They crowd by dozens, broken faces of the 21st century, two buoys instead of lips, their skin leaking, their eyes so blistered that the tears, when they come, struggle to flow. With the craze surrounding aesthetic medicine – without a scalpel -, more and more clients who are victims of accidents are flocking to specialized practices. The fault lies with the injectors of social networks but also with real doctors who operate in “great scientific and regulatory vagueness”, warns Brigitte Dréno, professor of dermatology at the University of Nantes and member of the Academy of Medicine.
There has been a lot of talk about young people getting hyaluronic acid injections from pseudo-specialists who sell their services on Instagram, but who actually have no qualifications. But do you think there are also a lot of medical errors?
Brigitte Dréno: Unfortunately, I receive many patients who have serious reactions following cosmetic injections that are poorly done and yet performed legally. In addition to “fake injectors”, clandestine injections, there is a real challenge on the part of the practitioners themselves, some of whom are unaware of the correct actions and errors to avoid, due to lack of training and the necessary skills.
Injecting Botox or hyaluronic acid is not trivial. It is necessary to ensure potential contraindications, that the injection is carried out correctly and in the right place, to avoid accidents which can lead to serious infections or major aesthetic and motor dysfunctions of the face, sometimes unrecoverable. Botox paralyzes. If you do it too close to the eye, you end up with patients who can’t open it, and that’s just one example.
Doctors are not qualified to practice aesthetic medicine?
Aesthetic medicine is not a medical specialty, unlike its big sister, surgery. Only plastic surgeons and dermatologists are trained in these issues during their student training. With the explosion in demand in recent years, particularly after the health crisis, more and more doctors are getting into it. Nothing prevents them from doing so, because the sector, which has developed on the job, is not regulated at all. But these injectors did not benefit from adequate training in their initial training.
“Nothing is known about the consequences of repeated injections over decades”
What does the Academy of Medicine recommend?
In spring 2022, the Academy of Medicine was asked by the Order of Physicians to produce an analysis of the challenges posed by the growth of this medicine. The practice, I remind you, only exists in fact. It was born from the misuse of botulinum toxin, a powerful paralyzer which allows muscles to relax and therefore, for example, to erase facial wrinkles. It has grown to follow fashion, from Hollywood to TikTok, outside of the regulatory framework.
Following this referral, we published several recommendations. As a priority, the Academy of Medicine requests that training be compulsory to practice aesthetic medicine. The Order of Physicians and the National Council of Universities have already looked into the issue. Training solutions exist, it is now up to the government to decide. There is urgency, because the failures are more and more numerous and are not limited to injections given in a parking lot or in hotel rooms by quacks.
What are the figures for these “failures” in aesthetic medicine?
Most of these are upswings, and it is difficult to extrapolate, but they have been constantly increasing in recent years. It is not obligatory to declare serious side effects induced by aesthetic procedures, which limits visibility in this area, even if certain learned societies develop their own registers. The Academy suggests that this should be the case, and that practitioners be forced to take action where appropriate.
Brigitte Dréno, dermatologist from the Academy of Medicine, warns about the practice of aesthetic medicine without training.
© / Youtube/VJoncology.com
This anomaly is notably due to the fact that hyaluronic acid, one of the main substances injected, is not a medicine, but a medical device, in the same way as a prosthesis. This classification does not require as much monitoring as that dedicated to the pharmacopoeia. Until last November, when a decree was passed, it was possible for anyone to obtain it.
What do we know about the long-term effects of cosmetic injections?
Aesthetic injections, when there is no accident, are entirely resorbable. Their effects fade on their own within a few months to one to two years, varying from patient to patient depending on a number of factors, including the type of filler used, the area of the face treated and the patient’s lifestyle. They can also be dissipated using certain products. However, we know nothing about the consequences of repeated injections over decades, but we also do not know the long-term effects of many drugs. But, unlike this pharmacopoeia, aesthetic medicine is practiced to beautify or rejuvenate and does not respond to any pathology. Unless you consider aging a disease…
Botox is marketed under a marketing authorization issued by the European Medicines Agency. It has therefore been tested in clinical trials, but never in an aesthetic setting. The fact remains that we benefit from significant hindsight. It is overall very well tolerated. The other products are medical devices. Their effects are therefore much less documented and are not subject to clinical trials as strict as drugs. Just like cosmetics, creams and technical solutions used in particular to reduce bruises and redness after certain actions. With these products, practitioners are in the dark.
Many patients interviewed by L’Express indicate that they do not wish to go back, to return to their previous face, unretouched. Are they at risk of becoming addicted?
The effect of an injection disappears quite quickly and sometimes in disparate ways. Some areas remain more swollen than others, which does not give patients time to get used to this regression. This can be quite unbearable. The question of dependence on injections is therefore very serious and the subject is not often discussed with patients. Too sudden a change in the face can cause significant psychological destabilization. This is one of the elements to study before the injection. So many concepts that must be covered in training.
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