Will 2024 be the year that facial filler is cancelled?

In September, the UK government launched its first-ever consultation on how to make non-surgical cosmetic procedures safer as thousands complained of “botched” procedures. Photo / Getty Images

For those with pockets deep enough, facial filler can be an instantaneous tool to prop up one’s flagging features by replicating the cushiony reservoir of fat and bone that resorbs with age. Or, as in the case of Gen Zers like cosmetics entrepreneur Kylie Jenner, who has admitted to having dermal filler to plump up her naturally thin lips, it’s a simple solution to a deep insecurity. In the hands of a skilled practitioner, injectables can be subtly transformative. And yet the stylised look that’s become synonymous with reality television stars and certain pockets of Hollywood, is far from discreet.

Have a play with Snapchat’s Glowing Doll filter or TikTok’s Lip Filler filter and at the click of a button you can watch your cheeks blow up, lips inflate and your skin take on a smooth waxy veneer. But the truth is the cyborg look is scarily real – an unsettling thought when you consider your friend, daughter or sibling could be one of the millions who go to such lengths, the face you once knew besieged beneath the standard filler solution of hyaluronic acid, calcium hydroxylapatite and Poly-L-lactic acid – a biodegradable synthetic material. Filler isn’t All Natural… just saying.

In September, the UK Government launched its first-ever consultation on how to make non-surgical cosmetic procedures safer as thousands complained of “botched” procedures. Save Face – a government approved register of accredited practitioners - received almost 3000 complaints in 2022, with over two-thirds of those complaints relating to dermal fillers; hardly surprising considering the injectable is now widespread.

According to a University College London study, the dermal filler market is projected to reach a value of £11.7 billion ($23.9b) by 2026, and as the UK aesthetics industry is currently unregulated, the potential for mistakes is endless. Hence why an increasing number of people (some well-known) are having theirs removed, and, thankfully, some are openly talking about it.

Kristin Davis: "You’re trusting doctors [but] people personally blame us when it goes wrong". Photo / AP

Actress Kristin Davis told The Telegraph last June: “I’ve had to get them [fillers] dissolved and I’ve been ridiculed relentlessly,” she explained, adding: “You’re trusting doctors [but] people personally blame us when it goes wrong – [as if] I jabbed a needle in my face…”

Artist Ariana Grande, 30, addressed her relationship with fillers in a Vogue beauty video this past September. “I had a ton of lip filler over the years, and Botox,” Grande said. “I stopped in 2018 because I felt so – too much,” she added.

Whereas Love Island-er turned mega influencer Molly Mae-Hague told Steven Bartlett on his podcast, Diary of a CEO: “I literally took it to the extreme and I just stripped myself back and weirdly, I felt the prettiest I’d ever felt, once it had all gone.”

Ariana Grande: ‘I had a ton of lip filler over the years. I stopped because I felt so – too much’. Photo / AP

Filler’s origin story

Filler wasn’t initially designed to reconfigure facial features like playdoh. The hyaluronic acid injectable given FDA approval in 2003 was meant to plump skin sympathetically, until in 2008 it went celebrity big when an annotated image of a then 49-year-old Madonna graced the cover of New York magazine with the headline “The New New Face” emblazoned across her plasticine-smooth forehead. “Out with the gaunt and tight, in with plump and juicy,” reads the article’s headline.

Deemed a new and better alternative to freezing expression lines with botulinum toxin (otherwise known as Botox) little did we know back then that this natural-but-not-natural injectable would lead to a plethora of fiendishly plush faces. Filler is now used to correct crooked noses, for chin augmentation and to give Ken Doll angles to jawlines. Suddenly celebrities – models even – who were, by western standards, already attractive, are walking around with pointy chins, superhero jawbones and golf ball cheeks, as if it’s normal.

Reputable aesthetic doctors blame unscrupulous practitioners who target vulnerable young women with appealing one-size-fits-all offers like “The Kylie Jenner Package”. I’ve lost count of the number of teenagers with artificially swollen lips I spot on my commute to work. The maternal me is horrified. But the professional woman in her late 40s? I can’t help but wonder how I’ll fare against the increasingly filled faces of women my own age if I don’t inject. Will I be a lone ranger in a sea of pillow faces?

Being truthful, I’ve already done a bit: two years ago I had a micro droplet of filler underneath my eyes to diffuse dark circles with Dr Marwa Ali, a light-handed practitioner I trust implicitly to be prudent, and I lean on a sprinkle of Botox every 10 months or so to soften a couple of mean-girl frown lines between my eyebrows. I, like many women my age, am vain enough to want to preserve my facial scaffolding for as long as possible, but not self-obsessed enough to have endless top-ups of what, if we’re honest, is no more than cushion stuffing in a syringe.

Madonna graced the cover of New York magazine in 2008 with her smooth complexion. Photo / New York Magazine

Perception drift: how fillers can become addictive

And yet it’s easy to see how one might get carried away. Friends actress Courteney Cox, recently spoke about her experience with injectables on the podcast Gloss Angeles. “It’s like you don’t realise that you look a little off, so then you keep doing more cause you look normal to yourself,” said the 59-year-old who had her filler dissolved in 2017 after she was mercilessly teased online, telling Woman magazine last October:

“There’s so much pressure to stay looking young in this industry that once you start, it becomes a bit of a domino effect and you keep on having more,” concluding: “It was a total waste of time and I wish I hadn’t caved into the pressure of having it.”

What Cox is referring to is what’s known in the aesthetic world as “perception drift”, says Dean Rhobaye, a qualified plastic surgeon who specialises in injectables. “One’s eye becomes accustomed very quickly to the adjustments. This can lead to unnecessary tweaks and, before you know it, you no longer resemble your former self,” he explains.

Rogue injectors: beware

Shockingly, you don’t have to be a doctor to inject filler and hence there’s endless cowboys about. “You can complete a one-day or two-day course to become an injector,” reveals Rhobaye. Is it best then to visit a plastic surgeon for injectables, I wonder? “It’s definitely an advantage,” he says. “When I’m injecting a client, I can envisage the musculature underneath the skin because I’ve seen it up close so many times during surgery.”

Courteney Cox: ‘It was a total waste of time and I wish I hadn’t caved into the pressure of having it’. Photo / AP

Moreover, the interplay between the muscles needs to be understood if you want a believable outcome. For example, says Rhobaye, “the shape of the lips at rest and when smiling is affected by an array of different muscles. In some cases, injecting an adjacent area to the one you’re aiming to correct or enhance can have an indirect effect – for the better, or worse – depending on whether the injector knows what they’re doing or not,” he warns.

The new vanguard of injectables

With increasing numbers of high-profile faces admitting to fillers gone wrong, there’s a thirst for less invasive treatments, says Dr Ashwin Soni, a GMC registered plastic surgeon whose practice is becoming increasingly non-surgical. Soni tells me he’s doing a lot more bio-stimulating injectables, otherwise known as “skin boosters”, like Nucleadyn, an injectable with polynucleotides (molecules extracted from salmon or trout sperm which closely resemble human DNA, an ingredient that Jennifer Aniston has spoken about trying) that stimulates collagen and elastin. These new smart injectables, Soni explains, work on the body’s own pathways to reverse ageing rather than adding a volumising substance as is the case with fillers.

“Bio-stimulators are proving a great option for patients that aren’t comfortable with filler – and it’s a more affordable option,” he points out. As for plumping lips, aesthetic doctors such as Dr Lizzie Tuckey at Michael Prager’s London clinic, are looking at methods such as PRP (platelet-rich plasma) to regenerate lip tissue. Though it doesn’t have the same inflatable qualities as hyaluronic acid, it will stimulate growth factors for a juicier, more youthful-looking pout.

The laser facelift alternatives

The war on overfilling is not won with a shiny new injectable alone. Natural-looking results are achieved through a combination approach including energy devices, says Dr Sophie Shotter. “We should be treating the face layer by layer, which is why lasers and skin boosters are now at the forefront because they allow cosmetic practitioners to target the entirety of the face from the quality of the skin’s surface to re-energising the fibroblast cells (the skin’s collagen factory) deep within the dermis.”

Collagen is the body’s main protein responsible for strong cartilage and bones and is what keeps the skin firm and cushiony. Energy devices work by utilising light at different strengths and wavelengths to create a controlled trauma that elicits an emergency uptake in collagen and elastin. The three main types of energy include ultrasound treatments such as HIFU (high-intensity focused ultrasound) or Ultherapy, which are best for firming, IPL (intense pulse light) that targets pigmentation, and radiofrequency which is good for tightening. When combined with microneedling (Morpheus8 and Profound) the results, which take a few months to fully transpire, are intensified.

When filler makes sense

Despite technology advancing, filler is a long way from being cancelled, insists Shotter. “It’s still my most popular procedure and can be vital for boosting confidence in patients who’ve lost volume through the ageing process.” Soni agrees: “The results from energy devices are subtle which can leave some patients feeling deflated.”

Dr Ashwin Soni: “In the right candidate, small volumes of filler can be extremely effective at contouring and defining the mid and lower face in particular." Photo / Getty Images

“In the right candidate, small volumes of filler can be extremely effective at contouring and defining the mid and lower face in particular,” says Soni. A good job, he tells me, is down to using the right viscosity and amount of filler at the correct injection point. The thickest fillers are ideal for creating structure when injected close to the bone. Medium-density fillers are suited for lip fullness, whereas barcode (smokers) lines require a very thin density, as does under eyes, bearing in mind there’s no accounting for taste and skill. “It’s not simple, you need experience and an understanding of how the product works within the skin on different areas of the face,” explains Soni.

And yet, the risks are undeniable

Ultimately, fillers have become the scapegoat for an industry that lacks regulation and allows the unskilled and unethical to profit from vulnerable clients. What’s not made clear on social media where non-surgical rhinoplasty, for instance, is touted as a safer, quicker alternative to surgery, is that fillers in certain areas of the face, like the nose, carry devastating risks like necrosis (tissue death) and even blindness. These “botched” jobs are at the heart of the complaints the Government is investigating.

In 2021 it was made illegal for under-18s to be injected, and under the proposed scheme, practitioners and their premises will need to be licensed with age limits and further restrictions for high risk procedures, including those involving injecting filler into intimate areas – the ever popular BBL (Brazilian Butt Lift) has the highest mortality rate of any cosmetic surgery. While the procedure typically involves a fat transfer, filler in the buttocks is gaining popularity, despite being deemed unsafe by both Safe Face in the UK and the FDA (the food and drug administration) in America.

Victoria Brownlie, chief policy officer of the British Beauty Council, the industry organisation representing the UK’s £24.5bn ($50 billion) beauty industry, told The Telegraph: “The problem with the current popularity of dermal fillers is that it’s often marketed as something quick and easy, when in fact the procedure can carry more serious and long-term risks than other aesthetics treatments. Whilst these kinds of procedures are having their ‘time in the spotlight’ as other procedures have done in the past, this mustn’t come at the expense of patient safety.”

She adds: “For too long there has been a huge disparity in the quality of non-surgical cosmetic procedures like fillers, which has put the public at risk and damaged the reputation of the industry as a whole. It’s time we set a robust standard of competency for anyone wishing to offer these kinds of treatments and a mechanism to ensure anyone proven not to meet this standard cannot operate. We’re confident that, with continued engagement with the Department of Health, we can achieve this and provide that much needed confidence in the services the aesthetics sector offers.”

Gywneth Paltrow was asked if she ever had botox by fans in a Q&A. Photo / AP

In a press release announcing an eight-week consultation period which closed on October 28, 2023, Maria Caulfield, Minister for the Women’s Health Strategy, said: “Whether it’s Botox, dermal fillers or even a chemical peel, we have heard too many stories of people who’ve had bad experiences from getting a cosmetic procedure from someone who is inexperienced or underqualified,” clarifying, “there’s no doubt that the popularity of cosmetic procedures is increasing, so it’s our role to ensure consistent standards for consumers and a level playing field for businesses and practitioners.” But of course, talk is cheap – what measures will come of this, time will tell.

In contemplative moments I question whether admonishing the overzealous use of injectables is snobbery in disguise. Work is work – whether you can tell or not is a matter of preference and access to a decent aesthetic doctor. But even then, it’s not a given. When Gwyneth Paltrow, 51, was recently asked during a session of “ask me anything” on Instagram if she’d ever tried Botox, the Goop founder responded: “God yes. Both successfully and unsuccessfully I’m afraid.”

Alas, as more famous and admired faces get honest about aesthetic procedures, the less in the dark we’ll feel out here in the real world, where dropping a few thousand pounds on a razor sharp jawline isn’t your everyday. To quote Kylie Jenner in season three of The Kardashians: “All of us need to have a bigger conversation about the beauty standards we’re setting.”

As the second most followed woman in the world with almost 400 million followers on Instagram alone, including my 18-year-old daughter (and probably yours too), the beauty mogul who’s endured endless scrutiny over her own lip fillers (and made billions selling lip gloss kits on the back of it all), couldn’t have said it better.