The Last Word

Dr Tatiana Lapa questions whether aesthetic practitioners are promoting a ‘do-it-yourself’ culture

The last two decades have seen considerable growth in the non-surgical aesthetic sector. The demand for these treatments has increased by over 400%,1,2 and last year alone, non-surgical treatments were worth more than $8.5 billion in the US.2 This has been attributed to increasing numbers of people being dissatisfied with their appearance,3,4 as well as improved convenience, affordability and perceived safety of non-surgical treatments. I have noticed that this growth in non-surgical aesthetics has recently been accompanied by an apparent rise in ‘do-it-yourself’ (DIY) treatments. This term refers to members of the public treating themselves with medical therapies, ranging from chemical peels to self-injecting. One author has suggested that practitioners themselves are partly responsible for this trend.5

Social media and DIY Practitioners are increasingly using social media platforms to engage with patients, provide education and promote their services. This has been accompanied by a recent trend in practitioners using these channels to share videos or photographs of themselves performing DIY cosmetic treatments. Instagram has more than 2,200 posts tagged with variations on the term ‘self-injection’; many of which are aesthetic practitioners such as doctors and nurses, demonstrating on themselves how to inject.22 Practitioners also use YouTube to share these videos, with some of them attracting more than 100,000 public views.23 Of concern is the correlating trend for members of the public performing DIY medical treatments; a search using YouTube for ‘self-injection dermal filler’ returns several pages of videos where members of the public self-inject dermal filler with clear and worrying errors in administration.23 For example, individuals are re-using syringes,6 sharing syringes,7 over-injecting,8 injecting in unsafe zones8 and purchasing unverified products through forums and social media platforms.5

The risks of DIY Trained professionals are very well-aware that aesthetic treatments are not riskfree. Dermal fillers for example, even in the hands of trained professionals, can cause infection, anaphylaxis, local tissue necrosis and embolisation.9 In his report for the Department of Health (DoH) on the regulation of the cosmetic industry, Sir Bruce Keogh, the medical director of the NHS and director general of the DoH at the time, highlighted that ‘dermal fillers are a disaster waiting to happen’.10 In my opinion, dermal fillers in the hands of untrained members of the public, are a disaster that is already happening. A simple PubMed search for the term ‘selfinjection for cosmetic treatment’ identifies 14 case reports of self-injecting for cosmetic reasons and the complications that arose as a result. The reports describe individuals who have self-injected dermal filler,11-13 paraffin,14-16 oil,17-19 lipase20 and bovine fat.21 Almost all of these individuals were left with significant long-term morbidity as a result of their self-treatment.

Patients are watching us It is important that we, as responsible practitioners, understand that the public are watching and learning from what we post on social media. A recent article by Brennan et al. has shed light on the growing DIY trend among members of the public.5 The authors collected data from four online forums and interviewed members of the public who had previously self-injected botulinum toxin or dermal filler, or those who were planning to self-inject. Reasons for choosing to self-inject included cutting cost and lack of confidence in practitioners. Those interviewed reported that they had found information about self-injection by watching YouTube tutorials and downloading instructional materials from the internet. I believe that professionals who post videos of self-injection are facilitating this DIY culture and enabling unsafe practice and are therefore partly responsible for serious risks to public safety. The selfinjection trend is not without considerable risks; even if it is a practitioner injecting themselves we should not consider them immune. A recent case report describes a 37-year-old practitioner who self-injected her temples using hyaluronic acid dermal filler.11 The practitioner developed occlusion of a branch of her left superficial temporal artery and required hospital admission and hyperbaric oxygen therapy. The authors comment that practitioners should adhere to local guidelines on self-treatment, but fall short of saying that self-injection should be avoided. Numerous professional bodies including the General Medical Council,22 Nursing and Midwifery Council,23 General Dental Council24 and the Medical Defence Union25 have provided guidance stating that medical professionals should, wherever possible, avoid providing medical care to themselves. The GMC states that a lack of independent assessment, lack of appropriate checks and measures (especially in drugs of addiction), possibility of inaccurate diagnosis, and potential impedance to further treatment, for example emergency treatment, are all reasons as to why clinicians should not self-treat. With present concerns about safety, ethics and regulation of the aesthetic sector,10 practitioners should ensure that they adhere to such guidance and follow gold standard practice.

Conclusion The rapid growth in non-surgical aesthetics has recently been accompanied by a trend in practitioners using social media to share videos or photographs performing DIY cosmetic treatments on themselves. Of concern is the correlating trend for members of the public following their example, with obvious safety concerns. As professionals, we must be more mindful of what the public are learning from the content we post online and we should work towards promoting safety and quality standards, rather than a DIY culture.

Dr Tatiana Lapa qualified as a doctor at St George’s Medical School, following a Bachelor’s of Science degree at King’s College London in Aerospace Medicine. Whilst attaining her membership to the Royal College of General Practitioners, Dr Lapa gained an interest in non-surgical aesthetics and was awarded a First-Class Master’s Degree in Aesthetic Medicine at Queen Mary University. She established the Dr Tatiana Clinic in London in 2014.

REFERENCES

1. Surgery ASFAP. ASAPS 1997 Statistics on Cosmetic Surgery 1997 <https://www.surgery.org/sites/default/files/ASAPS1997Stats_0.pdf> 2. Surgery ASFAP. Cosmetic Surgery National Data Bank Statistics 2017<https://surgery.org/sites/default/files/ASAPS-Stats2017.pdf> 3. Cash TF, Henry PE. Women’s body images: The results of a national survey in the USA. Sex Roles. 1995;33(1-2):19–28. 4. Frederick DA, Jafary AM, Gruys K, Daniels EA. Encylopedia of body image and human appearance. Cash TF, editor. Elsevier; 2012. 9 p. 5. Brennan R, Wells JSG, Van Hout M. “Saving Face”: An Online Study of the Injecting Use of DIY Botox and Dermal Filler Kits. Plast Surg (Oakv). 2018 Aug;26(3):154–9. 6. C AJFABK. Fillers self injection YouTube; 2017. <https://www. youtube.com/watch?v=ZM_obJn-_kE> 7. OBrien Z. REVEALED: lip filler frenzy leaving teenage girls with

HORRIFIC damage. Sunday Express. 2016 Feb 25. <https://www. express.co.uk/news/uk/647566/REVEALED-Lip-filler-frenzy-leavingteenage-girls-with-HORRIFIC-damage> 8. Dermis DO. Dermal Filler Injection Technique on Yourself. YouTube; 2017. <https://www.youtube.com/watch?v=bUxBzN9XW8Q> 9. Urdiales-Galvez F, Delgado NE, Figueiredo V, Lajo-Plaza JV, Mira

M, Moreno A, et al. Treatment of Soft Tissue Filler Complications:

Expert Consensus Recommendations. Aesthetic Plast Surg. 2018

Apr;42(2):498–510. 10. Health DO. Review of the Regulation of Cosmetic Interventions. 2013. <https://www.gov.uk/government/uploads/system/uploads/ attachment_data/file/192028/Review_of_the_Regulation_of_

Cosmetic_Interventions.pdf> 11. Henderson R, Reilly DA, Cooper JS. Hyperbaric Oxygen for

Ischemia due to Injection of Cosmetic Fillers: Case Report and

Issues. Plast Reconstr Surg Glob Open. 2018 Jan;6(1):e1618. 12. Raoof N, Salvi SM. Self-injection of dermal filler: an underdiagnosed entity? Br J Dermatol. 2015 Mar;172(3):782–3. 13. Ono S, Hyakusoku H. Complications after self-injection of hyaluronic acid and phosphatidylcholine for aesthetic purposes.

Aesthet Surg J. 2010 May;30(3):442–5. 14. De Siati M, Selvaggio O, Di Fino G, Liuzzi G, Massenio P,

Sanguedolce F, et al. An unusual delayed complication of paraffin self-injection for penile girth augmentation. BMC Urol. 2013

Dec;13:66. 15. Iversen L, Lemcke A, Bitsch M, Karlsmark T. Compression bandage as treatment for ulcers induced by intramuscular self-injection of paraffin oil. Acta Derm Venereol. 2009;89(2):196–7. 16. Cohen JL, Keoleian CM, Krull EA. Penile paraffinoma: selfinjection with mineral oil. J Am Acad Dermatol. 2002 Nov;47(5

Suppl):S251–3. 17. De Gado F, Mazzocchi M, Chiummariello S, Gagliardi DN,

Alfano C. Johnson’s baby oil, a new type of filler? Acta Chir Plast. 2006;48(4):123–6. 18. Darsow U, Bruckbauer H, Worret WI, Hofmann H, Ring J.

Subcutaneous oleomas induced by self-injection of sesame seed oil for muscle augmentation. J Am Acad Dermatol. 2000 Feb;42(2

Pt 1):292–4. 19. Thomas P, Boussuges A, Gainnier M, Quenee V, Donati S, Ayem

ML, et al. [Fat embolism after intrapenile injection of sweet almond oil]. Rev Mal Respir. 1998 Jun;15(3):307–8. 20. Khoo AAK-A, Branford OA, Javaid M. Self injection of lipase--an extreme case for regulation in non-surgical cosmetic procedures. J

Plast Reconstr Aesthet Surg. 2010 Jan;63(1):e6–8. 21. Tumerdem B, Aydin A, Kesim SN. An unusual case of self-injected bovine fat in liquid form to the face for cosmetic reasons. Aesthetic

Plast Surg. 2004 Jul;28(4):251–3. 22. GMC. Guidance on assessing the seriousness of concerns relating to self-prescribing, or prescribing to those in closer personal relationships with doctors. 2016 <https://www.gmc-uk.org/-/media/ documents/DC6649_Guidance_on_assessing_the_seriousness_ of_concerns_relating_to_prescribing.pdf_58666780.pdf> 23. Instagram, theenhancers, <https://www.instagram.com/p/

BmwIPlSH32i/> 24. YouTube, self-injection dermal filler. <https://www.youtube.com/ results?search_query=self-injection+dermal+filler> 25. NMC. The Code. 2015 Jan 29. <https://www.nmc.org.uk/ globalassets/sitedocuments/nmc-publications/nmc-code.pdf> 26. GDC. Guidance on prescribing medicines. 2013 <https://www.gdcuk.org/search?querytext=prescribing> 27. MDU. Self-prescribing, 2018 <https://www.themdu.com/guidanceand-advice/guides/self-prescribing>

4T Medical 01223 440 285 info@4tmedical.com www.4tmedical.com Clinic Software 020 7194 7878 contact@clinicsoftware.com 35 New Broad St, London, EC2M 1NH

H

HA-Derma Iveta Vinklerova 0208 455 48 96 info@ha-derma.co.uk www.ha-derma.co.uk

N

Natura Studios 0333 358 3904 info@naturastudios.co.uk www.naturastudios.co.uk

5 Squirrels Gary Conroy Own Brand Skincare www.5squirrels.com info@5squirrels.com

AestheticSource Ltd Lorna McDonnell-Bowes 01234 313130 www.aestheticsource.com info@aestheticsource.com Cosmetic Insure Lizzie Newton www.cosmeticinsure.com 0845 6008288 sales@cosmeticinsure.com

Enhance Insurance Sharon Allen sharon.allen@enhanceinsurance.co.uk 0800 980 776 www.enhanceinsurance.co.uk

D

DermaLUX Louise Taylor +44 0845 689 1789 info@dermaluxled.com www.dermaluxled.com

AZTEC Services Anthony Zacharek 01494 956644 az@aztecservices.uk.com www.aztecservices.uk.com

Beamwave Technologies Nik Kane 0208 191 7117 hello@beamwave.co.uk www.beamwave.co.uk

Boston Medical (UK) Ltd Lucia Krivonak 020 7727 1110 info@boston-medical-group.co.uk www.boston-medical-group.co.uk

Breit Aesthetics breitaesthetics.com info@breitaesthetics.com 0207 193 2128

Church Pharmacy 01509 357 300 info@churchpharmacy.co.uk www.churchpharmacy.co.uk

Consentz Tai Gantois 01932 481 081 contact@consentz.com www.consentz.com

Cosmetic Digital Adam Hampson 01159 140640 enquiry@cosmeticdigital.co.uk www.cosmeticdigital.co.uk Digital Aesthetics Creative and Marketing Agency 0203 397 3736 team@digitalaesthetics.co.uk www.digitalaesthetics.co.uk/

E

Eden Aesthetics Tania Smith +44 01245 227 752 info@edenaesthetics.com www.edenaesthetics.com | www.epionce.co.uk

e-MASTR info@e-mastr.com www.e-mastr.com

F

Flawless Pen Microneedling, Training, Support 07841 389234 enquiries@fl awlessdistribution.co.uk www.fl awlesspen.com

Fusion GT 0207 481 1656 info@fusiongt.co.uk www.fusiongt.co.uk

G

Healthxchange Group Juvéderm, Botox, Obagi, Clever Clinic & more +44 (0)1481 736837 orders@healthxchange.com www.healthxchange.com

John Bannon Pharmacy enquiries@johnbannonpharmacy.co.uk www.johnbannonpharmacy.co.uk Contact: 01827 338115

PHARMACY

L

Lumenis UK Ltd Hannah Nugwela hannah.nugawela@lumenis.com Tel: 0208 736 4110 www.lumenis.com/Aesthetic

M

Med-fx Ltd David Tweedale 07864 801229 David.tweedale@med-fx.co.uk https://medfx.co.uk/

Medira Ltd +44 (0) 800 292 2014 info@medira.co.uk www.medira.co.uk

Medical Aesthetic Group David Gower +44 02380 676733 info@magroup.co.uk www.magroup.co.uk

MedivaPharma 01908 617328 info@medivapharma.co.uk www.medivapharma.co.uk Facial Aesthetic Supplies

WELLNESS TRADING LTD – Mesoestetic UK Adam Birtwistle +44 01625 529 540 contact@mesoestetic.co.uk www.mesoestetic.co.uk

Aesthetic Pharmacy Open 365 days until 10pm 01744 638 713 scripts@sthelensmcp.co.uk info@sthelensmcp.co.uk

O

Skin Diagnostic Equipment ian@observ.uk.com www.observ.uk.com 07773 778 493

R

Rosmetics info@rosmetics.co.uk rosmetics.co.uk 0345 5050601

S

Schuco Aesthetics 01923 234 600 sales@schuco.co.uk www.schuco.co.uk

SkinCeuticals www.skinceuticals.co.uk contact@skinceuticals.co.uk

SURFACE IMAGING

S O L U T I O N S Surface Imaging Solutions Limited Nicolas Miedzianowski-Sinclair 07774 802 409 nms@surfaceimaging.co.uk www.surfaceimaging.co.uk

Syneron Candela UK 0845 5210698 ukinfo@syneron-candela.co.uk www.syneron-candela.co.uk

T

TOR Generics LTD Sharon Wilson 01923 836700 www.tor-generics.com

TEOXANE UK 01793 784 459 info@teoxane.co.uk www.teoxane.co.uk

The Restylane Webinar The anatomy of the smile

Join us from 7-9pm 11th March 2019 on aestheticsjournal.com

How do I guarantee my place on ‘The Anatomy of the Smile’ Webinar?

1. First register for DocCheck – IMPORTANT please do this by 7th March 2019 in order to guarantee that your registration will be processed in time for access to the webinar a. Visit the following link: https://www.doccheck.com/com/ account/register b. Register and provide your medical certification as proof of your profession c. Your information will be checked and once verified you will be provided with a DocCheck password 2. Register for the Webinar at https://aestheticsjournal.com/

Webinar_GaldermaMarch2019 3. Login or join for free as a member 4. You will then be prompted to use your DocCheck* password to confirm you are a doctor, nurse or dentist 5. Tick the box to confirm you would like to pre-register for the webinar