“I Was Told I Needed More Work” – How Clinics Exploit Our Insecurities

It's 10am and I'm sitting in a consultation room at a famous Harley Street clinic. A doctor is peering earnestly at my face. "The problem we have here," he says, holding up a mirror so that I can inspect said 'problem', "is the gap between your nose and lips. It’s too long. You’ll need a lip lift. And the shape around your chin and jaw is not symmetrical. You could try a lower face reshape."

Horrified, I find myself agreeing with him and leave the clinic feeling like a total failure. The ridiculous thing? I’d only gone in for microdermabrasion. Back home I check the 'flaws' and wonder how many people that day he’d told they needed 'work'.

Research reports that in 2019, the cosmetic aesthetic industry is worth £2 billion globally, with that figure set to rise over the coming years. Never has the perfectly symmetrical 'golden ratio face' been more popular among individuals in the UK and with the endless scroll of flawless Instagram selfies, it’s difficult to tell what’s real, cosmetic or just a little bit of Facetune.

While there might not be an end to the quest for perfection any time soon, are clinics playing on women’s insecurities and contributing to the rise of cosmetic aesthetic procedures? My own experience tells me yes. In the name of honest journalism, I decided to test the 'peddle-o-meter' by visiting another clinic, just off fancy Wimpole Street, where countless big name aesthetic clinicians take up residency. It’s full of glossy magazines and thousands of pounds worth of plush decor.

"I'm thinking of getting a chemical peel," I say. The doctor gives me a good once-over. "Yes, we can do that," she replies, then out of nowhere: "We could also administer some filler to restore your cheeks too." Wildly, I find myself agreeing – again. As the aesthetician shows me a 2ml syringe, she almost looks poised to inject me right there and then, but I tell her I need to think about it and promptly leave.

Talking to friends and colleagues proves that I'm not alone in my encounters with pushy aestheticians, especially when it comes to having my insecurities exploited for money. Amelia, 29, had a similar experience. "I went to a clinic as they were offering free 15-minute facials," she told me. "During my consultation they said my skin was 90% damaged and I needed a HIFU laser (a non-invasive face lift). I said I wasn’t sure but they persuaded me to wait in the reception area. When I said I couldn’t afford it (it was over £2,000) they tried to convince me to start a payment plan. It left me feeling insecure about my skin."

Personally, I'm no stranger to a bit of 'work'. I’ve dabbled in Baby Botox and liked that it gave my face a subtle refresh. But is being told you need cosmetic enhancements ethical? Mr Naveen Cavale, consultant plastic and reconstructive surgeon and clinical director at King's College Hospital, thinks not.

"Up-selling should never ever happen in the aesthetics industry," he told me. "This is not like casually buying a television. It is a major change to your face or body with potentially lifelong consequences. What's more, pointing out other flaws is a form of bullying and anyone who does this should be reported." Mr Cavale's advice is especially poignant when you consider that one in 20 girls aged 17 to 19 were found to have a body dysmorphic disorder (BDD), according to the NHS' Mental Health of Children and Young People survey. In the UK there is no legal age restriction on aesthetic treatments like Botox, meaning even teenagers can step into clinics nationwide.

Jackie, 26, from London, experienced the emotional consequences of up-selling when she had nose surgery aged 22. "I had been unhappy with my nose for many years," she told me. "During the consultation, at a reputable Harley Street clinic with glowing magazine reviews, I was told that I’d need a very expensive chemical peel to go with the £5k procedure. The surgeon said that this would get rid of the 'orange peel' look of my nose, which I now know is entirely normal. We all have pores! That said, this gave me a further complex. It’s only now that I realise the surgeon was trying to up-sell me treatment to make more money. This should have made me question the surgeon’s authenticity but I was impressionable and believed I needed these add-ons to look and feel good."

Dr Anjali Mahto, a consultant dermatologist, has heard similar stories from patients who have visited other clinics and been advised on a menu of injectable treatments they really didn't need. She believes this leaves them feeling confused, vulnerable and inadequate. "When booking treatments, don’t be temped by 'cut-price' deals and discounts," she says. "A reputable clinic should not be doing this. You should not be pressurised into having any treatments on the same day and a proper consultation should always take place first to make you fully aware of the results."

But it can be hard to say no, as Sarah, 26, experienced when purchasing lip filler in an online promotion. "I should have questioned the price as it was an absolute bargain," she told me. "I was attracted by the W1 postcode but on arrival it all went downhill. The doctor said my lips were too thin and I would need more than I had purchased. I immediately handed over an extra £150. Within a week there was literally nothing left in my lips. I still don’t know what he used. I had waited four years to pluck up the courage to meet with an expert and my experience was ruined. Now I hate my lips even more."

Psychologist Sara Rourke of Soho Psychotherapy believes this kind of up-selling can be damaging for women’s mental health but is also the linchpin of some cosmetic clinics' sales strategy. "In uncertain and vulnerable positions, we seek authority figures to contain our anxieties," she says. "They are deemed 'safe' and given immediate trust due to their position. Too often, however, these industries are implicitly promoting their services and the financial success of the business is placed over people's physical and emotional wellbeing."

A good place to start is to find the right practitioner. There are a handful of informative sites such as RealSelf and SaveFace, which show authentic reviews of clinics with real pictures (some slightly graphic), as well as the British Association of Dermatologists (BAD).

Dr Rita Rakus, who has a cosmetic aesthetics practice in Knightsbridge, always urges women who want aesthetic procedures to find a reputable practice by spending time researching a range of cosmetic doctors. "Firstly, you should make sure they are certified and a member of a professional organisation such as the General Medical Council," Rita says. "Also the doctor should put a treatment plan together that is individual to a person and make a qualified judgement as to whether the patient is getting the treatment done for the right reasons."

It's important to recognise that people book in for aesthetic enhancements every day for completely different reasons, and that there is absolutely nothing wrong with this individual choice. But being explicitly told you need work can leave people feeling insecure, insulted and vulnerable.

Ultimately, real change lies in the hands of the government and the establishment of a model to regulate the industry. But this is a call for clinics everywhere, whether offering cosmetics surgery such as a nose job or an aesthetic treatment like Botox, to consider the implications of their practices on women. No one should ever be pushed into a decision, especially something as life-changing and potentially risky as an aesthetic procedure.