“OK, sharp scratch, you’re doing really well Nemo, well done.”

I was lying down in a clinic room in Islington with my eyes tightly shut, my right hand squeezing a very thoughtfully placed massage ball, as Sieu Ming precisely injected my lips with just under 1ml of lip filler. She had already coated my lips with a local anaesthetic gel, so although occasionally grimacing, I was fairly tolerant. Sieu Ming is a Maxillofacial Surgeon, which means she is both medically and dentally trained. She possesses the kind of surgical precision that fills you with umpteen confidence. Thirty minutes later, I was at James Cochran’s 1961, slurping spoonfuls of mussels doused in a south Indian spiced sauce, every so often catching my reflection in the side mirror. Is that Priyanka Chopra or is that Nemo Singh? 

Lip fillers seem to be all the rage these days. In August the Sun published an article in response to a TikTok video posted by Daniella, a thirty something year old woman who had undergone 0.5ml lip filler and was visibly upset; warning others not to get filler unless they were sure. Well at first thought, yes that is fair advice actually. And probably worth delving into, given that the Sun has an estimated 32.8 million readers. According to the Sun. Just saying. 

Lip filler is composed of hyaluronic acid, a compound present naturally in the human body and used as a viscous fluid in order to improve the shape and volume of the lips. This is surgical art in itself and is deemed far trickier a procedure than botox injections. Dr Elizabeth Wick is a plastic surgeon at the University of Miami has written extensively on the science behind fillers, and whilst research is still being carried out, there is wide choice available on the type of filler used as well as its application. 

But was Daniella’s experience normal? In the video, Daniella posts a selection of post procedure photos, reporting multiple bumps in her lips, as well as a sensation of “feeling” filler in her lip.  Dr Wick estimates lip filler complications can be anything up to 5%. Clearly this is multifactorial and depends not only on the customer, but the type of filler used and more the experience of the aesthetic practitioner carrying out the procedure. She cites the most common adverse reactions are to all to be expected and are classified as injection site reactions: bruising, redness, pain, swelling and itching: minor complications that should settle within a week. 

On the other hand, there are some early occurring events that are far more serious and include immediate hypersensitivity which can lead to anaphylactic shock. Tissue necrosis can also occur when filler is inappropriately injected into an artery, thereby blocking blood supply to lip tissue and causing tissue to die and a disproportionate amount of pain. These are medical emergencies that require prompt treatment with hot compress, massage and a reversal agent, and in rare cases, emergency services. Dr Wick emphasises the importance of the practitioner being able to recognise this and thereby treat accordingly. Interestingly, granulomas (bumps in the skin) can develop up to 24 months after, and often depend on the viscosity of the material used.  These are now relatively rare as products are now tested thoroughly. Cheaper products, however, are not. 

An experienced practitioner is clearly paramount. Bumps under the skin like Daniella experienced are usually minimised by careful but firm massage at the time of the procedure. Late onset complications such as filler migration, meaning the movement of filler that isn’t reabsorbed by the body can occur when too much filler is used to begin with. This is avoided by slowly increasing the volume of the lips over several visits. 

At present there is a fairly diverse provider group outside clinically trained staff like doctors, dentists and nurses and this includes (respectfully) beauty therapists. But things are changing. In March 2022, under the a newly proposed amendment to the Health and Care Bill, the government intends to introduce a legislation in England, where anyone who carries out injectable treatments must hold a licence. Whilst it will be some time to fully compile an agreed licensing accreditation, this is a good public health move that protects both practitioners and customers.

But back to Daniella. Would looking at her video on TikTok put you off? In her video I see a woman who is upset about complications that are both expected and relatively quick to recover from. These should have been explained clearly to her before and also afterwards. Open communication and a post procedure SOS plan, including contact details for advice, should be a fundamental part of the procedure and goes hand-in-hand with excellent surgical technique by an experienced and well trained practitioner.

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