We are living in very interesting times. The internet, for one thing, is a place where you can find information to support any idea in existence. Then there's social media, where you can find other people, maybe even some niche influencers, who support that same idea and possibly recommend a product to go with it. Finally, there's global e-commerce, where you can buy said product from halfway around the world with just a click or swipe.
What we're trying to say is what you likely already know: All of these amazing technological advances — the internet, social media, e-commerce — have a dark side. Perhaps a combination of all of these things is what's fueling a dangerous trend in the cosmetics world: DIY injectables.
It seems a growing number of people are skipping the doctor's office and taking this less expensive, though much more dangerous, route to getting facial fillers. "The trend of people purchasing injectable products online and self-injecting is not new, but it is rising," says Nancy Samolitis, a board-certified dermatologist in West Hollywood, California. The availability of counterfeit fillers for purchase online, paired with social media video tutorials that make it look easy to inject them yourself, has become a very worrisome combination for consumers.
I was first tipped off to this trend by New York City-based and board-certified dermatologist Dhaval Bhanusali. "The DIY procedure trend is definitely picking up speed," Bhanusali wrote in an email. "I am not sure how it is legal, but it's happening more and more often, which is terrifying, from a safety standpoint."
Sure enough, when I asked a number of other dermatologists about their experiences and thoughts on this topic, the floodgates opened and they shared similar sentiments. Based on this feedback, it seems the lower half of the face is a popular area for self-injecting (i.e., smile lines, the jaw, and the lips), although I've heard horror stories about patients poking themselves almost everywhere on the face.
"This is the most dangerous and irresponsible trend I've heard of in years," says Lara Devgan, a board-certified plastic surgeon in New York City. "I have heard of private citizens with no medical knowledge injecting their own lips, cheekbones, under-eyes, and even nose."
"I have a patient whose friend injected her lips with what she was told was Juvéderm," says Susan Bard, a board-certified dermatologist in New York City. "She said it came in a Juvéderm box and looked legitimate, [but] it was a counterfeit product that was adulterated with silicone that the patient had to have surgically removed."
"I recently saw a young man who purchased a filler over the internet and attempted to inject his undereye area," says Thomas Adrian, a dermatologist in Washington, D.C. "Needless to say, he came to me concerned that his filler was very uneven and lumpy, and he was also having some sort of allergic reaction to whatever was injected."
"I've had a patient come to see me for bumps in the lips from filler done by her friend who performs these services out of her basement," says board-certified dermatologist Mariana Atanasovski. "I performed repeated injections of the antidote to reverse the type of filler that was supposedly used, with no success in dissolving it. I suspected silicone was injected."
I could go on and on.
Where are people buying these fillers, and where are the fillers coming from? All it takes is a Google search to see how quick, easy, and relatively inexpensive it is to buy filler for yourself. Bhanusali recalls listings he saw for counterfeit fillers on Chinese e-commerce giant Alibaba, though recently he has seen more and more become available for purchase on everyone's favorite online marketplace, Amazon. Both Alibaba and Amazon maintain strict counterfeit policies, but one search yields plenty of hits.
"I received multiple phone calls from prospective patients in the last [few] weeks who purchased a filler injection online," says Danny C. Del Campo, a board-certified dermatologist in Chicago. "Where did they purchase it? They purchased it from Amazon: No license, no medical degree, and with two-day delivery."
With a product description page, positive reviews, one-click buying, and sometimes even free shipping, you can see how it might be tempting to add one of these items to your cart. Some injectables might even feature familiar brand names that are used in doctor's offices, such as Juvéderm or Restylane. There are also no-name generic fillers, listed under something like "hyaluronic acid filler," which can be bought for under $100 on Amazon, says Mathew Elias, a board-certified dermatologist in Florida. But where are they coming from?
"Most are illegally re-imported from Asia and Eastern Europe," explains Devgan. "I have [also] heard stories of expired or discarded products retrieved from the trash, and legal products that have been stolen from unsuspecting offices."
When we reached out for comment, representatives from Galderma (the manufacturer of Restylane) and Allergan (maker of Juvéderm) said they were already aware of the issue, which has been ongoing but is apparently on the rise.
Both companies confirmed that they only sell their products directly to licensed specialists, including dermatologists, plastic surgeons, aesthetic physicians, and nurses. In other words, any injectable that you see for sale on the internet is absolutely, positively not coming directly from the manufacturer — whether that means it's counterfeit (i.e., totally fake) or genuine, but has somehow fallen into the wrong hands, is hard to know. Either way it's illegal and definitely not something you should inject into your face.
"Though the aesthetics industry is strictly regulated, it has unfortunately seen a rise in both counterfeit and illegally imported product sales, especially from unlicensed online distributors," Alisa Lask, general manager and vice president of U.S. Aesthetics at Galderma, tells Allure. "We do not engage in any direct-to-consumer, online sales, so any products appearing in these forums are not licensed and cannot be verified by our strict safety and efficacy standards."
Allergan issued a similar statement, ending with this recommendation: "We cannot overemphasize the importance of doing your research and only seeing a licensed and trained professional for injectable treatments."
Fortunately, between the time I started working on this article and the publish date, two of the suspicious product links that I was sent by dermatologists have been removed from Amazon; all dermal fillers, and counterfeit products, in general, are prohibited by Amazon entirely. I reached out to Amazon for comment, and a spokesperson for the company sent the following statement: "All selling partners must follow our selling guidelines and those who do not will be subject to action, including withholding of funds and potential removal of their account. The products in question are no longer available." Allure also reached out to Alibaba for comment but did not hear back before time of publication.
One of the biggest risks of purchasing illegally available fillers is that you can never know exactly what you're going to get. Even if the package claims that the filler inside is made of hyaluronic acid, without the FDA's stamp of approval, anything could be in that package, including but not limited to adulterated ingredients (like silicone, which has to be surgically removed), unsterile ingredients that can cause an allergic reaction or severe infection, which then can lead to loss of tissue and scarring, explains Samolitis.
"People are also buying various forms of silicone, sometimes not intended for human use," Devgan adds.
When something goes wrong with doctor-injected dermal filler, such as blocked vessels or even just dissatisfaction with the resulting appearance, dermatologists inject an enzyme called hyaluronidase to dissolve hyaluronic acid. This is one way they can tell whether or not a filler contains what it says it does. "We are now using it more and more to dissolve over-filling by unqualified injectors," Bhanusali explains. "It only works with hyaluronic acid, so when we see things like silicone or other foreign materials, our options [to dissolve them] are slim to none."
And even if you do magically find a filler online that contains exactly what the package says it does and is approved by the FDA, you still have to know how to correctly inject it.
This may seem obvious, but trying to inject yourself with filler of any sort — even if it is legit and straight from the manufacturer — is incredibly dangerous for many reasons. DIY YouTube tutorials and social media posts can make it seem easy enough to do on your own. Two words: It's not.
"It looks easy because we make it look easy," Devgan explains. "But injecting filler and Botox is remarkably complex and requires intensive knowledge of anatomy and physiology to understand the tissue. We train for years — literally, years — to learn how to properly and safely inject."
Still, one quick YouTube or social media search results in dozens of tutorial videos that might make you think, If they can do it, so can I.
"Now, we can actually watch fillers being injected on Instagram, YouTube, etc., and that may give one a false sense of security because it looks so 'easy,'" says Ritu Saini, a board-certified dermatologist based in New York City. "The potential complications can be catastrophic."
Social media has made injectables look so "regrettably easy," says Devgan. "It seems like just pushing fluid out of a syringe, but the technical aspects of these procedures require extensive knowledge of tissue behavior and anatomic relationships," she says. "Facial anatomy is extremely complex."
The central area of the face is sometimes called "The Danger Triangle," explains Devgan, because it is in direct communication with the vessels that feed the brain. As such, there are a lot of things that can happen when a DIY injection goes wrong. Aside from a result that appears lumpy and uneven, you could also inadvertently inject into a blood vessel, which can lead to permanent scarring. Or worse, you can cause skin necrosis, which is the permanent loss of skin tissue (also called skin death). Worse still, you could go permanently blind.
Let's repeat that: The dangers of DIY injections include skin loss, disfigurement, and permanent blindness.
"This is truly a case of 'you don't know what you don't know,'" Devgan says. "Injecting yourself after watching a YouTube video and going on an Amazon shopping spree [for injectables] has a very real risk of leaving you blind or permanently disfigured."
Unfortunately, experts aren't seeing any signs of illegal filler purchases slowing down; they're seeing the opposite. "My guess is that some of these sites don't even know people are selling these products," Bhanusali says. Hopefully, increased awareness of this situation will lead online retailers to step up their game and better monitor the availability of illegal products on their sites. But often the reality is that when one listing gets taken down, another has already popped up in its place.
The good news is that the companies that manufacture dermal fillers, as well as Amazon, are fully aware that this is happening and, we're told, are dedicating resources to more closely monitor the situation.
"Online illegal fillers will likely just get less expensive and become more widely available," says Darren Smith, a board-certified plastic surgeon in New York City. "The key to stopping this practice is patient education." That means you, dear reader.
The bottom line: Don't ever — under any circumstance — try to inject yourself with filler that you've bought online. Don't ever buy filler online in the first place. And unless you're a trained medical professional (i.e., a board-certified dermatologist and/or plastic surgeon), don't ever try to inject yourself with anything at all (or let one of your friends try to do so in their basement). The results of just one misplaced poke of a needle can be life-changing and irreversible.
More on injectables:
- The Complete Guide to Facial Fillers
- This Injectable Treatment Dissolves Unwanted or Botched Facial Fillers in Seconds
- Dermatologists Are Now Using Fillers to Simulate Instagram Filters, So I Decided to Try It
Now, see how plastic surgery has evolved within the last 100 years:
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