You may have seen a few a weeks ago that I posted some content about an 18-year-old woman who I saw as an emergency after she had lip fillers. This patient has been very brave and has allowed me to share her story as a lesson to others and as a learning point for myself and other practitioners. The following account is based on the patients’ and my experience of treating her.
I had scheduled a weekend off to prepare Ena for school, and we were both mooching around the house in our pjs. I received a phone call from an anxious mum who told me her daughter (who we will call K) had spent the night in A&E after having lip fillers with another practitioner. A&E could only give her antihistamines. She told me that they had contacted the original practitioner who, K tells me, told her that her swelling, and pain was normal. They also told me they had contacted various other practitioners who advised that she be seen by the original practitioner or someone who is a registered healthcare professional.
I asked mum to get K to send me some pictures. What I saw was some very swollen lips with a dusky looking area at the right Glogau-Klein point (GKP). I could see that K needed to be reviewed quickly and dragged my behind out of the house.
I met K, who is a lovely, articulate, and beautiful 18-year-old. Her mum joined us soon after to support her. I took a detailed history, here is some of what she told me:
- She had found the practitioner through social media and liked her work and appearance.
- The practitioner was a non-healthcare professional and worked in a local salon as well as offering injections in her own home.
- The patient went to the practitioners’ home and paid £100 for 1ml of injectable dermal filler.
- K said that the treatment was very painful and continued to be painful for the whole day and night.
- Her lips swelled to the point that she couldn’t close her mouth, eat, or drink.
- K says that she contacted the practitioner who told her there was nothing to worry about.
- She eventually went to A&E and was discharged in the morning with some antihistamines.
- Her mum spent the morning calling other practitioners who were not available to see the patient or were too far away. One Harley Street doctor advised that K be seen immediately.
I then performed a physical examination that included feeling for lumps and checking blood flow. I could feel two large masses of filler in the top lip and one large mass in the bottom lip. Blood flow was appropriate in most of the lip, but blood return to the GKP and surrounding area slow and sluggish. On the inside of this part of the lip there was a large haematoma with an area that looked macerated, and I could not discern if this was caused by trauma created by the lip rubbing on the teeth or by small blisters (often present with vascular occlusion).
After a discussion with K and her mum, I felt it was appropriate to dissolve the filler as an emergency. I believed that that K had a compression occlusion, whereby the filler was squeezing the artery so that blood and oxygen could not perfuse an area of tissue. Without an ultrasound it was difficult to determine what kind of occlusion it was, but I felt the risk of not dissolving immediately outweighed the risk of dissolving. Also, K was still in pain, and that itself was a good reason to dissolve.
We discussed the procedure, the contraindications to using hyalase, went through the consent forms together, took pictures and made a video consent also. It was important for K to understand how Hyalase works by turning the dermal filler from a polymer into a monomer, allowing us to massage out and away. There are also undesirable effects and risks to using hyalase. Hyalase dissolves your own hyaluronic acid meaning you can have a period of loss of natural volume; it can be sore to have the treatment; there is often bruising associated. However, the most concerning thing is that there is a 1 in 2000 chance of allergic reaction to hyalase. Like anything in medicine, treatments are rarely simple, so in case of anaphylaxis I had my emergency adrenaline ready, and my emergency protocol open on my desk.
K had no prior history of any allergy and as this was an emergency treatment, we did not perform a skin test. I reconstituted with lidocaine and injected directly into the mounds of filler starting with the area of concern. Almost immediately to flooding the area massaging, it became pink and well perfused. The hyalase itself caused swelling and bruising, but capillary refill time was less than two seconds, and I was satisfied that we had succeeded. After 30-minute rest and some more pictures, I discharged K with some prophylactic antibiotics and a follow up appointment. We kept in touch for the next few days and K’s lips returned to normal over the next 2 weeks.
What had originally cost K £100 ended up costing her a further £200 for me to dissolve, plus the cost of a private prescription for antibiotics. However, the pain and the time it took K to put her condition right cannot be equated to money.
How can we stop situations like this happening again? It’s true that even the most experienced medical aesthetic practitioner will have complications in their patients resulting from their treatments, but a good practitioner will recognise this and treat it as soon as possible. The government need to define minimum training and practice requirements for all of us and regulate the industry rigorously so that we are 1. Trained to the highest standards; 2. That non healthcare professionals work closely with a prescribing clinician; 3. That those who meet the standards are registered under a governing body. Until then it is up to the patients to be informed enough to decide who they go to for treatment, so here are some red flags for you to look out for.
- Cheap prices – they are using the cheapest products.
- Time limited offers on injectables – this is coercive and makes a quick buck
- Bundle deals on injectables e.g., ‘6ml of filler for a low price’– coercive, enticing you to have treatments you don’t need or want.
- They treat you in their kitchen or lounge – if they treat you from home, they should have a specific clinic room.
- Use hashtags on their social media like #medicalaesthetics #nurseinjector #doctor, but you can find no evidence of them ever being registered with the GMC or NMC or any other professional regulator, or they are no longer registered.
- When you ask to see their medical director or supervisor, they are not available, or things start getting a bit shady.
- They don’t offer consultations.
- If they do offer consultations, they do not complete and full medical and facial assessment.
- If they do not allow you time ask question, they do not tell you risks and do not allow you to read and sign a consent form.
- If they are not going to be available for the two weeks after your treatment, or they cannot provide contact details for another practitioner e.g., Going on holiday.
- They can provide no evidence of complications training and do not have a healthcare professional on call to help them deal with complications.
- They do not have quick access to emergency drugs and do not have protocols to deal with emergencies.
- They have had 1-2 days training in injectables with no previous medical/nursing experience – a good practitioner will pay to shadow another experienced practitioner and have some mentoring sessions.
It is not the responsibility of other practitioners to fix the problems of our patients. This only happens if you are not qualified to deal with the results of your work, or the patients has lost trust in you for various reasons (for example, you haven’t listened, or you have dismissed their concerns).
It is not the responsibility of the NHS to fix the problems aesthetic practitioners create. The NHS and its’ staff are on their knees. Resources should be saved for patients with actual life limiting health problems. Unless our patients suffer from life threatening complications like anaphylaxis, we should not be burdening the NHS. It is ours and our patients’ responsibility to manage and pay for any undesirable effects.
Furthermore, healthcare professionals who are not trained in medical aesthetics will not have the knowledge or resources to deal with complications from aesthetic injectables. For example, in the case of a vascular occlusion that is affecting a patient’s vision, the practitioner should accompany the patient with their own emergency drugs to the ophthalmologist if they are not trained to deliver retrobulbar injections.
I want to end this by stating that I do not think that all beauty therapist aesthetic practitioners are bad at their job. Equally I do not believe that some medical/nursing aesthetic practitioners practice ethically and safely. I do not think the beauty therapist in this case is to blame for the following events. I do however blame training academies who do not prepare their trainees to deal with adverse events, and I do blame the government for not having regulations and standards in place that protect our patients from all of us (no matter our profession).
Advanced Nurse Practitioner– Independent prescriber – NMC registered – registered nurse – aesthetics – Harley trained – insured – wrinkles – dermal fillers – microneedling – skincare – Frinton – lips – cheeks – marionette lines – nasolabial folds – beauty – Walton on the Naze – Holland on Sea – Clacton – Clacton on Sea – Frinton-On-Sea – Colchester – Harwich – aesthetics – Frinton – fillers – Obagi – skin care – Mole checks – Cryotherapy – moles – skin tags – skin boosters