Injectables Made Us Feel Worse About Ourselves — But Why?

At 23 years old I was examined by an aesthetician who was trying to work out what made my ‘resting bitch face’ quite so cattish. The solution was simple: filler placed in my chin to make my mouth appear less pursed and Miranda Priestly-esque. I left the consultation un-pricked but it awakened an obsession with my chin and a hatred of my side profile that still lurks years later. 

I felt too young to dabble in the world of cosmetic treatments but in a few short years, the stigma surrounding injectables had all but vanished. For many, they were even considered the norm. A 2019 survey found that 59% of 13 to 24-year-olds compared lip filler to getting a haircut or a manicure.

Whether or not you opt for cosmetic treatments is a personal choice and one that Refinery29 respects. But as injectables have risen in popularity, so have the various complications. According to Save Face, 48% of lip filler complications reported between 2017 and 2019 affected women aged 18 to 25. This is an unsurprising statistic to aesthetics doctor Ahmed El Muntasar. “Around five years ago, maybe 2-3% of people came to me for correction work,” he tells me. “Now, it can be up to 12-15% at times.”

Side effects aren’t new, however, the videos detailing botched jobs taking over my social media feeds are. Many of us book in for injectables to feel better but what happens when the very treatments we sought out — the ones we saved up months' worth of wages for — don’t make us feel the way we intended?

Depending on the type used, filler (in theory) lasts between six and 12 months before it is metabolised or broken down by the body, but various MRI scans have shown its presence almost a decade after being injected. Doctors, too, have admitted that filler seems to last longer than initially expected. As such, its longevity has raised questions — but so has its movement around the face.

This phenomenon is referred to in the aesthetics industry as migration, and it has racked up over 35 million posts on TikTok. Unsurprisingly, then, my feed has been full of videos detailing lip filler that had wormed its way up to the philtrum (the groove in the upper lip) or, as in TikTok user Alissa aka @alissainthecity's case, gone even further. 

“I didn't realise [my cheek filler] had migrated at first,” Alissa tells me. “It only appeared when I smiled on one side that my hair usually covered.” It went unnoticed until she saw some photos from a wedding. “There it was. Clumps of filler going up to my temples. I was embarrassed,” she says. This was four years after her initial injections. 

For Alissa, filler seemed like something celebrities and influencers were doing that was attainable and potentially beneficial. Her inspiration? “I wanted that ‘Bella Hadid’ sculpted look,” she says. Her first impressions were positive. “It made me feel pretty darn good! It was an adjustment, as it changed my facial proportions, but I got compliments on how ‘lifted’ I looked,” she says. It was such a success that it made her explore other areas to inject. For Alissa, getting filler quickly became an obsession. “I felt like I had to have more, more, more! Because once I got a bit, the doctor would suggest another area or another syringe of filler,” she says.

Aesthetics doctor Christine Hall believes that aestheticians need to say no to patients to help prevent negative psychological side effects. While a qualified injector will assess patients on a case-by-case basis (even turning people away if they deem injectables to be an inappropriate choice), others who are keen to make money simply won't.

“An injector that gives you a long list of treatments or tells you that you need ‘X, Y, Z’ is a red flag when trying to avoid perception drift,” says Dr Hall. She explains, “Perception drift is the phenomenon that sees patients desiring multiple aesthetic procedures as their perception of themselves changes — the end result is a person that no longer resembles you.” But this addictive approach can lead to something more sinister. Coined by surgeon Dr Steven Harris, the term “alienisation” is indicative of an alarming trend where procedures have distorted the face so much, we no longer recognise ourselves.

Besides acknowledging perception drift, looking after her mental health was the incentive Alissa needed to get her filler dissolved. “The high was only temporary and I was using it to hide behind my confidence issues,” she says. She feels more like herself since it was removed. But why aren’t the psychological effects being more openly discussed? “I think there can be a synergistic relationship between mental health problems and having treatments,” says Dr Ahmed. “Doctors must be aware that they’re not a cure for any mental illness and vice versa. [People] get treatments to make [themselves] look and feel better, but if the issue is deeper, the solution needs to be, too.”

The aesthetics industry claims that filler migration is rare but social media is awash with people discussing their experiences with the issue. Content creator Jeana DiCarlo has one of the most viewed videos on the subject. “I first got filler in 2009 in my 20s and was unaware of migration — I don’t think injectors knew it could happen then,” she says. Having had multiple filler top-ups from different injectors in various places, she has had the filler in her lips dissolved twice and regrets getting the injectable at such a young age. Unlike Alissa, she doesn’t feel injectables adversely affected her mental health but admits she “finally felt like I looked like myself again” after dissolving them.

Both Alissa and DiCarlo have posted videos on the topic to destigmatise “starting over”. “Dissolving made me think more about my choices; what I'm putting in my face, the side effects and consequences. Had someone talked to me about that when I first got filler, I seriously might've reconsidered,” says Alissa. She has no plans to get filler again. DiCarlo's experience hasn’t stopped her from topping up but she has much less now than what was previously injected.

It isn’t just filler. “Frozen” faces seem to be an epidemic, too. “I was out of town and, for reasons I’ll never understand, I saw a friend's injector instead of waiting to visit my trusted dermatologist,” content creator and actor Jillian Gottlieb tells me. “That decision left me with a crooked smile for seven and a half months,” she explains. Gottlieb wasn’t new to Botox but felt “gaslit” by the injector. “They insisted my crooked smile was normal but I knew it wasn’t,” she says. As an actor, she couldn’t work, which affected her career and mental health. Gottlieb describes the time as “emotionally difficult”. She was well versed in the complications of Botox including asymmetry, allergic reactions and drooping, but never thought it would happen to her.

Refinery29’s deputy beauty director, Jacqueline Kilikita, knows this all too well. Kilikita was so impressed with baby Botox — a minimal amount of Botox intended to produce more natural results — that she decided to step things up with a few more units at a totally different clinic a few months later. “This was a mistake I won't ever make again,” she says. “I expected better results: smoother, more radiant skin. But after a few weeks, my brows dropped significantly, resulting in multiple folds and creases on my eyelids, making me look older. Some days, I struggled to recognise myself in the mirror and it began to negatively affect my mental health. For six months until my face returned to normal, I had a crisis of confidence. It was upsetting and draining.” Now that the Botox has worn off, Kilikita won't be going back to injectables. 

“Temporary paralysis from anti-wrinkle injections can happen if it spreads to unintended muscles e.g. drooping eyelids from forehead injections or masseter Botox [jaw muscle injections] leading to an asymmetrical smile,” explains aesthetics doctor Jonny Betteridge. He believes that talking about complications openly is a positive thing. “There's been a shift towards transparency, with patients sharing their experiences on social media. This openness helps others understand the risks and the importance of choosing a qualified practitioner,” he says. He caveats that the beauty standard perpetuated on these apps often drives patients and practitioners towards more extreme, unnatural results in the first place.

To avoid potential side effects, looking out for red flags is important. Twenty-nine-year-old Bella* recalls, “The clinic I went to looked like a dentist [surgery] and [there was no] aftercare or follow-up appointment given.” Like Gottlieb, Bella’s injector was recommended by a friend. She even got a referral discount, making it half the price of her usual doctor, but the complications started almost immediately. “I had a headache for almost a month,” she says. Bella felt the Botox was injected incorrectly, causing her brows to drop. “Botox is there to make you feel confident and your skin look brighter. This didn’t do that.” 

Bella did get anti-wrinkle injections again — albeit with her regular doctor — but Gottlieb decided to hold off. “I needed more movement in my face for work. As for filler, my dermatologist and I just don’t think I need anything right now. It's always better to be underfilled than overfilled,” she says.

Dr Betteridge agrees. “Subtle enhancements are key; you want to look like a refreshed version of yourself, not a different person,” he says. Dr Hall believes that keeping before and after photos of patients will help ensure natural, cohesive results. She also recommends a “cool-off” period between procedures, rather than topping up immediately, to allow patients to mull over their decisions properly. It’s unanimous that realistic expectations are vital to prevent negative psychological and physical side effects. 

While complications can occur in even the most qualified hands, stricter regulations for practitioners could be the answer to the risk of unwanted results. “The lack of standardised training and regulation means that not all practitioners have the necessary skills or understanding of facial anatomy to deliver safe and effective treatments,” believes Dr Betteridge. This view is echoed across the industry. It often means it’s also easy for injectables to get into the wrong hands. “Aesthetic medicine remains poorly regulated in the UK; alarmingly, anybody can go online, purchase dermal filler and inject it without any prior training or experience,” says Dr Hall. As an A&E doctor, she’s seen a handful of patients who’ve bought injectables online and attempted to do a DIY job themselves, subsequently causing infections.

Whether or not botched injectables are as common as they seem on social media, it doesn’t deter clients from booking in. Dr Ahmed has a theory as to why. “People getting more treatments is a sign that disposable income is a real issue,” he says. “Before, [people would invest] in the latest Chanel bag, whereas now there is a mindset of having the latest and most expensive treatment.” 

As someone who doesn’t own a Chanel bag, I’ll admit that injectables’ core concept of “high maintenance to be low maintenance” beauty was a huge appeal. At 28, I experimented with Botox injections in my masseter (a large jaw muscle in the cheek) to treat TMJ symptoms. I also tried the newest buzzy injectable on the block, polynucleotides, in my under-eyes to counteract dark circles — and I feel better for it. But if I've learned anything from speaking to the women in this story, it's that my FOF (fear of filler) is valid, and for me, it isn’t worth the anxiety.