**TL; DR Dermal fillers should be better regulated in terms of advertising and administration.** In 2013 former Medical Director for NHS England carried out a review of regulation in the cosmetic interventions sector, encompassing both surgical and non-surgical procedures. It came in the wake of the discovery that breast implants made by French company PIP contained industrial rather than medical grade silicone. Though the surgical teams carrying out the operations worked by the book, the implants slipped past regulation at the point of manufacturing. (1) The author of the report, Brian Keogh concludes that dermal fillers are “a crisis waiting to happen.”(2) In light of this, it is important that dermal fillers are subject to statutory regulation to prevent harm to customers. Where regulation failed in the manufacture of PIP implant, it fails in the administration of fillers. As of January 2021, Botox cannot be administered without a prescription. Although it does not need to be give by the prescribing healthcare professional; that professional does have an obligation to ensure that the administrator is trained and appropriately insured.(3) It is also subject to strict guidelines on advertising, both online and in print. (4) The same is not true of dermal fillers. The industry is largely self-regulating and although bodies such as Save Face offer registers of accredited professionals in line with advice from NHS England, The Care Quality Commission and The Department of Health, engagement is voluntary. (5) When administered safely, dermal fillers are not dangerous. Studies like the JAMA’s 2015 investigation into adverse effects found that they occurred in less than 1% of participants- when administered safely.(6) Perspectives contemporary to the 2013 review leaned towards criticism of the patient/customer; and the legacy of them continues to influence public opinion. (7) It’s a misdirected criticism. In addition to being somewhat patronising, it minimises the vulnerabilities which may lead some people to make that choice. Through social media, dermal fillers are more visible and accessible than ever. Returning to Botox, the ASA highlights that “The Enforcement Notice focuses on social media because this is where we’ve been seeing the most recent breaches of this rule.” If a complaint is received, it will be investigated by their compliance team and the material will be removed. (8) This is the intervention that needs to be made. All of the above being said; concerns that social media exerts pressure to look a particular way should be taken very, very seriously. In one fell swoop it has the potential to intensify anxiety around body image (9) and to promote unregulated services as a solution. These are the vulnerabilities that need to be acknowledged- not dismissed as vanity or recklessness. However, there is a balance to be struck between respecting bodily autonomy and limiting the availability of procedures. Perspectives on consumers need to change- but so does the law on advertising and selling. 1.https://www.imarcresearch.com/blog/pip-breast-implant-scandal 2.https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/192028/Review_of_the_Regulation_of_Cosmetic_Interventions.pdf 3.https://www.asa.org.uk/news/botox-frequently-asked-questions-faqs.html 4.https://www.saveface.co.uk/laws-regulations-non-surgical-cosmetic-industry/ 5.https://jamanetwork.com/journals/jamadermatology/fullarticle/192206 6.https://www.theguardian.com/commentisfree/2012/sep/23/barbara-ellen-pointless-collagen-injections 7.https://www.asa.org.uk/resource/enforcement-notice-botox-social-media.html 8.https://www.bbc.co.uk/news/health-40358138 Additional reading: https://www.nhs.uk/conditions/cosmetic-procedures/dermal-fillers/ https://www.medicalnewstoday.com/articles/320510#key-differences