As New Zealand's interest in cosmetic treatments grows, how do Kiwis know what constitutes good and bad procedures? Image / Getty Images
A face altered by injectables is no longer exclusively found on the wealthy few.
With the advent of shopping mall-style Botox clinics in New Zealand, more than ever before, everyday Kiwis are going under the needle to look younger, fresher, fuller-lipped, wider-eyed, sharper-browed or, as some cosmetic practitioners are seeing, like they’re wearing a permanent Instagram filter.
As cosmetic treatments become more accessible and commonplace, they say so too has the increase in bad filler jobs and what one cosmetic doctor describes as “cookie cutter Botox”.
“There’s a look that we call Instagram face,” says Dr Sarah Hart, a cosmetic medicine doctor for more than 20 years and co-president of the New Zealand Society of Cosmetic Medicine (NZSCM).
“It’s a very generic look with smooth cheeks and full lips and sculpted brows, and that may look great in a photo, but it can look unusual. You know those filters that can make you look like you’ve had too much filler,” says Hart, who has clients booked almost a year in advance at her Auckland clinic.
She believes there is now “a large number of young women going to those cheaper mall-type clinics to get treatment.
“I see a lot more people with cookie cutter-style Botox where they’ve been treated with standard Botox points, standard dosing where they would have been better to have adjusted points with personalised dosing,” - something she says not all practitioners can achieve.
“If they haven’t learned about all the anatomy of the muscles, can see where the muscles are and adjust the doses accordingly, if they’ve just been taught one way to do it because there hasn’t been time to train them for very long, then they won’t be able to adjust the treatments to suit someone’s individual face. It’s a combination of training and experience,” she says, noting some cosmetic practitioners may have only trained in a weekend course whereas cosmetic doctors with NZSCM have typically had 15 years of medical training and of those, two years specifically in cosmetic medicine.
Cosmetic nurse Emma Lindley from Injectables by Emma has been in the industry for 10 years and also trains doctors and nurses in the field. In that time she says she has seen a massive boom in new clinics and Kiwis seeking treatment.
Among them she’s noticed a younger demographic, mostly in their 20s, wanting “the Instagram look”.
“It’s extremely angular. Very angled or very full. A kind of dramatic or obvious look. It may look really good in photos but when you see them in real life you’re kind of like, ‘oh’. In my opinion, if you can see it, somebody’s over-treated,” says Lindley, who has previously worked with Hart.
Hart says after years of “the Holy Grail” in cosmetic treatment being to achieve a natural look, what she’s seeing on Kiwi faces surprises her.
“I never imagined that some of the unnatural results that we see now would be where [cosmetic treatment] would be these days. It takes everyone to the same look ... I thought that we would be embracing the diversity of beauty, adjusting what we did and making sure everyone had their own beauty.
“That appearance has instead taken hold.”
As more Kiwis seek a more extreme look, Lindley is “definitely” seeing more examples of bad Botox along with it.
“There was a way to Botox that was very old school,” she recalls. “And I feel like that stopped about 10 years ago. But it’s come back. This really heavy dosing that causes splayed eyebrows, puffiness around the eyes and shelving.”
If you’re one of the growing numbers of New Zealanders undergoing cosmetic treatment, how do you know if what you’ve had done isn’t actually a bit of a botched job?
Hart says often people aren’t aware of issues themselves because they won’t be apparent by looking in a mirror or taking selfies. “You don’t see yourself making movements,” she explains.
But there are a number of telltale signs others may see or you may notice on a friend who’s gone under the needle:
Peaky Spock brows
“The Spock eyebrows are where you get a little peak, so the middle of your eyebrow drops and the outside pulls up a bit too high and you get a little line above the outside of your eyebrow, where it’s kind of going pull, pull, pull,” says Hart.
“It gives the eyebrow a slightly Mr Spock look. The forehead’s not moving apart from this one spot above the brow where you get a line. The muscles just above the eyebrow are pulling up and making the movement look a bit unusual. I call that the Peaky Spock Brow.”
Shelving
The lower crow’s feet under the eye are much more difficult to treat with Botox because the muscle that causes those lines also lifts the cheek, explains Hart.
“If you do a large dose right at that spot - in order to improve lower crow’s feet - that can drop the cheek down and hollow it out around the eye. Then, when you smile, you can get an unusual branching of the tissue that we called shelving. So, you get a hollow area under the eye and then it’s bunching up on the tissue when you smile.”
Puppet face
Lindley says when someone has had too much treatment in their lower face, their movements become puppet-like.
“When they animate, it’s very puppety. The movement doesn’t look normal and flow. There’s not the correct animation going on, the muscles aren’t working properly so it looks quite fake.”
She says a lack of movement in someone’s forehead is also a telltale sign someone’s had bad Botox.
Over-treated filler
Lindley says if someone has had too much filler, telltale signs will be full cheeks that, when the person smiles, push up and make their eyes smaller. Too much filler in the jawline makes a female face look masculine and square and it can also alter a person’s profile, she says.
“We’re seeing these over-treated lips that are changing the contour [when viewed] on profile.”
Hart has often been on the dissolving end of filler and Botox gone wrong. She recalls a patient who she describes as having a face that was “important to their career”.
“They had gone to see a practitioner who had been a little starry-eyed by them, had treated them with a lot of Botox and ended up making them look not themselves. And it took a long time to wear off. So that practitioner thought they were doing the right thing by giving them an extra strong treatment. They thought they were going to look better. But it didn’t look better, it looked weird. So, the understanding that more is not better, that less is more.”
Hart says when it comes to filler, people need to understand the real longevity of the stuff.
She points to findings by an Australian radiologist who also does injectables. Using MRIs they discovered that filler can still be present seven to eight years after being injected.
“It’s not just sort of a playground for your face,” says Hart. “And that you go, ‘Oh we’ll just get it and it’s worn off in six months, it doesn’t matter.’ It can last longer and if you don’t like it, not all practitioners are happy to dissolve out a treatment done by someone else.
“So these treatments are dissolvable but it’s not like waving a magic wand or erasing something out. You have to undergo another medical procedure and it could be hard to find a practitioner that does that.”
While Hart acknowledges the current prevalence of Kiwis after an overfilled face, she foresees that changing in time.
“I think we’re probably going to see in the years coming forward, people realising that they’re overfilled and wanting that to be corrected and dissolved.
“Internationally there’s much more of a trend for dissolving the overfilled face. And it’s a difficult thing to do because people often aren’t aware exactly how much of their face consists of filler. It could be a bit of a surprise when your real face has been ageing underneath.”
Face value: Lindley advises that when you meet the person you’re entrusting with your treatment, make sure that they’re on the same page as you about what you’re trying to achieve.
“If somebody goes into a consult with a practitioner and they don’t like the way that they look in terms of the practitioner looks over-treated, the likelihood of them making you look over-treated is high.”
Consent: Understanding the consenting process is also crucial, says Lindley.
“For example, I do Botox on the day of consult but I don’t do filler on the day of consult because the risks and the procedure itself is more involved.
“The Medical Council also suggest that the patient should go away and have a think about the procedure because it does last longer.”
Training: Hart says it’s important to ask about the training your potential practitioner has had, how many procedures they’ve done and the relationship they have with the doctor providing their standing orders.
Photos: As a standard part of your procedure, you should also expect photos - because they can be the only way to identify issues with a treatment.
“If [a practitioner] doesn’t get their patients back and take photos and examine those photos both at rest and on movement, you won’t see those mistakes.
“So often people aren’t aware of them themselves. You don’t see yourself making movements.”
Ongoing care: The practitioner should also provide you with after-hours contact details should any issues arise from your treatment. And they should be able to ensure that they can manage any potential complications.
Rebecca Haszard is a senior lifestyle and entertainment writer, co-host of the Herald’s parenting podcast One Day You’ll Thank Me and a former digital and magazine editor, including Girlfriend magazine.
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