By the dry, professional standards of a medical conference, one recent query produced a jaw-dropping response: Have you seen patients who’ve done their own injectables at home? When the question was posed at conferences in the U.S. and abroad, almost every hand in the room went up. “We’re talking 50, 60 doctors at the first, and hundreds at an international conference,” says Theda Kontis, MD, FACS, the double board-certified facial plastic and reconstructive surgeon who conducted the informal poll. (Kontis is also past president of the American Academy of Facial Plastic and Reconstructive Surgery or AAFPRS.) “There’s many people out there injecting themselves.”
You could call it the seedy underbelly of aesthetic medicine—unknown brands selling god knows what in syringes to any old customer online. It’s something Dr. Kontis got wind of last fall, after a colleague asked her to help treat an emergency room patient who had attempted at-home lip filler. “She’d been injecting herself for years, and just gotten into trouble," says Dr. Kontis, explaining that the patient’s needle had hit the “main artery for the lip—it pulled blood supply, so she could have potentially lost the lip.”
Multiple visits for hyaluronidase (an injectable that dissolves hyaluronic acid filler) saved the lip, and the patient shared that she’d been buying filler online. “This was my ‘oh my god’ moment—I went online and you could buy anything. Neurotoxins with weird trade names, stuff I’d never heard of, not the usual protocol” says Dr. Kontis. “The scary thing about that is, What are these products? Where are they coming from? Are the fillers really hyaluronic acid? Are they sterile? People shouldn’t be doing this. It is extremely dangerous.”
Dr. Kontis notified the FDA. “I reached out and said these products are everywhere, and people are autoinjecting,” she says. Though Dr. Kontis says she has not heard back from the FDA about a plan for dealing with DIY filler, she has noticed that “Amazon does not sell fillers anymore like they were before—fillers were $20, $60 on Amazon.” It has led her to think that the FDA has taken some kind of action. “If you Google ‘injectable fillers,’ there are a few things that still come up, but not as many as before,” says Dr. Kontis. “So the FDA has done something to get the chief products out of the hands of patients.” Allure reached out to the FDA for comment and had not heard back as of press time.
But even without Amazon, you can still buy injectables pretty easily online. “I have young patients who are very tuned into social media, see [someone self-injecting] on TikTok, and they’re like, ‘I’m going to try and do it myself, too,’” says Laura Garcia-Rodriguez, MD, a board-certified facial plastic surgeon in Detroit. She’s treated multiple complications from DIY injectables, including a marble-sized lump from at-home lip injections gone wrong— “it was this awful looking ball every time she smiled”—and “a dead nose” after a liquid rhinoplasty. (A liquid rhinoplasty is also known as a non-surgical nose job, and involves using filler to temporarily reshape the nose—you can find it on some board-certified doctors’ treatment menus, but other dermatologists and plastic surgeons won’t do it because of the potential for serious complications like blindness.) “That patient wound up with a dime-sized wound on the tip of her nose, all the way down to her cartilage—that dead tissue isn’t coming back,” says Dr. Garcia-Rodriguez. The woman had gone on eBay and bought her own fillers from Turkey. “Another patient went to Atlanta, and got lip injections from a friend at their home—this was not a medical professional," says Dr. Garcia-Rodriguez. “The syringe was either dirty or her lip wasn’t cleaned well enough, because the lip injections caused her cheek implants to become infected, and they had to be removed.”
It may not sound like it, but these patients were lucky, in that they had a board-certified plastic surgeon treating them. Some people who dabble in DIY injectables have trouble finding a doctor if and when things go wrong, warns Anil Shah, MD, FACS, a double board-certified facial plastic surgeon in Chicago and New York City: “You've injected yourself, and it's a huge liability at this point. The other risk for medical providers is you have someone who's already said that they're not necessarily going to follow medical advice, they're going to do whatever they want.” In his own practice, Dr. Shah has seen “multiple patients, unfortunately" who have tried injecting themselves. “People tend to think it looks good, until it doesn’t.” And then they wind up in his office. “You see so many things in lips that look obscene, like visible lumps—that's not how a normal lip is supposed to look,” he says. “The worst patient I've seen injected her forehead with something—you never know what you get on the internet—and the whole right side of her forehead was dark and purple and painful. It was a vascular issue—the area was oxygen deprived for a week. Sometimes nerves comes back, but sometimes they don’t. You can really mess up your face permanently, like completely disfigured.”
Now you may be wondering how someone can sell injectables online, and how people can buy them without having a medical degree. It’s happening outside of regulated channels—and “injectables that are acquired [this way] are often counterfeit and can pose serious health risks,” says Susan C. Taylor, MD, FAAD, a board-certified dermatologist in Philadelphia and president of the American Academy of Dermatology (AAD). “The concerning rise in counterfeit injectables poses a grave threat to patient safety.” On top of that, in order to buy an FDA-approved injectable, which is a prescription-only product, you need a medical license, explains Heather Faulkner, MD, FACS, MPH, a double board-certified plastic surgeon in Atlanta and chair of the American Society of Plastic Surgeons (ASPS) Patient Safety Committee. Drugs that are not FDA-approved, like the injectables you might find online, “cannot be sold or administered legally in the United States,” says Dr. Faulkner.
The FDA did not respond to Allure’s request for comment on the online sale and purchase of unapproved injectables by press time. But the FDA does warn against using these direct-to-consumer fillers and neuromodulators, including in a statement on fda.gov called Dermal Filler Do’s and Don’ts for Wrinkles, Lips and More: “The FDA warns against buying or using lip or facial fillers that are sold directly to the public. They are not FDA approved and may be contaminated with chemicals and infectious organisms... Do not inject yourself with dermal fillers or with needle-free injection ‘pens.’”
But in reality, “you can buy whatever you want—who’s going to come after you?” says Dr. Kontis. It’s more common for someone to want to inject filler at home than neuromodulator, she adds, because filler tends to be more expensive to get done professionally—so there’s more incentive to do it on your own—and it may seem less intimidating, since it’s not a toxin. “Neurotoxins, believe it or not, are not as dangerous,” says Dr. Kontis. “If you inject it in the wrong place, you just paralyze a muscle, it becomes inactive. Filler can embolize [obstruct] a blood vessel, and you lose tissues without blood vessels supply, including down the line—if you inject around the nose, the product can go backwards into the artery [that leads to] the heart.”
And a blocked coronary artery can cause a heart attack. In other cases, cutting off blood supply to tissues can “lead to disfiguring complications, including permanent blindness, necrosis (deadening of the skin), scarring, and potentially death,” says Shari Marchbein, MD, a board-certified dermatologist in New York City and clinical assistant professor at New York University School of Medicine.
“It is patently insane for a layperson to purchase a product off the 'street' and inject it into his or her face and expect the outcome to be anything other than a disaster,” says Min S. Ahn, double-board certified facial plastic and reconstructive surgeon in Boston.
Why would anyone risk it? And how did we get here? “TikTok and Instagram and YouTube,” posits Dr. Kontis. “There was a lady doing videos on YouTube of how she injects herself, basically [showing] this is how you could inject yourself. That video came down [shortly after] I notified the FDA.”
Along with these “injectable tutorials,” there’s the fact that we’re living in a time where medical procedures have, arguably, been demedicalized. Ours is a culture of med spa billboards, Botox parties, and filled faces everywhere from movie screens to the grocery store checkout lines. It’s perhaps no surprise that injectables can seem more like routine maintenance (akin to a facial or a new lip gloss) than the medical procedures they really are. We’ve come to a place where people are so desperate to look a certain way—and so unaware of the seriousness of injectables—that they’re willing to bring a syringe to their own lips and crow’s feet. Based on her own experience, Dr. Kontis certainly gets it. “I feel better when I have injectables—I just like the way I look,” she says. And when something makes you feel better, it can be hard to resist: “So if people can't afford it, they'll try to find it a different way.”
For now, Dr. Kontis and her colleagues are trying to get the word out to patients about the dangers of DIY injections. In a statement to Allure, the ASPS stresses that “while these treatments may be called minimally invasive, they are still real procedures with real risks” and “encourages patients to value their safety over any perceived savings.” The AAFPRS reminds patients on a daily basis to trust their faces to qualified plastic surgeons, and has a physician finder on their website. And AAD “strongly advises against people performing cosmetic injectable procedures themselves—these injections are medical procedures,” says Dr. Taylor, noting the AAD also has a physician search tool of “member dermatologists [who] have the most extensive medical training to avoid complications and provide patients with the best outcomes.”
“We're not going to convince everybody,” says Dr. Kontis.“But the fact that it's less available than it was a few months ago, that to me is huge—maybe it’s going to get better.”
With reporting by Kaleigh Fasanella.
Read more about injectables:
- The Truth About Social-Famous Surgeons: “He Had a Million Followers, So I Thought He Was Good”
- The FDA Is Warning Against the Use of These At-Home Lip-Plumping Devices
- The Most Surprising New Botox and Filler Trends
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