With so many teens requesting lip treatments, or those wanting something outside of what we understand as attractive and normal, it may be an ethical practitioner’s natural instinct to refuse treatment. We can emphasise the potential complications and try to persuade the patient that they don’t need a treatment to look better, but we may have to accept that the patient may well go to someone less ethical or professional who will agree to treat. As such, some might question if we as medical professionals have a responsibility to consider treating in these circumstances to ensure that the patient undergoes safe practices. This article will outline the important points to consider when treating lips in young people who are under 18, or in my opinion ‘underage’, and the ethical and legal approaches practitioners should be taking.
Underage and too big
The lips of TV personality Kylie Jenner have been an increasing topic of conversation amongst teens and young women across the UK. At first Jenner denied she had lip fillers at all, and claimed that skillful makeup alone had morphed her slim lips into luscious shapely ones at the age of 17. Jenner finally went public in May 2015, admitting her lips had been injected with a filler to achieve the look.1 According to some UK clinics,2 this initiated a deluge of young girls wanting to replicate her lips. Since then, this has increased the debate amongst aesthetic practitioners as to the ethical/legal dilemma on whether to treat or not in these circumstances. Lip fillers seem to have become a fashion accessory rather than an age-defying treatment and, although I don’t think there is anything necessarily wrong with that, we are now faced with the issue of size, mainly stemming from reality TV shows where participants such as Holly Hagan from Geordie Shore and, more recently, the women in the Channel 5 show ‘My Mum’s Hotter Than Me’, seek to continually enhance the size of their lips. With many of the younger age group wanting much larger and sometimes an ‘extreme’ lip look, the potential problems associated with lip injecting may be exacerbated due to inappropriate product choice and delivery. Manufacturers do not recommend the highly cross-linked molecule fillers (indicated to give facial volume) in the lips, however when I see photos in the press and on social media it often looks like this is what is being injected, or alternatively, far too many syringes of a less volumising filler seem to be used. Some fillers are more hydrophilic than others, but, either way, with a large volume, they can give rise to increased swelling and bruising, so the chances of necrosis and deformities also increase. Lack of product understanding coupled with the inability to understand and medically manage the complications by non-medical practitioners is of concern.3 I spoke to the Safety in Beauty campaign, which says that it has received an alarming number of complaints relating to lip fillers from young adults, with the most popular age group reporting complications being 18-34. The British Association of Cosmetic Nurses (BACN) has also received a number of enquiries regarding policy and legality of treating under 18s. The BACN’s closed Facebook forum has also seen a rise of discussions on the subject, with anecdotal reports of an increase in enquiries for treatment from this age group. A growing number of BACN members are also consulting patients who are seeking corrective procedures after poor treatment elsewhere.
Lip fillers seem to have become a fashion accessory rather than an age-defying treatment
Is it illegal to inject an under 18 with lip fillers?
Having spoken to both insurers and legal experts the answer is NO it is not illegal. However, aside from the ethics, there are a number of important points to consider before that answer has you reaching to open a box of lip filler for the excited 16-year-old sitting in your clinic. Eddie Hooker, CEO and founder of Hamilton Fraser Cosmetic Insurance, was quick to inform me that the company does not include under 18s in their cosmetic malpractice insurance policies. One cannot ban treatments to the under 18s, as from a medical position the treatment may be required, but they would generally decline cover unless there are clear medical reasons/evidence provided to demonstrate the treatment is in the best interest of the patient. Janine Revill, director of Cosmetic Insure, informed me that her company has different types of cosmetic policies. Some exclude under 18s and others are not specific. However, they would expect practitioners to adhere to their Code of Practice that highlights the importance of requiring identity and consent before administering a lip treatment, which Hamilton Fraser also advocates.
Checking identity is the responsibility of the practitioner offering treatment. Apart from the insurance issue, being unware of a patient’s age is unlikely to stand up against an ethics committee, and teens may lie about their age when seeking a treatment. Onus is on the practitioner during consultation to ask the correct questions and gather all relevant information before administering passport, birth certificate or driving licence being the most obvious. Hooker explains that Hamilton Fraser sees many claims rejected due to incorrect information or lack of verification, which may render any consent invalid.
In the media
Interestingly, in my clinic, Harrogate Aesthetics, we had a whatclinic.com email request from a 15-year-old wanting a lip filler. She was declined treatment and politely emailed with a host of reasons as to why lip filler would be unsuitable for her. In retrospect, I wondered if it was a hoax and sent to test whether we would offer treatment, as a number of media sources have been performing undercover investigations of clinics around this issue.
Recently The Sun sent two undercover, underage teenagers to clinics across the UK to see if they would be happy to treat them with botulinum toxin and fillers and six considered to treat.4 The practitioners were a mix of doctors, a podiatrist, a prescribing pharmacist, a paediatrician and a nurse. In response, a spokesman for the British Association of Aesthetic Plastic Surgeons (BAAPS), described giving an under-18 fillers (or botulinum toxin) as ‘completely unethical’ and added, “At such a young age, a patient does not require any ‘anti-ageing’ treatment. To suggest otherwise is irresponsible, especially given that younger people are likely to be more psychologically vulnerable and may not fully understand the long-term consequences or risks.” Mr Rajiv Grover, consultant plastic surgeon and former president of BAAPS, agreed, and told The Sun that, “An ethical practitioner should reassure them (an underage patient) nothing needs to be done and build their confidence in a positive way.”
What should be happening
My personal belief is that treating patients who are under 18 with lip filler is fundamentally wrong. These ‘children’ – and they still are children in my view – have yet to suffer the vagaries of ageing, and the management of these patients brings a host of potential problems to consider including the psychological/psychosocial aspect and consent. It is a difficult balance to maintain, but the important thing is to stay true to yourself as a medical professional and to follow your ethical compass when it comes to treating the lips of underage patients.