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When lip fillers go wrong!

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.

Red flags:

  • 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).

Helen Western

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

Lets talk about ‘Pillow Face’!

I love hyaluronic acid dermal fillers, and a modest amount expert placed in one’s face can have a beautiful and rejuvenating effect. What I don’t like is our obsession with trying to look like we did in our 20’s.

This distraction with youth often leads patients and practitioners to keep filling and filling, trying to chase the unobtainable. We have all seen those faces. The ones that are filled to max capacity. They look unnatural and almost disfigured. Now I’m not saying that adding a bit of oomph to your natural features is a bad thing. We just need to know when to stop.

Dermal fillers essentially fill a pocket of tissue to create lift and volume. It seems obvious then that if you keep filling the pocket it will become overstretched and you’re going to lose some. Yes, I said it! The filler will start to spread to places you hadn’t intended it to be. So, lets break down what contributes to pillow face. Starting at the top.

Forehead

Your forehead is covered in very thin layers of tissue, with slight concavity at the temples and gentle angles from the hair line to brow. In this area dermal filler can be used to smooth wrinkles and revolumise the temples. Because we are working with such a small space even a small amount of overfill can result in the loss of natural angles and rounded temples. Whilst the difference may be subtle, that fact that is very slightly odd-looking changes your overall appearance.

Nose

The angle from the forehead to the nose (nasofrontal angle) is an area the is most often filled when patients are hoping to achieve a straight, Eurocentric appearance with dermal fillers. It is very commonly overfilled, taking away that natural angle, creating instead and high and broad angle that quite frankly looks strange.

Cheeks

Cheeks can contribute to pillow face in 2 ways. 1. Overfilling the lateral aspect of the cheeks can create a ledge that throws out the balance of the face. We all want cheek bones and contour, but don’t need to look like Maleficent to get there. 2. As we age the apples of our cheeks flatten out and adding a bit of filler creates a feminine youthful look. It goes wrong when we keep filling. Again, the pockets have limited space so instead of creating definition we end up creating chub.

 Jaw and chin

So, we’re trying to create soft angles, but when we get to the jaw we want a razor sharp line? Don’t get me wrong, I think jaw revolumisation for older patients is transformative. But adding bulk to this area gives me Desperate Dan vibes and means the chin disappears somewhat.  In this case, instead of adding modest volume to the chin to create balance, we need to add much more, creating the typical witches chin that seems popular at the moment.

Honorable mention … Lips

The space in which your lips are housed is very small so when we overfill them the product needs to go somewhere (Russian lips, I’m looking at you!). Over time little bits of filler leak into the surrounding tissue. You may not notice it for a couple of years, but it’s happening. Then all of the sudden you notice that you no longer have lips, but a mound of tissue and dermal filler that starts under your nose.

What can we do to keep looking good without pillow face?

There are options.

1. Don’t do anything. You’re ageing and embracing this is healthy and empowering.

2. Use effective skincare recommended by your practitioner consistently. Healthy glowing skin is the cornerstone of aesthetics and is beautiful whether you have wrinkles or not.

3. Go to practitioner who believes in moderation and can skilfully place small amounts of dermal filler for maximum effect.

4. Consider consulting a plastic surgeon with a good reputation who specialises in natural looking facial surgery.

Whatever you decide to do with your face remember that any plan you embark on should be about self-love and not loathing. If you hate your appearance or are preoccupied by your features it is worth exploring this with a counsellor or therapist, as these are issues that cannot be resolved under the needle.

AND wear your bloody sun protection!

Disclaimer: No hate to those whose desired aesthetic is ‘pillow face’.

Helen Western

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

Why I hate ‘Trending’ aesthetic treatments.

Every year there seems to be a new ‘trending’ treatment, boosted by “influencers” and Instagram models. If you lurk like me, you would have noticed trends for tear trough fillers, liquid rhinoplasty and more recently the ‘fox eye’ thread treatment.

My colleagues in aesthetics and I experience high demand for these treatments which then seem to wane off when the realities of the treatments come to light, or the next trend enters the arena. Indeed, you will see some clinics really focusing their advertising on pushing the sale of trending treatments.

Whilst there is nothing really wrong with these treatments (indeed in the right hands they can be very successful), the high demand means that people with limited experience or expertise treat a lot of patients who are not appropriate candidates, or the practitioners just don’t have the skills to carry out procedures well.

In every ethical clinic we first consider if the patient is the right candidate. We then consider if the treatment is the right treatment to achieve what we want. Then we need to pick the correct products. I also consider ‘is it worth it?’. Is the potential improvement worth the risks if something going wrong? Does the longevity of the effect justify the financial cost of the treatment? Is there another cosmetic or surgical treatment that would be better?

I personally like to watch and wait when new trends make it to Instagram. I like to listen to clinician’s experiences and read case studies. I then observe the emergence of adverse events and undesirable results relating to these treatments.

For example, many people will not see a significant improvement with tear trough fillers. Too often patients are left with swelling under the eye that stays for the entirety of the fillers life. There is only one product in the UK that is licenced for tear troughs, so many practitioners substitute with what they have got. Complex structures around the eye means that it is all to easy to place the fillers in the wrong space unless you are guided by ultrasound.

And don’t get me started on the risk of vascular occlusion with non-surgical rhinoplasty. Yes, it is a great treatment done well, but demand amongst my patient group is low and it is not something I wish to be pushing towards a younger audience when saving for surgical rhinoplasty may be better.

Similarly, the fox eye trend is commonly marketed to younger patients, but I fear that the scar tissue created in the delicate periocular area Vs the length of efficacy and reports of dissatisfaction amongst patients means the risk far outweigh the benefits. Indeed, a surgical eye lift may be much better for patients who may benefit.

Fortunately, some new trends veer towards the natural appearance and skincare is becoming more popular and effective. By simply adding a good vitamin C serum, Retin A and SPF 50 to your daily routine you will help your skin to glow and protect it from the environment. Investing in peels and microneedling is also a great way to start resurfacing the skin and induce collagen production.

To round up this rambling blog, my purpose has never been to alter my patient’s appearance so that they fit in with current trends or look like a cast member of TOWIE. It has always been to rebalance, create facial harmony and rejuvenate the appearance of my patients so that they can have a moment to practice self-care and improve their confidence.

Disclaimer: This is my personal and professional opinion. If you are reading this and your aesthetic is the TOWIE look or you make people look like this, more power to you. You do YOU! These trends are just not for me or my patient group.

Helen x

Helen Western

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

It’s almost time!

Ready for the relaunch!

Hi there,

Thank you for all your support over the last year. Your custom has meant that I can upgrade the clinic and give you the surroundings you truly deserve.

When we reopen it will be in The Mews Therapy rooms on Connaught Avenue. The space is looking beautiful, and apart from a couple of tweaks, it is ready for me to move in.

There is parking out front or to the rear of the building, and we are close to all the amenities. When you enter the building you can take a seat outside of my room until I grab you.

I would really love your feedback about the new environment and the service so please don’t be shy and let me know. Also your Google reviews are very much appreciated as this is helping the business grow.

Keep an eye on my social media for more information, and as ever, I am so looking forward to welcoming you.

Best wishes,

Helen

Happy Face Aesthetics

The Mews Therapy Rooms, 118/120 Connaught Mews, Connaught Avenue, Frinton-on-Sea, CO13 9AD

07984 184180

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 – aesthetics – Frinton – fillers – Obagi – skin care

Vitamin C: a true skin hero

Vitamin C, or L-ascorbic acid is a powerful antioxidant that neutralises harmful free radicals. It also inhibits tyrosinase which catalyses the production of melanin. This means that it protects the skin from being damaged by environmental pollutants and has the power to improve and prevent mild to moderate hyperpigmentation.


This skincare hero aids your skins natural regeneration, repairs damaged skin cells and may protect the skin from precancerous changes caused by UV. On top of this, because of vitamin C’s acidic qualities it triggers the production of collagen and elastin within the skin matrix.

Using it in the form of a pure serum gives better results than creams or lotions because it less likely to be contaminated or neutralised and can pass through the skin’s barrier more easily. When you buy your vitamin C serum it should come packaged in a dark glass vial to stop light and air neutralising it.


Vitamin C is available in different strengths from 5% to 20%. As a general rule of thumb for most people it is advisable to titrate the strength of your serum, so that your skin can become accustomed to this powerful product. If you’re prone to breakouts a weaker concentration is better as stronger doses may worsen your acne. If you have any redness or allergy you may need to discontinue use, but please consult your skincare practitioner for ongoing management.

Skincare regimes can be confusing, but with a little knowledge you can add this fantastic product to your regime easily. Here is my basic skincare regime for those of you not on treatment plans.


AM: Gentle cleansing wash > Toner > Vitamin C > Moisturiser > SPF 30-50

PM: Gentle cleansing wash > Toner > Vitamin A > moisturiser

NEVER use Vitamin C and Vitamin A at the same time as the products interact and can cause skin irritation at worst. At best, they just won’t work.

My favourite Vitamin C serums are the Obagi Professional-C range, which come in concentrations of 10% to 20%. This is such a potent range that you only need 4-6 drops to massage into your face and neck.

Benefits of Vitamin C:
– Improves uneven texture and colour
– Improves acne scarring
– Improves fine lines and wrinkles
– Improves dullness
– Reduces and prevents hyperpigmentation
– Can prevent precancerous changes
– Repairs damaged skin cells
– Triggers collagen and elastin production

Just like my SPF, I never go a day with out my Obagi Professional-C 20%.