Before and After photographs issued by Allergan show how dermal fillers can plump up the skin and smooth deep lines around the eyes and mouth.

We have all seen – and laughed at – pictures of “trout pout” celebrities, those who went overboard with collagen injections.

Puffy, oversized lips aren’t the only bad result of aesthetic medicine. Some Hollywood actresses with frozen faces have been mocked for their Botox addiction.

In the UK there has been a dramatic rise in reports of botched facial filler procedures that have left women permanently disfigured, due to adverse reactions, including infection and the erosion of deeper tissue. Poor quality products being used by poorly trained practitioners have been blamed for this.

Injectable facial fillers, which are made of hyaluronic acid, a naturally occurring human protein responsible for plumping the skin, can result in the skin lumping (called granulomas) or discolouring, or if the product is not evenly distributed, it can result in asymmetry (lopsided lips, for example). Fillers can also result in cysts, swelling, haematomas, bruising, dark circles, or even necrosis (dying tissue).

The worrying rise in side effects has been picked up in the UK and Ireland by plastic surgeons, who are calling for the industry there to be better regulated. According to the London Daily Mail, fillers “can be administered by anyone who has completed a half-day course”.

This isn’t the case in South Africa but, still, there is no shortage of women here who have been less than satisfied with the outcome of having facial fillers injected to smooth out wrinkles.

“I had filler in my lips and have to confess they were a little too pouty afterwards. But worse was that after a few weeks, I noticed the filler injected in my nasolabial lines (lines around the mouth) had become lumpy. You couldn’t see it, but I could feel the lumps under the skin,” says Lucille*, who doesn’t want to be named.

As in the US, facial fillers are classified a scheduled substance in South Africa and may be injected only by a medical practitioner, dermatologist, dentist or nurse with the correct qualifications – not by beauty therapists or non-medical aestheticians. That said, consumers are being urged to increase their awareness, not only of the skill of the practitioner but the product they are using.

Demand for aesthetic medicine is growing and an increasing number of registered medical professionals – including general practitioners, dermatologists and plastic surgeons – are offering aesthetic treatments to women and men, specifically fillers and Botulinum toxin (Botox).

“There are so many different formulations of dermal fillers on the market. You need to ensure that the product has good science behind it,” says Caroline van Hove, director of facial aesthetics for Allergan Europe, Africa and the Middle East, who was in South Africa recently to attend the World Congress of Aesthetic Medicine.

“And you need to go to a well-trained aesthetic doctor or plastic surgeon, never a beautician.”

Low-grade products “may have a granular consistency, and can cause granuloma”, Van Hove warns.

Recommended products on the South African market include Restylane, Perlane and Juvederm (the latter by Allergan). “Allergan products are minimally invasive, and the gel formulation in its fillers is extremely smooth. It is the best in class,” says Van Hove.

Newer fillers or volumisers used to fill larger volume loss like sunken cheeks, lost cheekbones, and very deep nasolabial folds and marionette lines, include Teosyal Ultra Deep, Teosyal Deep Lines and Sculptra, though be aware that these fillers entail much deeper injections than the regular fillers and can be quite painful.

Looking at the statistics, however, anti-ageing potions are apparently more than worth it, and it must be said that procedures that go wrong are uncommon.

Globally, the anti-ageing market is expected to reach about $274 billion (R2.4 trillion) this year, with more than $100bn of that devoted to aesthetics, an indication of just how commonplace non-surgical procedures like fillers and Botox have become.

The trend today is to achieve a youthful but natural appearance, says Van Hove.

“There are countless women you see every day and wouldn’t know they’ve had a facial filler procedure. These are just ordinary women like you and me, juggling jobs and families. It is for women who realise lotions don’t really work, but they’re averse to having surgery.

“Unfortunately, the trout pout has put off a lot of women who could actually benefit from a softer lip, (but) you will find that those women actually asked for more filler to create that look.”

After Botox, facial fillers are the most popular request at Medi-Sculpt Clinic near Krugersdorp, with volumising treatments being a regular request among older patients.

“Facial sagging is one of the least attractive results of age-related collagen loss,” says Dr Anushka Reddy.

“Volumising treatments can add volume to all parts of your face, from cheeks, to neck, to the folds around the chin, the jowl areas and to the hollow areas around the eyes and between the mouth and nose.”

Dermal fillers achieve visible results in smoothing not only nasolabial lines and marionette lines (“laugh lines”), but acne scars. Increasingly among the converts are men – though their number is a fraction of that of woman devotees.

Awareness of what the treatments are, and what they do, is important, however, as some patients are not well informed.

“Botox is for the upper part of the face – for frown lines especially, and fillers are for the lower part. Botox does not restore volume,” explains Van Hove.

A good dermatologist or aesthetic physician knows that a beautiful face is a symmetrical face, but more important knows facial anatomy and where veins and arteries are.

In the UK, untrained cosmeticians have caused facial nerve damage by injecting filler in the wrong place, and in one case a woman went blind. “Again, it is important to go to someone highly trained,” says Van Hove.

But a medical degree is no guarantee you will get a suitable result – it depends on what training they have had in injectables.

Jill Stuart, from Pietermaritzburg, says she “definitely went to the wrong doctor” in 2011 when she asked him “what I could have to remove the terrible smoking lines around my mouth”.

“He proceeded to inject both the filler and Botox around the edges of my lips. He must have injected at least 10 to 12 times, with no anaesthetic at all. It was without doubt the most painful procedure I have ever experienced,” she says.

Stuart was bruised and swollen for days afterwards. “I looked like the victim of a serious punch-up,” she says.

The swelling and bruising took a few days to improve and disappear, and simultaneously there were signs of some improvement to the contour of her lips and the lines around her mouth. “But the improvement wasn’t fantastic, and the pain was definitely not worth it,” says Stuart.

Some people bruise more easily than others, Van Hove says, but with a good product the pain of the procedure and swelling should be minimal. “Five years ago most dermal fillers didn’t have an anaesthetic, but today they contain a local anaesthetic called Lidocaine, so the patient should hardly feel the injection.”

This goes for lip fillers too, and Allergan has just launched a new one called Volbella, which Van Hove says is designed to provide “soft enhancement” of the lip. It is available at top skin clinics.

However, it’s also important to realise that facial fillers last from three to 12 months and usually require touch-ups to maintain their results, so it can be an expensive treatment to maintain.

At Medi-Sculpt Clinic, a treatment of Restylane fillers, which lasts nine to 12 months, costs R2 650, and a facial volumising treatment using Restylane Sub Q, which lasts 18 to 24 months, costs R8 000.

At the Skin Renewal Medical Aesthetic Centre, a treatment with Restylane, Surgiderm or Juvederm is priced from R2 900, and at Melrose Aesthetic Centre, a best-of-breed Juvederm treatment costs R3 450. A first-time consultation fee of about R500 is also the norm.

So the rules of thumb would be: ensure the product is top-quality, that the practitioner is well trained and experienced in aesthetic medicine and, not least, that you have the money to maintain the look.

CONTACTS

l Allergan – Call 011 545 6600 or see www.allergan.co.za

l Medi-Sculpt Clinic – Call 0861 003 007 or visit www.medisculpt.co.za

l Skin Renewal Medical Aesthetic Centre – Visit www.skinrenewal.co.za to find a branch near you.

l Melrose Aesthetic Centre – Call 0861 372 6869 or visit www.melroseskin.co.za