Facial aesthetic treatments now form part of a maintenance routine for many of us, and whilst these treatments are not for everyone, when performed properly and in an appropriate way, can bring a real positivity and improvement in self-confidence and well-being.
Whether you want just to soften some fine frown lines that have developed, gently volumize your lips, or feel your more in need of an overall freshening up, you are not alone. The medical aesthetic business in the UK is valued at 1.2 billion, and without doubt the two most popular treatments are Botox ™ and HA (Hyaluronic Acid) Dermal fillers.
This blog is predominantly directed at those seeking Botox and filler procedures, however, the advice provided is applicable to most types of aesthetic treatments.
I speak as an experienced practitioner and describe how, with my knowledge, I would approach the task of finding an aesthetic practitioner. I’ve compiled my list of top tips and provided a complications list.
So, after months, if not years, of debating the issue and trying all the latest creams and lotions, you’ve made the decision to have something done, so where do you go now? Search engines, social media, ask a friend?
When you first embark on this journey it can seem a little overwhelming with the sheer volume of places and practitioners that offer these services. There is no doubt the industry is swamped with competition. So how do you make the decision? This post will hopefully guide you in the right direction, and get you asking the right questions.
Firstly, it must be remembered, however trivialised or normalised these procedures are, they are still medical procedures and should only be performed by General Nurses, Doctors and Dentists. There are also advanced Pharmacists able to offer some procedures as well. Those performing the procedures should have a detailed knowledge of facial anatomy or at least detailed knowledge of the area they are treating.
So How Do You Go About Finding an Aesthetic Practitioner?
There is no doubt recommendations and word of mouth is one of the main ways people find aesthetic practitioners. If your fortunate to have an open relationship with friends or family about this subject and you like the results that they have been achieving, then this is a great way to go. However, these procedures are generally still quite a private affair and some people like to have a degree of discretion. Moreover, a fear of looking overdone, or false, is often the biggest concern of those yet to venture into this world. Besides word of mouth, there are predominantly two ways in which people search for any service, Search engines and social media; medical aesthetics is no different.
Although there is an obvious overlap, undoubtedly, a generational divide exists as to how we perform these searches.
Typically, the 18-35 age group will use Instagram, those 35 and over will use Facebook and Google search engine. By far the most popular and powerful social media tool is Instagram. Kylie Jenner has built up an estimated one-billion-dollar business selling makeup on the back of her millions of insta followers.
As a visual tool it is extremely useful to be able to see the types of procedures that can be performed and the results that can be achieved. It can also be an extremely effective marketing platform; however, you should not always trust what you see.
Accounts are easy to set up and have very little rules or regulations. Images can be reused from other posts or edited to make them look more aesthetically pleasing. Followers can also be bought to increase numbers, as can social media influencers (those who already have lots of followers).
Questions to ask include;
Do they have a website link from the account?
Who is the practitioner performing the procedure and will it be that person you see?
Have a critical look at the before and after images and the environment?
Do they sound professional and knowledgeable in their posts?
How long has the account been open?
Facebook is also another great way to promote services. Again, these accounts are free to set up and a more professional provider will have a specific Business page rather than using a personal account. Although it can be a lot more work to set up, FB does provide a platform to highlight a detailed overview and provide a community following but is less intuitive than insta which can provide an easy to see way of promoting the latest deal or treatment.
I would say if a provider has both insta and Facebook accounts and they look professional and well put together then this reflects on the practitioner or company providing the treatment.
Both platforms also offer a great way to advertise and you may even see pop ups on your social feeds after you navigate away. However, due to nature of platforms, rogue practitioners can easily close accounts and set up fresh ones if negative reviews are posted.
Websites without doubt offer the practitioner the greatest way of showcasing their services and for some clients, this is often the shop window they look through before making direct contact. A website requires the most work, money and effort to set up, so due to the ease of social media, lots of practitioners, particularly those just starting out will often not bother until they are more established.
The layout of websites for aesthetics services are often difficult to navigate around and may be part of a general website such as that of a dental or medical practice. They may also be word heavy (this is for SEO purposes). The two pages people generally look at are the treatments area and prices pages, so I advise to spend a little time looking around the website and try to get a feel of it.
When internet browsing, searches such as ‘Botox near me’ or ‘fillers near me’ will often list many providers. Like lots of searches we are inherently lazy and tend just to focus on page one of our search. Companies or individuals spending the most on a marketing budget are most likely to show up first on this page, so do spend the time to look through a few extra pages beyond page one
Do websites and social media accounts discuss the practitioners background? Although this may seem like showboating, it is important to gain an idea of the practitioners experience as well as qualifications. This leads us on to our next section;
In the aesthetic industry in the UK, there are TWO very important issues to be aware of;
The first is;
A lack of regulation;
Without doubt the main issue in the non-surgical aesthetic arena is a lack of regulation. The biggest culprit for this are Facial Fillers, with lip fillers, cheek fillers and jawline fillers all being hugely popular. Shockingly, absolutely any person could attend a training course, gain a certificate, buy stock and start offering these treatments. There are some restrictions put in place by reputable training providers, pharmacies and insurers whom request medical qualifications, but there are also a number who don’t.
We had a client at one of my aesthetic clinics only last week who told a story of her friend whom had been in HR for 10 years and decided on a career change. This person did some research and paid £4000 to go on an aesthetics masterclass and has set up her own clinic!
This isn’t to say that someone without medical qualifications or knowledge couldn’t learn to undertake these procedures and become proficient at them. However, the issue is that in order to perform a medical procedure, the provider must be at an appropriate educational level to be eligible. As an example, you can’t undertake a degree without having the prerequisite A levels or GSCE’s. A medical qualification, attained by Doctors, Dentists and Nurses, allows them the privilege to be able to train and provide medical aesthetic procedures. These degrees take many years of hard work and dedication to attain. They are also inter related to medical aesthetics and many of the skills used in these professions are transferable, as too are complications management and medical emergencies.
This puts great importance in due diligence and doing your research to make sure the practitioner your trusting has the prerequisite medical qualifications and is not a beauty therapist or someone who used to be in HR!
Now you’ve found someone who is medically qualified. Everything sorted? Unfortunately, all practitioners are not the same! This leads on to the second consideration;
A lack of experience
Just because someone is a nurse, dentist or a doctor, doesn’t mean that they are automatically the best injector around. They may be awful, have no artistic eye and be quite clumsy with the treatments. Also, do not assume because someone is a Doctor rather than a nurse, they are a better injector.
When I started out in aesthetics around 15 years ago, I used to shadow a nurse, for experience, and she was wonderful, one of the best injectors I have seen. She was ahead of her time and was extremely generous with her advice.
Several years ago, I was on a weekend training course for PDO thread lifts and one of the delegates was a dermatologist, whom is a medical doctor that has specialised in skin care. He was so clumsy that he pierced the model’s cheek on several occasions and was told off by the trainer. Certainly not someone I would be comfortable having treatment with.
Its important to remember, many training courses, for medical aesthetic procedures, are generally only one or two days. It is then down to the practitioner to gain experience, typically on family and friends, to develop and learn the procedures.
There are now an increasing number of courses that offer more in-depth, advanced training and support, such as what are called Level 7, or a master’s course in aesthetic medicine. These do offer far more hands-on experience for the provider and certainly more in-depth knowledge is gained.
Again, this doesn’t guarantee proficiency. You need someone with the correct blend of medical knowledge, have artistic eye and be comfortable with injectable procedures. This only comes with experience, particularly in the treatment you are considering. For example, a practitioner may be the best at Botox treatments but has only just started performing cheek augmentations. So, ask about their experience with the procedure your seeking to have, or which has been recommended.
Overall this can seem a lot to take on board so to help in this journey I’ve compiled a list of the most important points be aware of
Below are my top tips for finding your most suitable aesthetic practitioner;
-MEDICAL QUALIFICATIONS; What is their profession and are they registered. Look at the register; GMC for Doctors, GDC for Dentists, NMC for Nurses or Pharmacy regulations for pharmacists; just run an online query and type in the name, its free, quick and simple to use.
Do they have any advanced qualifications or society memberships related to medical aesthetics? This again will indicate professionalism.
-EXPERIENCE WITH THE PROCEDURE; if you’re having your lips treated, how many lips have they treated and for how long have they been practising. Do they have before and after photographs. You don’t want to be one of the first few patients they have performed the procedure on unless you’ve been informed and are confident with the practitioner.
-PRODUCTS AND/OR EQUIPMENT USED. Particularly with fillers, there are an awful lot of products on the market now. If you want to be safe, then consider fillers that have FDA approval. Some practitioners would have been trained with one brand so haven’t used other products that may be more appropriate.
FDA Approved List at the time of writing are;
Teosyal RHA range
Other fillers that have are well established include;
CLINIC SETTING; Botox parties and treatment in someone’s living room are becoming a thing of the past. A clean, safe and appropriate environment with a clinical waste and sharps bin should be an absolute minimal requirement.
COST; It’s an old adage, but if something seems too good to be true, it probably is. Don’t be tempted by ultra-cheap products. Particularly fillers, check the filler list above, make sure you see the filler box being opened, there are many unscrupulous practitioners that will re-use filler syringes on different clients.
You also need to factor in the experience of the practitioner and clinic location, particularly if it’s a high-end clinic, as costs will usually be higher.
VOLUNTARY REGULATORY ORGANISATIONS; These provide a checklist of criteria required to become an approved practitioner or clinic. So are an excellent ‘also have’. Save Face, JCCP, and Treatments You Can Trust, are among some of the better-known groups. These are not compulsory so many practitioners or clinics, and some of the best injectors around aren’t necessarily registered but it does show that the clinic or practitioner are proficient.
GUT FEELING; do not feel pushed into having treatment, if something doesn’t feel right or your uncomfortable with the procedure, don’t be afraid to walk away. You’re in control so calmly say you would like more time to think about it. Any practitioner worth their salt should be happy with patients taking their time if they’re unsure. I would much prefer a patient return for a treatment once they have had time to reflect, rather than rush into a procedure, they are unsure or uncomfortable about.
I would also start my journey with more routine treatments, say just one area of Botox. To gain perspective and have an idea of what the treatment feels like. I always say to my clients, “You may decide that the treatment is not for you, so you’ll have the reassurance that once the product wears off, you’ll be the same as you were before; however, most people love the effects”!
What If Things Go Wrong?
It’s important to remember the difference between what should be expected or is normal after treatment and what is classed as a complication.
What I always advise my patients to expect with each treatment session is;
Even in the most skilled hands any of these events could occur. They are generally injection related rather than product related. This means just the act of injecting into the skin could cause these events.
Also, just because they don’t occur with previous treatment sessions does not mean that they will never occur. Conversely, if they were to happen it doesn’t mean that they will occur with future sessions. They effects are generally short lived and will resolve quickly.
Product related side effects or complications can include;
Overcorrection; too much product placed or placed in the wrong place. Thankfully, practitioners have at their disposal a product that can dissolve fillers away. It is essential, in my opinion it should be compulsory, that all practitioners performing HA dermal Filler treatments are proficient in the use of the Hyaluronidase and are able to dissolve filler away. The importance of this is highlighted further down.
Swelling; This event could have a separate section all too its self. There are the obvious cases we see in the press of girls having their lips treated and having a severe reaction with severe swelling. This, although thankfully extremely rare, could occur with any lip treatment. It is usually due to an immune response to filler, an allergic reaction. The lips have lots of blood vessels which ‘leak’ causing the swelling. Management is usually a short course of oral steroids and dissolving the filler away.
Another area that is always more prone to swelling is the tear trough area under the eye. It should be remembered that fillers will always attract water so can be prone to this
Lumps; medically know as nodules. These are typically a result of the body effectively sealing off filler. There are classifications of nodules, but these are beyond the scope of this discussion
Infection; Any procedure that breaks through the surface of the skin could result in infection. The skin surface is host to a wide range of bacteria and if these migrate under the skin via an injection then there is the potential for infection. The highlights the importance of the practitioners having excellent cross infection control and making sure the skin surface has been thoroughly cleansed and disinfected as much as possible before, during and after the procedure. Sometimes antibiotics are needed to treat this, occasionally the product may need dissolving away.
Scarring; medically known as necrosis; Probably the most relevant complication to be made aware of. It is caused by either compression or blockage of a major artery in the face with filler product. This in turn reduces the blood flow and oxygen to an area of skin or tissue and result in scab formation or scarring. This usually happens fairly quickly, within a few seconds, and gives a tell tale appearance. In the unlikely event this were to occur, your practitioner should have protocols in place, including the ability to dissolve the filler away. Usually just bruising will then be left which can take upto a week or so to clear.
Blindness; YES BLINDNESS. This would have many people running for the hills. Again, I must emphasize this is an extremely rare complication. Millions of filler treatments are performed in the world each year and thankfully there have only been a handful of cases reported in the world. However, this is probably the most significant reason to search for someone that is medically qualified and knows facial anatomy.
Eyelid Ptosis; drooping upper eyelid. This can range from a feeling of heaviness when placing eyeliner on to a partial closure of the upper eyelid. Its important to be aware as to why this occurs. Botoxtm is a muscle relaxant, so it weakens muscle contraction. There is a muscle that is responsible for lifting the upper eyelid that is near the treatments area for frown lines. If product migrates to affect this muscle it will do the same, relax it and cause it to droop. This complication almost exclusively only seems to affect one side and is likely to persist for as long as the effect of the product, possibly up to three months. Eyedrops can be provided that help lift the lid back up and do certainly help.
I have performed thousands of muscle relaxant treatments over my career, and thankfully, this rarely happens, but that’s not to say that it could never happen.
This is an example of the wrong muscle being affected. Botox, although only licensed for three areas of the upper face, is often used on the lower face, to help lift or tighten different muscles. If the wrong muscle is inadvertently affected then this may result in, most likely, a smile asymmetry
Brow Ptosis; drooping brow, this always sounds horrendous. It is usually more of a feeling of heaviness of the brow and can vary in severity. Strangely this can be corrected with further Botox
Too much product; The frozen look! This is often a contentious issue between myself and my patients. My ideal patient is the one who want s just a softening, a relaxation of the muscles. I want to soften not paralyze the muscles
New patients without doubt will often want a softer look with some degree of movement. Those more accustomed to treatments will often request the frozen look, ‘I don’t want any movement at all’, they tell me!’ Ultimately, within reason, it is my job to make my patients happy. If they request a certain look and they are aware of my feelings, then I will often accommodate their request. Obviously, there are situations were treatment is inappropriate and I have turned people away or refused to add more, but usually the patient get what they want!
On a more serious and important footnote to this is the introduction of mental health screening that has been recommended by NHS England and the JCCP, to try and protect the physiologically vulnerable. Particularly those that exhibit characteristics of BDD (Body Dismorphic Disorder). Individuals thought to be demonstrating these characteristics should be signposted to near by NHS Mental health services.
The most relevant complications don’t necessarily mean the most common.
There has been a change on medical law regarding disclosure. What is called the Montgomery law. This basically means that all medical aesthetic practitioners should disclose side effects that are most relevant to that person or ‘a reasonable person in the patient’s position would attach significance’.
I am often amazed when new clients come to see me who have been receiving Botox and filler treatments for many years that have never had a conversation with a previous practitioner regarding potential complications. I think this is hugely unethical, an essential part of the consultation and would place them in an extremely vulnerable position should a complaint arise.
Although not really a complication, another relevant point is dissatisfaction of treatment outcome. This could be either the practioner has overpromised an outcome or your expectations as a patient are too high. It is important to remember as good as these tresmetns can be, they are not surgery. However, if an outcome has not been achieved it should be possible to discuss your feelings with the practitioner, and what could be done to improve. This could simply be having more treatment in a particular area.
Whatever the concern, it imperative you talk with the providing prationer first, they will know what product is used and were it was used. Id advise always to take photographs of the area yourself. Your practioner should always take pre-treatment photographs as part of there assessment. It is certainly true that sometimes, what we perceive as a problem was already present.
So why do we even consider these treatments when presented with this list of possible complications and side effects. That’s because they are relatively rare. If treatment is provided by an experienced practitioner with a medical background and knowledge of the procedure, potential complications and their management, then the chances of them occurring can be greatly reduced if not eliminated.
Moreover, the treatments are relatively quick, can have minimal downtime and the results achieved can be wonderful and bring about improved self-esteem.
I hope the advice provided has been of some help. If you decide to go on this journey and need any advice or guidance along the way, then please feel free to send me an email or message or even give the clinic a call. We are always happy to help,