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Botox, fillers, and safety

Ms Fitzgerald was interviewed by Alex Meehan for this piece in the Irish Independent Health and Living supplement, published on 16th July 2018.

https://www.independent.ie/life/botox-is-something-i-do-to-look-as-well-as-i-can-37114762.html

Full text below:
“At a time when we’re surrounded by perfectly sculpted bodies on Love Island, and when Instagram influencers delight in showing off their enviable bodies, does the average person’s self-esteem stand a chance?

A glance around our high streets at the increasing number of salons selling cosmetic procedures like Botox and facial fillers might make you presume that the answer is no.

But while it’s possible to argue that this is being driven by an increasingly beauty-obsessed society, undoubtedly part of the appeal is that as Botox becomes cheaper and more accessible, it’s increasingly within the reach of average people.

And according to one expert, not only is it safe, it has a long pedigree in medicine that predates its current use as a cosmetic agent.

“Botox is a really safe drug. The medical profession has been using it since the 1970s when it was first indicated for neck spasms caused by cerebral palsy and other situations where something was needed to relax muscles. It’s been used for a long time and it has an excellent safety profile,” says Éilís Fitzgerald, consultant plastic reconstructive and aesthetic surgeon with the Beacon Consultants Clinic in Dublin.

Botox is a brand name used by the Allergan company for its product, a form of botulinum toxin that is used to treat many conditions. However, it’s best known today as an agent that relaxes facial muscles.

“When it’s injected into the face it relaxes and stops muscles from working, which has the effect of smoothing out wrinkles. It’s been prescribed for so long that we can be fairly sure it’s safe to use, other than for a very small number of people who can develop antibodies to it if they use it for a prolonged period of time. In their case it stops working, but that’s really unusual,” Fitzgerald says.

The great majority of the Botox Fitzgerald injects is for cosmetic and aesthetic reasons, where it’s used on dynamic lines and wrinkles around the upper face. As a general rule, she doesn’t use it on the lower part of the face, where fillers are used instead. These are usually based on hyaluronic acid and can be used around the mouth and lower face, where they plump out the area and create volume without stopping muscle movement.

“As part of the training to be a plastic reconstructive and aesthetic surgeon, we learn to assess people very carefully if they are looking for a cosmetic procedure, be it a temporary one like Botox or a permanent one like a tummy tuck. You meet the patient and assess their expectations,” says Fitzgerald.

“If someone says ‘I want to freshen my face up’, or ‘my daughter’s wedding is coming up and I want to look good in the photos’, that’s fine. But if someone says my relationship has broken down, or I’ve lost my job and I’m miserable, then that’s a different matter.”

The reality is that no cosmetic procedure, be it permanent or temporary, will change a person’s life; it’s just going to change their body. And in fact it could actually make things worse if they’re doing it for the wrong reasons.

“They need counselling away from making changes that they may regret later. We advise people not to make major changes to themselves for at least six to 12 months after a major life event, to make sure that they really want it,” says Fitzgerald.

“At the other end of things are people who get hooked on the sensation of creating change, and want more Botox or fillers when really they don’t need them. Then my obligation and professional responsibility to that person is to say ‘I can’t do that for you’.”

The issue of whether it’s psychologically healthy to seek to change your appearance is a much-debated one, but according to Dublin psychologist Karina Melvin, if it’s done for the right reasons, it can be.

“It completely depends on the individual. There are people who do it as a form of self-care and it makes them feel good, and there’s no problem at all with that. At the other end of the spectrum, there are people who are suffering greatly and who focus obsessively on an aspect of their appearance to a degree that isn’t healthy,” she says. “Then there are others who have feelings of never being good enough and who think that something like altering how they look is going to change that. ”

Melvin emphasises that it’s important for someone thinking of getting work done to ask themselves questions like ‘why am I doing this, and how do I hope to feel afterwards’?

“Sometimes people can feel very disappointed when they realise that changing something external about themselves isn’t going to change how they feel on the inside. But if it’s part of an overall effort to look after yourself, it could be quite good for you,” she says.

Age can also be a factor in mental health and self-acceptance.

“As we age into our 30s and 40s, we gain a better sense of our own identity and ideally we come to accept who and how we are.

“But younger people and teenagers are very susceptible to being influenced, especially when they see their peers in age doing something. They’re still trying to figure out what their style is and how they look,” says Melvin.

Andrea Ryan is 44, lives in Swords in Dublin, and works as an auditor. She started using Botox and fillers around five years ago and sees no reason to be shy about wanting to look her best.

“At around 39 I started to see the signs of aging and thought, now is the time to try this out, and if it works I could use it as a preventative measure. The first time I had it, it was a bit uncomfortable, but nothing I couldn’t handle. The Botox is put in as a series of short, sharp injections and it’s done in about five minutes,” she says.

“Normally I get it in the forehead, around the frown lines, and in the eye area. It gets rid of wrinkles and frown lines and removes crow’s feet around my eyes. It gives you a smooth complexion in the areas where you see wrinkles most. Because you can’t move that area, it doesn’t develop any new lines so you get two effects – existing lines are de-emphasised and new lines don’t develop. For me, it’s the same as putting on make-up or getting my nails done. It’s something I do to look as well as I can.”

Ryan sees a dermatologist for her treatments every six months, with each treatment costing approximately €300 a time. She doesn’t consider this too high a price to pay given that many women spend more on skin care products that can’t ultimately stop wrinkles from forming or deepening.

“I have no issue with telling people I do it. I know lots of people who won’t tell their family or friends they get it done, and I even know women who get it done who haven’t told their husbands.

“My lips are probably a little bit more obvious but when you get rid of frown lines, people don’t automatically think ‘Botox’; they just comment that you look fresh and well,” she says.

Éilís Fitzgerald cautions that due to problems with regulations, there is a wide spread of expertise and experience on offer to Irish consumers looking for Botox or fillers. Botox is a prescribed drug, which means it’s illegal for anyone other than a medically-qualified doctor to administer it.

However, she says, just being a doctor or a dentist doesn’t mean that you are trained to administer it properly.

“The two specialties in which people are actually trained to give Botox are plastic surgery and dermatology – and that’s it. The reality is that any doctor can buy Botox and start giving it to people, but that doesn’t mean they’ve had any training in it whatsoever,” said Fitzgerald.

“I’m on the specialist register for my discipline in Ireland and am listed with the Irish Association of Plastic Surgeons. That took 14 years of training on top of a basic medical qualification, including a six-year higher surgical training programme in plastic surgery, and an additional couple of years of fellowship at hospitals abroad. There are a lot of people out there who describe themselves as specialists in this area when there is no training programme for it. It’s not a recognised speciality by the Irish Medical Council, and there is no way of regulating it.”

A quick glance at Facebook will uncover clinics in Ireland advertising special offers in cosmetic procedures. As Botox is a prescription drug, this is illegal. “If I scroll through my Facebook feed, I’ll see multiple places advertising it, and I’ve even seen promotions such as get two parts of your face done and a third will be thrown in free,” Fitzgerald says.

It’s in situations like these that consumers can run into problems. Administering Botox or fillers responsibly requires the practitioner to have a high level of skill in facial anatomy and physiology.

“My strongly-held view is that if you’re considering having a cosmetic treatment done, you should be looking to have it done by a consultant plastic surgeon or a consultant dermatologist – in other words, someone on the specialist register,” says Fitzgerald.

“There are some really good people out there doing good treatments who don’t have specialist qualifications, but the problem is that as a consumer there’s no way for you to know their level of skill. For that reason, that official qualification is really important.”

For those unfortunate people who have had a procedure done and are unhappy with the result, this specialist’s advice is clear – hold the person who did it to account.

“If you have a bad experience, the first thing you should do is go back and tell them you’re not happy. Even if you don’t want them treating you further, do that and let them talk through what’s gone on and find out exactly what was used on you,” Fitzgerald says.

Botox is temporary, and fillers can be dissolved out with further injections, but according to Fitzgerald, to do so the doctor needs to know exactly what substance was used.

So if you decide to pay for a cosmetic procedure to your face, how much can you expect to pay? While there are various ways to price cosmetic treatments, as a general guideline you should expect to pay a minimum of €250 as a starting point for Botox, going up to around €650, depending on how much you’re getting done.

For this price, you should be getting branded Botox or another reputable substance that you should be able to inspect before it’s used. It should be in date and exactly as it appears.

For fillers, patients need to be particularly aware of potential cost-cutting. For a proper filler, you should expect to pay around €400 per syringe. However, they’re regularly advertised on Facebook at a much lower rate. If you’re paying €100 for a filler, there is absolutely no way that you’re getting a premium brand.

With a new survey of those who haven’t had Botox or fillers revealing that over half of them – 57pc – have said they would consider it in the future, compared to 47pc in 2015, more and more of us are likely to be going down this road in the future. For that reason, it’s essential that we are honest with ourselves about why we are doing it, realistic about what the results will be, and incredibly safety-conscious about who we entrust the task to. Never has the phrase ‘caveat emptor’ – let the buyer beware – been more relevant.”