Dr Lam Bee Lan from Ageless Medical Centre gives the lowdown on how injectable treatments administered by people who are not medically trained can be dangerous to health.

Have you come across any reports on (1) original/ fake injectables being put on sale online (2) original/fake injectables being imported into Singapore (a) not through authorised distributors (b) sold to non-doctors? Please describe one or two case studies if you have come across.

1) Yes. You just need to go online and you will find many different renowned brands of injectables being offered and sold such as Restylane, Juvederm, Botox and Dysport, to name a few.

2) I have patients telling me that their friendly beauty therapists or manicurists offer to inject their faces with botulinum toxins and fillers, and asked me if these injectables are safe and if they are allowed to do so. These injectables are apparently imported from other countries. My patients were also told that beauty therapists have apparently been trained by Korean doctors to do the injections. They were even shown before-after pictures so that they can be convinced to take up the treatment.

  1. Have you come across cases of medical doctors purchasing injectables online instead of through authorised distributors? Why don’t medical doctors do this? Do medical doctors face consequences if they purchase injectables online?

Health Science Authority (HSA) in Singapore has very stringent requirements when it comes to licensing and allowing a medical product, let alone an injectable, to be brought into Singapore. None of the doctors I know will risk purchasing injectables online instead of through authorised distributors. The medical doctors will face serious legal consequences if these injectables are not genuine and cause complications to the patients. The authorised distributors who carry the injectables will not be able to support the doctors if fake products are used. The stringent requirements of HSA help protect both consumers and doctors.

  1. What are the risks that consumers undertake when they (1) purchase injectables online (2) administer the injectables themselves or ask untrained individuals to administer the injectables on them? Why is it crucial for consumers to go to medical doctors for their aesthetic treatments?

In Singapore, due to the stringent regulations, all injectables (anything that is injected into the skin) such as fillers and botulinum toxins injections, are prescription medical grade products that legally can only be sold on order of a prescribing physician/doctor.  In short, only licensed doctors can order injectables and only licensed doctors can use them on patients. So if you are not a doctor, it is illegal to order any form of injectable online; injecting yourself or others with these online injectables can be very dangerous.

Secondly, one cannot be sure what sort of product one is getting online; it’s hard to judge a product by the packaging and the packaging can be very sophisticated and appear to be genuine. You run the risk of injecting counterfeit or contaminated products and cause severe, irreversible damage to your face.

Thirdly, all doctors who use injectables for aesthetic purposes on patients are required by Ministry of Health (MOH) to undergo training and obtain a Certificate of Competence.

In order to obtain good, aesthetically pleasing results and prevent complications, the doctor needs to have good knowledge of injecting, a very clear and good understanding of the facial anatomy, good sterility techniques, knowledge of the possible complications and side effects, and good previous injecting experience. Injecting fillers and botulinum toxins into the face is not a DIY procedure.

Take for instance botulinum toxins; it has to be kept refrigerated at all times to maintain its effect and reconstituted correctly to prevent complications. If the fake botulinum toxins are overdosed and wrongly reconstituted, it can cause respiratory arrest in patients and be life-threatening! This is because the actions of botulinum toxins is to relax muscles, and if the dose used is too high, it can diffuse into the blood stream and reach the chest muscles and cause the patient to stop breathing.

Some filler injections are also contaminated with silicone oil, which are permanent products and not biodegradable like hyaluronic acids and cause irreversible damage to the face.

  1. Have you come across patients who have approached you to ask to correct botched treatments? What would be the appropriate response for a medical doctor if he or she comes across such a situation?

Yes, I have quite often received requests from patients to correct botched jobs done by non-doctors. Often, they involve permanent fillers which are very difficult to remove except by surgical excision.

Usually I will get a detailed history to find out as much as possible what has been done and injected into their faces, to see if they can be treated by my injecting hyaluronidase, an enzyme, to dissolve hyaluronic acids fillers or by using Accusculp, a type of laser to help melt away the fillers. Otherwise they may need to be referred to a plastic surgeon to have their permanent fillers surgically removed

  1. What can consumers do to curb the demand of parallel import injectables into Singapore and fakes?

Be informed and educated. Do not visit non-doctors to have fillers and botulinum toxins injected into your faces or bodies.

If we are so cautious about what we eat, and we stay healthy by exercising regularly, even wash our hands before our meals, then there is no reason why we should allow unknown and foreign materials to be injected into our faces and bodies by untrained persons and risk the complications and side effects.

  1. What should a consumer look out for when considering an aesthetic procedure such as botulinum toxin injections, fillers or even laser treatments?

Make sure you go to a clinic and be treated by a doctor who is trained in giving the injectables. They must have Certificates of Competence. Read up about the various procedures and ask questions about the procedure before undergoing the treatment.

In Singapore, all lasers, too are required to be performed by doctors and the doctors will also need Certificates of Competence to perform laser procedures on patients.

Dr Lam Bee Lan, Medical Director, Ageless Aesthetic Medical Centre. She has over 20 years of experience as a general practitioner and an aesthetics physicians and she trains for the following injectable brands: Q-Med Galderma (Restylane fillers), Allergan (Juvederm fillers and Botox injections) and Menarini (Dysport Botulinum Toxin Type A injections).