This article originally appeared on VICE UK
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.
Beauty therapists and aestheticians in the UK are failing to ask children their age before booking them in for lip fillers, a VICE investigation reveals today.
Figures released by the British Association of Aesthetic Plastic Surgeons (BAAPS) in 2017 revealed that 70 percent of 18 to 24-year-olds would consider having a cosmetic procedure. In the UK, there is no legal age limit for lip fillers, in which collagen or hyaluronic acid is injected into the lips to create volume and shape.
Medical professionals believe it is unethical to perform this procedure on anyone under the age of 18, and experts warn that it is damaging both physically and psychologically.
In practice, what is ethical or right in theory doesn't appear to come into the picture for many lip filler providers. Accompanied by 16-year-old actor Ellie Andrews, VICE went undercover and visited 20 beauticians in London and Essex over three days. We wanted to investigate how easy it was for a child to get booked in for the increasingly common procedure.
Shockingly, every single clinic we approached was prepared to book Ellie in for lip fillers without seeing an ID. Eighteen out of 20 clinics (90 percent) did not even ask how old she was at the time of booking. When Ellie said she did not have any identification on her at the two clinics that did query her age, they said she would need to bring it for the appointment itself and subsequently booked her in anyway.
Thirteen out of 20 providers (65 percent) didn’t bother asking Ellie to fill in a form with basic information like next of kin, local GP and home address – effectively making it an off-the-books procedure. Some even prepared the chair for her there and then, or gave her the hard sell – offering the nearest possible date, rushing over the details of the procedure and being overly positive about the potential results.
At one aesthetic clinic in Essex, a woman encouraged Ellie to interrogate her looks for any shortcomings that could be fixed through fillers. "Now, it's not to make you insecure, it's to make you understand things like asymmetry," the woman said, touching her own plumped lips. "You'll start noticing all sorts wrong. Really look at your lips between now and the injections, study them. You can change these things."
The same woman told Ellie that she would be able to inject 1ml of filler – twice the recommended starting dose.
My role was to act as Ellie's sister or older friend, to help Ellie negotiate leaving the building before making the deposit or being taken for the procedure. As we left the clinic, Ellie seemed dazed. "I didn't realise there was so much wrong with my lips," she said.
This turned out to be one of the better clinics we visited – the young women at a roadside tanning salon in Essex simply wrote Ellie’s name and phone number down and asked for her to come back in a few hours for a 1ml injection.
Notably, neither of the two Harley Street clinics we visited asked to see her ID – even though the London area is renowned for providing the best quality aesthetic procedures in the UK, and often the most expensive. It made no difference whether we visited a costly top-rated clinic or a visibly dirty hair salon with a woman doing fillers in a backroom: there was a visible lack of concern over the age of potential clients like Ellie.
The current Love Island look in the UK is a "post-racial" Kardashian-style face that works as a canvas – a contoured and plumped construction built to hold a full face of make-up. If you haven’t been blessed with the facial features necessary to pull off the look, a whole industry of "tweakments" has sprung up to fill the gap. But these procedures are intended for consenting adults – not teenagers and children.
Professor Ash Mosahebi, a plastic surgeon from BAAPS, told VICE there are physical side effects and psychological risks to performing these procedures on young people: "On the physical side, you haven't quite grown and matured. The facial structure is still changing and growing, and fillers might damage that growth. On the psychological [side], 16 is a very vulnerable time, and they need the level of maturity that they really know what they’re doing, and might do this for the wrong reasons.
"All things considered, it's really not a good idea. It’s definitely unethical to administer these to teenagers."
Mosahebi added that most of his colleagues who were members of BAAPS would never contemplate giving lip fillers to teenagers, and reiterates that the procedure was designed for older women whose lips have thinned with age.
Some clinics even refuse to administer fillers to anyone under 21. One Harley Street clinic warns on its website: "Due to the natural development of the face and muscles we have made the decision not to provide dermal or lip fillers to anyone below the age of 21."
Jackie Doyle-Price, Conservative MP for Thurrock, Essex and former Parliamentary Under Secretary for Mental Health, Inequalities and Suicide Prevention, was shocked by the results of the investigation.
"No treatment should be given unless the person receiving it fully understands the risk," she told VICE. "I am appalled that these practitioners have been negligent about establishing whether or not the person in front of them is an adult. Clearly we will have to change the law. At the very least we must have an age qualification. I want to make it illegal to administer fillers to anyone under 18."
She added: "You need to be 18 to get a tattoo or use a sun bed. We should do the same for lip fillers and other cosmetic procedures."
When I first met Ellie at Euston train station, I thought she looked her age in a way that the vast majority of teens now don't: no make-up, natural hair, clothes that existed outside of fast fashion and Instagram trends. She had the blank face of youth – and I mean that as a compliment. It made me shudder every time a practitioner or receptionist glanced at her and told her they could fit her in for filler that day.
Ellie told me that she hasn’t felt tempted to get lip fillers, but she knows of people in her year group who are considering it. "Fillers are something I see on girls every time I go on social media – they’re everywhere. I guess you don’t even know when you’re seeing them anymore," she said.
A boom in the market for beauty procedures has meant many providers now use aggressive marketing techniques and cut price deals to stay competitive. "It’s business as usual in the Wild West," BAAPS president Rajiv Grover commented in 2014, "and the message from the government is clear: roll up and feel free to have a stab."
Five years on, the rise of social media has made these problems even more pronounced. Mosahebi said: "Social media has encouraged younger people to do the procedure. Unfortunately now, we're seeing limited offers – 'Get this procedure and you can get this free' – [and clinics] rushing people in, doing it as quickly as possible."
You don’t have to be a trained medical professional to offer non-surgical cosmetic treatments like lip fillers, and the "tweakments" industry is currently unregulated. This means that many consumers fall for dodgy providers who carry out potentially dangerous treatments and offer little to no aftercare, and zero accountability.
"Since 2017 we have received over 20 reports of girls having lip fillers under 18, and 48 percent of all complications are reported by women aged 18 to 25," said Ashton Collins, the director of Save Face, a national register of accredited practitioners who provide non-surgical procedures. "Young women are amongst those most vulnerable to exploitation. They are prone to seek out a look that has been perpetuated by social media and reality TV, which often leads to them unwittingly falling into the wrong hands."
Doyle-Price added: "I am aware that some of the courses which train people in these procedures are less than adequate. Many people have been through these courses and have no idea that they are poorly trained. All practitioners should join an appropriate register so that consumers can be sure that they are getting appropriate treatment."
The lack of legislation around these procedures means that less qualified or knowledgeable beauty therapists are offering services that others would deem dangerous or unsafe. Though the recommended starting dose for lip fillers is 0.5ml, multiple salons volunteered to start Ellie on 1ml immediately.
"Besides the fact it looks unnatural, the complications of infections, forming lumps and lips becoming deformed increases the more filler goes in the first time," explained Professor Ash Mosahebi. "I also suspect that the places offering that amount don't stick to the strictest hygiene, so they're at a higher risk of infection. Nor might they have the expertise to do the job well, so that can cause complications, such as the filler going in an artery and travelling up to the eye, causing blindness."
On a few occasions, both Ellie and I left the salon with the impression that the receptionist was working on commission – they were far too eager to brush over preliminary details, keen to book her in ASAP and secure the deposit. "What’s your number, babe?" one asked, once we’d said what we wanted. After handing over her number, Ellie asked if a consultation was required. "Don’t think you need a consultation, just book in 0.5 [ml] or one, whatever you want," was the response.
Concerningly, the industry also operates on a largely freelance basis. That means that many providers work remotely and book clients in without even meeting them first. VICE visited an additional six salons that told us to confirm a time over the phone directly with the person administering the lip fillers. If a client has already paid up and booked themselves in, what are the chances that the therapist will check their age or suitability for the procedure when they turn up?
"It's hard to comprehend that there are treatment providers out there that are not even applying basic screening checks to ensure that the patients they are booking in are over 18," Collins said. "My fear is that when basic checks are not being carried out, what else is being overlooked? It seems that rather than assessing patients properly to determine whether they are suitable for treatment, a lot of these providers have a nonchalant, one-size-fits-all attitude that can lead to dangerous consequences."
Mosahebi agreed: "Clients should have medical history checked, making sure they don’t have any medical problems or allergies." The potential risks are immense – severe bruising, the possibility of going into anaphylactic shock, and even necrosis in the lip and lower face.
When asked for comment, the Department of Health said in a statement to VICE: "Anyone considering a cosmetic procedure should take the time to find a reputable, safe and qualified practitioner, and make sure they understand the impact of any treatment on their physical and mental health."
As we drove between London and Essex, we found people administering fillers out of hairdressing salons, gyms, leisure centres, dentists and Harley Street clinics, and even turned up to home addressed to find that people were running businesses in their living rooms.
So-called clinics were in rundown suburban areas and sandwiched between French restaurants and bakeries on yummy mummy high streets. Lip fillers are now so ubiquitous that they’re not even considered a medical intervention. While you're having them done, the person in the next room might be having their teeth extracted, or their hair blow-dried.
Social media is flooded with posts promoting treatments using hashtags like #loveislandlips and #KimKPackages, used to target young women and girls with cheap deals and packaged treatments. On Instagram and Facebook, anyone can brand themselves as a "clinic" or legitimate practitioner.
Save Face has supported multiple people who have suffered botched fillers after being fooled by a therapist's seemingly reputable profile on social media. "These posts are often made by people who have set themselves up as treatment providers without any relevant training and insurance, who often source cheap products over the internet with no idea of their safety or efficacy," said Ashton Collins.
With lip fillers widely normalised, it’s crucial that children aren’t able to casually access them. "Until all practitioners start identifying young and at-risk patients, and managing them responsibly, this issue will continue to escalate," she added. "These practitioners are negligent, unethical and they are fuelling a very serious issue by not having proper processes in place, not only to refuse treatment to under-18s, but to educate them about the risks and long-term issues that may be caused by having a cosmetic procedure at such a young age."
On one occasion, Ellie and I met a beautician who operated out of a gym in Essex. She didn’t ask Ellie’s age, and then handed her a pot of numbing cream, told her to smear it over her lips and come back in three hours for the injection.
We quickly made our excuses and left, numbing cream in hand. As Ellie and I walked across the gym's car park she laughed and asked the exact question I had on my mind: "Why are they letting me do this? I'm a child!"