Dermal fillers have come to play an essential role in the management of aging skin, becoming part of the grooming regime for women and men. The exponential growth of dermal fillers’ market is the result of increasing demand for non-surgical treatments as well as improvements in the manufacturing of new types which allow to not only correct the wrinkles and folds but also contour and replace the lost volume.

Injectables are generally considered safe, however, as in any other medical procedures, there are certain risks related to using them, especially if relevant precautions and contraindications are not adopted from both doctor and patient.

First Step: Licensed Medical Professional

The probability of side effects can significantly increase when, firstly, products are of the non-confirmed origin or with unapproved ingredients and, secondly, the practitioner conducting the injection wasn’t trained and certified for the specific kind of treatment.

Those looking to get dermal fillers should always seek for a licensed and board-certified healthcare professional, with a specialty in dermatology or plastic surgery and trained to perform injections with hyaluronic acid.

At first glance, treatments with dermal fillers may seem like easy to conduct. Their accessibility and time efficiency are some of the main key selling points that are being communicated with end-customers. In fact, these “lunch-time treatments” require extensive knowledge of the facial anatomy and different techniques on the doctor’s side that can be possessed only by a qualified professional: a plastic surgeon or dermatologist. Dermal injections conducted in the wrong way can have severe consequences, starting with undesired patient’s appearance (facial or body asymmetry, skin stretching, lumps) and finishing with serious skin damage (such as wounds, infections and scarring) or even blindness.

Online Businesses and Fake Dermal Fillers

An immense threat comes also from a growing interest in purchasing dermal fillers online, which only contributes to the rise in sales of counterfeit products from illegal businesses run by unlicensed distributors. Dermal fillers are officially qualified as medical devices and no lawful company would ever sell them directly to the consumer. When purchasing products online, patients can never be sure what’s inside the packaging because even if it mentions it’s hyaluronic acid, it can be literally everything.

Non-sterile Environment

This is all accompanied by very small awareness of not undergoing the treatments in non-medical settings, for example in the privacy of someone’s home, with consumers going as far as injecting themselves after watching YouTube tutorials[i]. According to the Consumer Complaints Audit Report 2017-2018 published by Save Face[ii], 33% of complaints were results of treatments conducted in a domestic setting, 26% in a beauty salon, 17% using services of a mobile practitioner, 11% during a treatment party, 9% in a hair salon and 4% on training venues and conferences.

[i] DIY beauty injectables are fueling a horrifying online black market, available at: link (last accessed: March 2020)

[ii] Save Face – Consumer Complaints Report, available at: link (last accessed: March 2020)

According to the same source, 84% of patients didn’t know what products were used during the procedure and 31% weren’t aware of what qualifications or training their practitioner had undertaken. As scary as it sounds, the results of such activities can be irreversible.

Enhanced Regulations

On a positive side, we are witnessing the introduction of the tightened control mechanisms for medical devices throughout Europe. They are meant to ensure better protection of public health and increase patients’ safety by improving the quality of the medical devices and harmonizing the legislation within the European Union.

The EU Medical Devices Regulation (MDR), which entered into force on 26^th May 2017, replaced the EU’s Medical Devices Directive (MDD) (93/42/EEC) and Active Implantable Medical Device Directive (AIMDD) (90/385/EEC) with a 3-year transitional period. This means that all dermal fillers are now being classified as medical devices[i] and must be certified by a notified body to be sold after 26^th May 2020, with current certificates in accordance with the old directives remaining valid until the expiry. The new directive classifies injectable dermal fillers with hyaluronic acid as the highest risk class – III, which refers to medical devices with absorbed ingredients.

[i] Annex XVI No. 2 MDR (2017/745): “Substances, combinations of substances, or items intended to be used for facial or other dermal or mucous membrane filling by subcutaneous, submucous or intradermal injection or other introduction, excluding those for tattooing.”

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