1


This lady visited our Exeter skin clinic with a badly overfilled face and asymmetrical cheeks.

She had been treated by an Exeter based female doctor who had misplaced the dermal filler for a nasolabial fold treatment, overfilling the area in the process. Not only was it the wrong treatment for the client's needs but also poor product selection (i.e the wrong dermal filler). It was also overprescribed and incorrectly administered too.



The resulting bad treatment had traumatised the client. The overfilling caused pain and discomfort, putting pressure on the internal carotid artery. This in turn restricted nasal breathing on her left side and gave symptoms of tightness on the left side of the face. I advised the client to return to the clinic and ask that the treatment is corrected. Unfortunately, she was wrongly advised by the doctor into thinking that the dermal filler would even out over time.

The next time I saw the lady she had been seen by the doctor who attempted to dissolve the dermal filler with hyalase. This wasn't done correctly either as the client's cheeks were still asymmetrical. The client then told me that the doctor informed her she had never used hyalase before.



As you can see from the left hand image the face was left looking asymmetrical, causing the client both physical discomfort and emotional trauma too.


The right hand image shows how the client looked immediately following the correction procedure at our Exeter clinic.

Notice how the lips are poised in the two images. In the left hand image the pressure from overfilling weighed on the upper lip. In the right hand image with the filler dissolved and the pressure released, the lips return to normal


Client 2

Tear trough filling has become one of the most popular procedures at our Exeter clinic. Sadly, for some clients who have visited a certain female doctor in Exeter they have had to endure injury and temporary deformity before calling on us to correct things.

My second case study is a client who came to our Exeter clinic having visited the same GP as in case 1 for a tear trough correction procedure. Unfortunately, we have not yet obtained consent to use images from the treatment (as with the client above), but will update the blog if and when that changes.

When I first met the client she knew that the treatment had not been performed correctly. Again, I suggested that the practitioner should rectify this, but the client had been upset by the practitioner's hostile response when she previously requested remedial work for the bad treatment.

The dermal filler had been so badly misplaced that it was actually placed outside the peri-orbital area, causing swelling and discomfort to the entire area.

In my assessment the doctor was afraid to inject along the orbital rim, and close enough to the eye as she did not understand the tissue she was injecting nor the consequences of her injection placement and so decided to cautiously inject further away. This may seem sensible at first but when one considers that the placement of the doctor's injections were in the suborbicularis oculi fat pad, which is between two ligaments then it is easy to understand how this caused pressure on the eye and a restriction of movement along with pain and discomfort too. Filler has to be accurately placed in the tissue close to the tear trough and any slight circling under the bottom eye lid. It should never extend out to the suborbicularis oculi fat pad.

Why do injuries and bad practice occur with 'qualified' doctors and practitioners?

Here is some food for thought...

Is a qualified plumber the same as a qualified gas engineer? After all they both plumb and with the same tools, and, both attend to your hot water system. The answer is a resounding NO!

So why would one expect a general practitioner to be the same as a medical aesthetics practitioner? The principal is identical. Of course many plumbers also happen to be CORGI registered gas engineers as do many doctors also happen to be qualified medical aesthetics practitioners. It just so happens that one does not automatically imply the other.

As a paying client you need to see evidence of training and certification in medical aesthetics but you also need to see evidence that the training translates into properly performed procedures.

It is not a foregone conclusion that any practitioner who has been trained in medical aesthetics can perform any treatment you ask for perfectly. Training standards vary and many practitioners consider 'working with a doctor' or working as a nurse alongside a plastic surgeon' to qualify them as an authority in medical aesthetics.

It's really quite simple: if you want a tear trough filler treatment then ask to see evidence of the practitioner's work in tear trough filling with a dermal filler.


Are injuries and corrective procedures a UK wide problem?

The most plausible answer here is  'probably.'

I practice at 10 clinics across England and Wales and have treated clients requiring corrective procedures in most if not all of these clinics.

There are variances between clinics both in terms of the numbers of corrective procedures and the areas requiring correction. For example, at our Exeter clinic business is thriving, and particularly for corrective procedures to tear trough filling.

I alone have corrected 3 bad dermal filler treatments in the past month from the same Exeter based female doctor (GP). I won't attempt to name either the doctor or the Exeter skin clinic she practices at but just to remind potential clients to always ask two vital questions of the practitioner:

1. Are your trained and certified by a recognised medical aesthetics training company in the exact procedure I require, and can I see evidence to that effect?

2. Can I see evidence of your work and results from previous identical procedures?


As a practitioner we all want to see our clinics thriving but not at the expense of patient well being.

Give your doctor nowhere to hide

The old saying "trust me I'm a doctor" has absolutely no place in medical aesthetics. No doctor is trained in this field as part of a medical degree.

There are increasing numbers of clients who want to have cosmetic treatments but are too afraid based on perceived risk and who are also afraid to challenge or question a doctor.

I want to encourage the public to translate that fear into a determination to put doctors and other practitioners on the spot, asking difficult questions about their qualifications and ones which they cannot hide from.


Doctors are not experts in medical aesthetics by right. They certainly do not have any automatic right to use a medical degree as a status for providing medical aesthetics treatments.

Doing things correctly for the sake of our clients

So, what exactly should you look for in a practitioner?

Obviously, you want them to have at least a medical or health care background. If you were to suddenly react to a substance injected into your skin then you would want to be sure they know how to address it quickly and safely. Prevention is always better than cure.

The practitioner should be trained and certified by an expert in the exact procedure you are enquiring about. In addition evidence of both the certification and of the practitioner's work should be available to you.

It is not an inconvenience to the practitioner in asking for such evidence but an absolute right of the client.

...and in your own practice?


My own prescribing qualification was gained in the study of aesthetic medicine. Doctors, dentists and most nurse prescribes only have prescribing in General practice or other clinical roles.

Remember, medical aesthetics is not a part of general medical, dental or general nursing practice.

As a matter of principle I only ever treat conditions or provide cosmetic treatments that I have been independently trained and certified for.

So, if you are seeking a tear trough filler then please ensure that the practitioner you choose is trained and certified for Teosyal Redensity II the word's only approved dermal filler for tear trough correction.

About the author

Helen Bowes

RGN, BSc (Hons), NISP, AMAP

Clinical Director at Skin Beautiful Medical and Cosmetic Clinic


A Harley Street certified advanced medical aesthetics practitioner, Registered nurse prescriber (medical aesthetics) and registered general nurse.

Pioneer of ADFS advanced dermal filler systems for lips, cheeks and non surgical facelift, the UK only clinically developed dermal filler systems.

Helen holds 10 medical & cosmetic skin clinics across England and Wales at Exeter Milton Keynes Bristol Coventry Swansea Warwick Daventry Carmarthen Llanelli and Neath