The wild west of beauty: why Ireland's cosmetic treatment craze needs taming
Botox, fillers, and other cosmetic procedures are now as normal as booking in for a hair appointment, a chin wax, or a dental scale and polish. More traditionally associated with a select number of providers, the offering open to people now who are looking for cosmetic improvements is wide, with people also considering travelling abroad for procedures, or simply getting together with 'the girls' for a laugh, a drink, and a shot of botulinum toxin (botox) in the comfort of their own home.
This week's Irish Examiner Women's Health Report shows that a growing number of women, particularly in the under 34 age profile, feel positive towards cosmetic treatments and plastic surgery procedures including brow lifts, 'nose jobs', and breast augmentation. For example, 44% of those in the 25 to 34 age bracket felt positively about cosmetic treatments compared with just 17% of the over 65 category.
While there is slightly more reticence about plastic surgery procedures among all age cohorts, the age differential remains. Over a third, 35%, of those in the 25-34 age category felt positively about plastic surgery compared with just 10% in the over 65 category.
Overall, 12% of the 1,078 women interviewed for the Ipsos B&A survey conducted over a two-week period had undergone a procedure involving botox or fillers. For the vast majority of respondents, the experience was positive.
Of those who had undergone botox or anti-wrinkle injections, 82% would consider doing it again.
Why do people do it?
So why do people do it? Almost half of women who opted for cosmetic treatments such as botox or anti-wrinkle injections did it to boost their confidence.
The desire to roll back the years was also evident in the responses with 50% saying they had undergone lip fillers/injections for anti-ageing purposes, compared with 66% who said they had done botox or anti-wrinkle injections for anti-ageing reasons.
In recent years, dental practices across the country began offering cosmetic procedures including botox and dermal fillers, with the Dental Council having its own code of conduct for the area, which was updated in 2023. The Irish Examiner survey shows that while one in seven of the surveyed women were aware of dentists offering cosmetic procedures, just one in 10 knew GPs also offered such services.
Dublin-based aesthetic medicine practitioner Eithne Brenner has been a doctor for 36 years, including 25 years as a GP. She diverted her focus to aesthetic medicine in 2007 and says that her clients are mainly women in the over 45 category, who are looking for cosmetic work to tackle signs of ageing.
'I do work with lasers improving people's ruddy complexions, doing work that can be very subtle and very effective,' said Dr Brenner.
'The filler side of it is one of the areas where there is still a lot of bad work out there.
I don't see the younger girls at all because they are looking for a bargain in somebody's kitchen.
"I tend to see people 45 or 50 plus who want subtle changes and they are terrified of looking different but they want something. My work is more restorative. The younger girls are going to beauticians and people who are cheaper. They take more risks.
'I have colleagues who do amazing breast reconstruction for somebody who has very heavy, very droopy boobs and pain. In the right hands, surgery can be transformative. But it is about doing research. These are very serious medical procedures.'
Dr Brenner accepts that there is more awareness now of the dangers of unscrupulous people carrying out cosmetic procedures but said: 'There is still a drive for plastic surgery and there is an issue of how do we raise our younger generation to be really careful and know they don't need these things.'
Currently, botox is supposed to be only available through prescription, under the administration of qualified doctors and dentists.
However, as seizures conducted by the Health Products Regulatory Authority show, there is a thriving market for counterfeit and illegal versions in Ireland. Last year, 1,709 units of fake or illegal products claiming to contain botulinum toxin were seized, compared with just 26 in 2020.
Unlike botox, dermal filler is not yet subjected to stringent regulations, meaning that it can be administered in unsafe settings and environments.
Legislation delayed
Legislation mooted in 2016 still has not been enacted for governing the area of cosmetic procedures. The Patient Safety (Licensing) Bill was approved by the then government in 2017 and subsequently underwent pre-legislative scrutiny. It was then referred to the Office of the Attorney General for drafting.
In March, in answer to a parliamentary question, health minister Jennifer Carroll MacNeill said the legislation remained with the AG's office and that her department continues to work on it. She said it will, for the first time, 'introduce a licensing requirement for all hospitals, public and private, and certain designated high-risk activities in the community'.
The general scheme of the bill outlines that 'designated activities are likely to initially relate to cosmetic surgery services but other services may be added over time as the licensing system becomes embedded in the health system'.
Social Democrats health spokesman Pádraig Rice called the delay in progressing the bill unacceptable.
'It's almost eight years since the draft legislation received government approval, and yet there is no sign of the final bill,' said Mr Rice. 'In that time, there has been an exponential increase in demand for unregulated cosmetic procedures. Until Hiqa has the necessary accreditation, inspection, and enforcement powers, patients will continue to fall into the hands of unqualified practitioners.'
Almost half of women who opted for cosmetic treatments such as botox or anti-wrinkle injections did it to boost their confidence, and the desire to roll back the years was also evident in the responses, the IPsos B&A survey found.
Last week in the UK, the Health Security Agency (UKHSA) revealed that 14 people from Co Durham and Darlington had experienced 'adverse reactions' including eye drooping and double vision following a procedure involving 'botulinum toxin' injections.
Of those, 10 people required treatment as a result.
The County Durham and Darlington NHS Foundation Trust said that investigations were ongoing 'but evidence so far does not suggest that the product used has been contaminated' and that 'symptoms are being reported a few weeks after injection'.
It added: 'UKHSA has issued advice to clinicians to ensure that they look out for botulism in people who may have had a recent aesthetic procedure in order to provide them appropriate treatment which includes giving anti-toxin.'
Meanwhile, a public health notice was issued in the past 10 days by the UKHSA asking clients of an aesthetics company in Wolverhampton who received 'vampire facials' to contact it to arrange free blood tests, due to concerns about the risk of bloodborne viruses including hepatitis. The notice said that 'inadequate cleaning of equipment used for this treatment at the clinic' had been identified as 'a risk to health'.
Dr Brenner is adamant that progress needs to be made on the planned Irish legislation and cites the recent UK cases as examples of why there needs to be regulation of the sector.
'Botox is a prescription-only medicine so you have to see a doctor or dentist for a consultation to make sure you are suitable,' she said. 'But there is absolute widespread fraud and illegal use among non-medical staff and we do know there is illegal product coming into the country.
When we get into fillers, it is even more Wild West. They are not counted as a medicine at all, they are counted as a medical device, a bit like a bandage.
"So you could legally go onto any website, buy filler, and inject one of your friends and you are technically not breaking the law. There are good quality products but there is also a tonne of cheap stuff.'
She said that people opting to buy bargain filler products online have no concept of 'cleanliness, hygiene, safety, anatomy'.
Unscrupulous use of filler products can lead to strokes or other health implications such as scarring and loss of tissue, she added.
'It has been really trivialised. It has become like a commodity like getting your hair done. I do think in the 40 plus age group, they are more cautious and more nervous of looking overdone and they are the people who come to a medical person.
"But the younger ones are very bargain-led, which you can understand, but that is where there is a safety issue. And you have people doing what are major surgical procedures and all that kinds of crazy things in filthy conditions.
'There was a death last year of a mum of five in the UK who died from having a litre of filler injected into each buttock.'
Dr Brenner said that botox parties are not the right location for such a procedure.
People could be on medications that they might not disclose in a public setting at a party. It is not conducive to cleanliness or confidentiality.'
A spokesperson for the Department of Health told the Irish Examiner: 'The general scheme of the Patient Safety (Licensing) Bill was approved by government on December 12, 2017. It underwent pre-legislative scrutiny at the Oireachtas joint committee of health on June 13, 2018, was subsequently referred to the Attorney General's Office for drafting.
'Legislative priority was given to the Patient Safety (Notifiable Incidents and Open Disclosure) Act 2023 which was commenced in September 2024.
'A decision is now being sought from the Government to recommence drafting of the Patient Safety (Licensing) Bill. A memo for Government will be considered at Cabinet shortly.'
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