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
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
Trained professionals are very well-aware that aesthetic treatments are not risk-free. 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 ‘self-injection 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.
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 self-injection 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.
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.
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-leaving-teenage-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: self-injection 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.gdc-uk.org/search?querytext=prescribing>
27. MDU. Self-prescribing, 2018 <https://www.themdu.com/guidance-and-advice/guides/self-prescribing>