People all over the UK undergo non-surgical treatments like fillers every year, but the industry operates almost completely unchecked. Fill Me In is a VICE UK editorial series in collaboration with Save Face, the national register of accredited aesthetic professionals, that aims to raise awareness of the dangers of unregulated procedures. Read all our stories here.
"Shall we start with the popping one?" Dr Tijion Esho asks his assistant Annice Ling, over the strains of Rihanna's "Wild Thoughts". This isn't how I thought my first trip to a Harley Street clinic would go.
Behind Esho – who is almost certainly the only doctor on the London row famed for its high-end plastic surgeons to play MTV Base on his consulting room flatscreen TV – is a framed Sunday Times Magazine cover. A facsimile Esho looks sternly across an ornate mahogany desk. "THE SELFIE DOCTOR WILL SEE YOU NOW," reads the cover.
Ling nods: the popping one it is.
I’m spending an afternoon with Esho to see up close – probably a little closer than I'd like, if I'm honest – the cost of the UK's addiction to cosmetic fillers. According to a 2018 report from Save Face, the UK's register of accredited non-surgical practitioners, 939 consumers complained about dodgy cosmetic procedures last year. To make matters worse, a VICE investigation found that 90 percent of clinics in London and Essex didn't even check the age of a 16-year-old posing as a potential client, meaning children could be exposed to this dodgy handiwork.
Some of those with botched fillers will eventually find themselves in Esho's chair as he attempts to fix other practitioners' poor craftsmanship. Not every case is salvageable. Earlier this week, Esho saw a woman who'd had silicone injected into her lips. "I had to tell her that we cannot remove this," he tells me. "It’s permanent. The only way to get rid of it would be surgical removal… and that would leave the lip more disfigured than with the product in."
A medical doctor by training – although he no longer practices as a GP – Esho strongly believes that only doctors should be able to perform non-surgical interventions like fillers. "It's a medical speciality," he says. "It's a medical treatment that has adverse effects that can only be managed by medical people."
I tell him I've seen many providers claiming qualifications in advanced aesthetics. He dismisses them: "Aesthetic training is lip service. I could watch my mechanic fix my car tomorrow. Does that mean you’re going to bring your car into me for a service?"
Unlike doctors, who spend years in training, aesthetic technicians have sometimes only been on courses lasting a few hours. "With social media, everything is smoke and mirrors," warns Esho. "You can land on a page, see someone dressed up in scrubs, read the words 'advanced practitioner' and think they’re the best person. But these people don't know how to deal with complications… Could I teach you how to manage a patient in anaphylactic shock? No."
The door opens, and in walks the popping case. Twenty-six-year-old Catherine, whose surname we have withheld for privacy reasons, is a nursery school teacher from London. In stout walking boots and with a timid disposition, she's not your usual Love Island type.
What drove her to get fillers? She says she wasn’t happy with the outline of her top lip – her gums would show when she smiled. "I should have been happy with what I had," she sighs.
A friend of her mum worked in a clinic in Harley Street, so she came around with a needle and a dermal filler called Teosyal Kiss. Even as she was being injected, Catherine knew something was wrong. "It was so painful," she says.
Catherine’s lips are visibly disfigured. Lumps of filler the size of pomegranate seeds are bobbled under the skin. But mostly, Catherine's not so worried about how her lips look – it’s more that she wants them to stop hurting: "I'm just hoping it’s not going to be painful any more."
"All right, lovely," says Esho, brandishing an enormous needle. "Let’s start." He’s not able to use anaesthetic for the first part of the procedure, as it will cause Catherine’s lips to swell, limiting his visibility. So he goes in without pain relief, literally popping globules of filler with a needle, before squeezing it out of her lips.
I get in close; it looks like he’s working the guts out of a dead jellyfish. A Chris Brown song starts to play on the speakers. "Oh god," I say. Esho asks me if I’m going to faint.
After the first stage is over, Esho injects the smaller lumps with hyaluronidase, an enzyme used to dissolve dermal fillers. The whole procedure takes about 20 minutes, and when Catherine leaves her lips are looking noticeably more normal. As we wait for the next patient, Esho tells me about his patient list. "I'm seeing more and more botched cases," he says. "Probably a third of my list are corrective cases, every day."
His phone buzzes. It’s a message from a prospective patient who’s emailed a selfie to Esho’s team – she’s concerned her non-surgical nose job has gone wrong. Esho is instantly alarmed: the tip of her nose has gone white, a tell-tale sign she has necrosis. The skin on her nose is literally dying.
Esho tries to call her, but she’s not answering her phone. "She needs to go to A&E immediately," he says, texting her. Could she lose her nose? "100 percent. It is dying now."
Lavinia Talhos, 29, is next to walk into the consulting room.
Talhos works in recruitment, and had her lips injected with Juvederm, another brand of dermal filler, at a Harley Street clinic three-and-a-half years ago. This is unusual – most of Esho’s cases had their fillers done by unlicensed practitioners, often at home. Her lip isn’t bumpy like Catherine’s. Instead, there's a wide, flat plane on the upper-right hand side, like there's a hard tube beneath the skin.
"People ask me if I've had my lips done, and I say, 'Yes, years ago, but I'm not happy with them,'" Talhos says. Esho injects the tube of Juvederm with hyaluronidase, and massages it out. It looks painful, but Talhos bears up well.
Despite it all, the experience hasn’t put Talhos off fillers for life. "I would get them done again," she says, "but only with Dr Esho."
As I bid Esho farewell, it strikes me that he might be one of the only people doing well out of the UK's addiction to unregulated fillers. Esho charges £300 per corrective case and he normally sees about five people a day. (The two patients I met weren't charged as part of his charitable pro-bono work.) But I think he’d much rather he wasn’t having to fix other people’s botched handiwork; Esho seems genuinely anxious about the girl with necrosis, and keeps trying to contact her, even as I’m leaving.
After our interview, I get in touch with Esho via Twitter to find out what happened to her. She’s in hospital, undergoing hyperbaric oxygen therapy to limit the damage to her nose. Will they save her nose, I ask? "I hope so," he replies. "But touch and go."
If you have been affected by any of the issues raised in this piece, please visit Save Face, email firstname.lastname@example.org or phone their hotline for advice on 01495 239261.
UPDATE 24/09/19: An earlier version of this article stated that Dr Esho charged the two clients quoted in this piece, when in fact he conducted the procedures pro bono. The article has been updated to reflect this.