Illegal aesthetic injections: in Occitania, investigation of a low cost market that can turn into a tragedy

“Not a week goes by without a report …” Aesthetic doctors are warning about illegal injections of hyaluronic acid, offered at low cost on social networks and which can be responsible for necrosis, blindness and even stroke. In Nîmes or Montpellier, we went to meet these “clandestine injectors” who offer the lips, a nose or a chin of stars for a few hundred euros.

Hyaluronic acid injected into the faces of young women by more or less professional beauticians, who promise to look like American stars. The trend has been raging for several years on social networks and pushed, this Thursday, January 6, the National Syndicate of Reconstructive and Aesthetic Plastic Surgery to sound the alarm. “Not a week goes by without receiving reports of patients with sequelae that are sometimes so serious that they lead to hospitalization. We doctors can no longer stand by and do nothing. We must alert the population, justice, public authorities… ”, rages Dr. Adel Louafi, president of SNCPRE.

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€ 250 for the “mega injection”, € 600 to redesign our chin

The problem is not new. It was identified in France in 2018. But it is expanding rapidly throughout the country, and in particular in Occitania. All we needed was a fake profile on the social network Instagram – 22 million monthly users – to verify it. In Montpellier, Nîmes or Béziers, dozens of virtual institutes offer hyaluronic acid injections at discounted prices. On the social network that serves as their showcase, the photos of luscious lips scroll, accompanied by the keyword #RussianLips, the name of the technique used.

“There is no traceability on the products used”, warns Dr Adel Louafi

In a few minutes, contact is established with a young woman who introduces herself as a “cosmetologist”. Based in Béziers, she promises us to “become the best version of ourselves at attractive prices”. € 250 for the “mega injection” of hyaluronic acid in the lips (2 ml), € 160 for the correction of the nose, more than double for a Botox rejuvenation and up to € 600 to redesign our chin in Kylie Jenner fashion, the American influencer with 300 million subscribers.

The injections are sometimes done in the back kitchen, without changing the needle or respecting hygiene standards.

Same proposals with another “beauty specialist”, who comes to his home in Montpellier. The speech is professional. “Hyaluronic acid is naturally present in our body. There is no risk if the person knows his job well. I am perfectly formed ”, reassures us the young woman, indicating in passing that she worked in hospital intensive care.

On the client side, the fortunes are diverse. While the majority of young women we interviewed are delighted with the interventions, some confirm failures. “I ended up with a huge upper lip and a very flat lower lip. I then realized that the person who injected me had lied about his skills and that the photos she had posted on social media were wrong. But with the second injection, everything went well … “

If the business of hyaluronic acid injections is so flourishing, it is because the product is still available over the counter on the internet and in pharmacies today. In three clicks and against sixty euros including delivery, we were able to obtain around forty milliliters. And at that price, an explanatory video is even included with it.

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The illegal injection of an over-the-counter product

“There is no traceability on the products used, which may come from counterfeits or brands prohibited in France., warns Dr Adel Louafi. Our investigations have shown that the injections are sometimes done in the back kitchen, without changing the needle or respecting basic hygiene standards… ”

In the sights of aesthetic physicians, “Clandestine injectors” of cours. But also Instagramers “Who use their notoriety to promote an illegal practice to a young audience that trusts them”. And pharmacists. “We are talking about almost mafia networks where everything is done in cash. When someone walks into a pharmacy to buy ten boxes of hyaluronic acid in cash, as a health professional, we have to ask ourselves questions… ”

the "Russian Lips", the fashionable injection technique.

The “Russian Lips”, the fashionable injection technique.

Nine complaints filed for “deception” and “illegal practice of medicine”

At the beginning of September, the National Syndicate of Reconstructive and Aesthetic Plastic Surgery (SNCPRE) decided to take legal action. Nine complaints for “illegal practice of medicine” and “deception” were filed through Me Fayon, lawyer at the Paris bar. Since hyaluronic acid is over-the-counter, it is the act of injecting it for remuneration and without medical training that is the subject of these actions before various courts in Île-de-France and the PACA region.

“These complaints target people who illegally offer cosmetic injections on Instagram, specifies Me Fayon. These are only nine cases and we are well aware that they are much more numerous everywhere in France. But we have to make an example, if only to warn those who would like to get into this business of the risks they run. “

For illegal practice of medicine, French law provides for up to 2 years in prison and a fine of 30,000 euros. For deception resulting in danger to people, 7 years and a fine of 770,000 euros. At the same time, a copy of the complaints was sent to the regional health agencies (ARS) and to the General Directorate for Competition, Consumption and Fraud Control (DGCCRF).

But professionals also hope that this lawsuit will act as an electric shock for the victims. “They are still few to file a complaint, mainly because they are afraid and they are ashamed. Some also wonder if they can be held responsible for having requested an illegal act. Our approach is also there to free them from guilt. and reassure them of their victim status. Tell them that they are not alone “, concludes the lawyer. Several investigations were opened following these complaints.

Necrosis, blindness, stroke … “in the event of a problem, you have to know how to react quickly”

Dr Benoit Henault is a surgeon in Nîmes, specializing in plastic, reconstructive and aesthetic surgery. For this professional, used to handling hyaluronic acid, the consequences of improper use of this product can be dramatic.

Dr Benoit Henault, plastic surgeon in Nîmes.

Dr Benoit Henault, plastic surgeon in Nîmes.

Can we consider hyaluronic acid, however over the counter, as a dangerous product?

In aesthetic medicine, we use hyaluronic acid as a filling product. It has very good safety. Even if it is necessary to know the exact composition of each product according to the area to be injected, hyaluronic acid does not present any danger in itself. This is why we find it quite easily, on the internet or in pharmacies. Serious complications come from the injections. They happen when hyaluronic acid ends up in a place where it shouldn’t be.

What is the risk of a bad injection?

The least serious and most common risk is above all not being satisfied with the result. In case of poor hygiene, one can also be exposed to abscesses at the injection site. But the big complication, the one we fear, is the intra-vascular injection. If hyaluronic acid gets into the veins or arteries, it can cause terrible necrosis with patients who lose part of their face and have to go through reconstructive surgery.

The risk increases if the person injecting does not have the right knowledge

How far can complications go?

If the product migrates to the arteries in the eye, then you can get blind. If it continues on its way and goes back up into the brain, there is a risk of a stroke. These are complications that are rare, but the risk increases if the person injecting does not have the right knowledge. The anatomy of the face is very complex. Even a general practitioner who has not been specifically trained cannot master it. And in the event of a problem, you have to know how to react quickly, with the right diagnoses and the right products. There is an enzyme that cancels the effect of hyaluronic acid, hyaluronidase. But only doctors can get them.

Is there also a broader health risk?

From the moment a needle is used for injection, a very strict procedure should be followed to avoid cross infection in particular. We professionals, we use rigid collectors which are then collected by specialized companies. Throwing these needles in the household trash is a risk …

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