All beauty consultant Hanisah Ahmad (not her real name) wanted was to enhance the appearance of her nose. But she never imagined the cosmetic procedure she had made two years ago would leave her scarred for life.
A beautician, claiming to have been trained in aesthetic beauty, performed the procedure in less than five minutes. But Hanisah wasn't given any anaesthesia and endured severe pain during the treatment.
"Three hours after the procedure, I felt a tightening sensation in my forehead. It was painful and my face looked bruised. Two days later, the problem worsened as the bruising didn't go away. The skin of my nose later turned gangrenous," recalled the 58-year-old from Johor.
Desperate, she consulted a plastic surgeon and learnt that the filler used was a counterfeit product.
"The skin around my nose was damaged and my blood vessels were clogged. After removing the dead tissue, I had a gaping hole through my nasal cartilage. My nose had to be reconstructed using skin and cartilage grafts from other parts of my body. I now have a reconstructed nose and am still undergoing treatment," she said.
Not worth the risk
Truth is, we aren't like Benjamin Button (the fabled man who ages in reverse). We want to look good as we grow older but with ageing comes wrinkles, sagging skin and pigmentation.
Author Paula Begoun (The Beauty Bible and Don't Go To The Cosmetics Counter Without Me) on her website, paulaschoice.com, said that no skincare products work as well as botox or dermal fillers.
"Dermal fillers are one way to help get your youthful appearance back. In fact, when celebrities, models and women all over the world age 45 or older have facial skin that looks really smooth, plump and young, you can bet a big part of the reason is that they have had dermal filler injections," she said.
Even in war-torn Baghdad, there's a newly-opened Barbie Clinic offering various treatment from lip fillers, facelifts to liposuction.
The article Iraq's traumatised women seek Botox as alternative to therapy on www.middleeasteye.net said that Iraqi women were using beauty treatments as an avenue of escape for the psychological pain they felt.
It's a phenomenon that's not unique to Iraq alone. Lebanon, for instance, is experiencing a huge and well-documented plastic surgery boom in the wake of its brutal civil war.
But dermal fillers are expensive, with the price of licensed injectable fillers costing between RM1,800 (S$645) to RM2,800 per ml in the market. So when there are cheaper alternatives, consumers unknowingly buy them without knowing the dire consequences.
Cosmetic injectables manufacturing company Galderma's head of regional centre of excellence (Asia-Pacific) Scott McLennan said in a press release that with more people undertaking cosmetic procedures, the temptation to seek cheaper alternatives may seem to be too good to be true.
Unfortunately, it often leads patients on a dangerous and painful path.
"The use of unapproved, unlicensed cosmetic injectables, including fillers can result in unwanted, undesirable and permanent issues that leave patients scarred for life. The practice of prescribing and administering these products is a dangerous one which the majority of licensed health care practitioners don't undertake," said McLennan, whose company manufactures hyaluronic acid-based dermal filler Restylane.
Malaysian Society of Aesthetic Medicine president Dr Hew Yin Keat said the past few years has seen an explosion in the availability of fake dermal fillers.
"More alarming is the rise of counterfeit fillers, claiming to be produced by well-known brands in the market, appearing at beauty expos. These fake products are sold at prices far below originals costs," said Dr Hew, adding the sale of such products are readily available on social media platforms such as Facebook and Instagram.
On websites fillerworld.com and dhgate.com, various beauty enhancements such as collagen lip injections, permanent dermal fillers and hyaluronic acid dermal fillers can be purchased with a few simple clicks of the mouse. With prices as low as RM80 for a filler injection, it's alarming how women are risking their looks and life without knowing the products' authenticity.
Even more worrying is how unlicensed beauticians and massage therapists are administering aesthetic treatments. There are even YouTube links giving viewers practical hands-on sessions of how dermal injectables work.
"It requires skill and trained doctors to inject fillers on patients without complications. It would be reckless to buy fake fillers online and injecting it yourself while looking into the mirror," Dr Hew said.
Counterfeit fillers - often produced in unhygienic and non-sterile conditions - may contain harmful ingredients such as silicone, which are not naturally absorbed by the body.
The face has dozens of muscles, hundreds of blood vessels and thousands of nerve fibres. A misplaced needle carries the risk of infection, scarring, nerve damage, and even blindness and death.
"Unlike counterfeit apparel and electronics, using fake medications and medical devices can lead to serious consequences that may leave permanent and irreversible damage, and cause catastrophic impact to health," Dr Hew said, adding reactions of fake fillers can also lead to complications when undergoing other injectables or treatments with medical devices.
A 2006 article "Fake products can bypass quality, safety", the Los Angeles Times reported that a Californian woman died after receiving a supposed botox injection that was actually cooking oil.
In Miami, a group of people who thought they were getting botox became paralysed after a different, highly concentrated form of the deadly botulinum toxin intended for research purposes was injected into their faces instead.
MCA Public Complaints Bureau chief Datuk Seri Michael Chong said there have been 10 cases of botched facial treatments reported since 2013. But he feels it's just the tip of the iceberg.
"Although I have received many calls from women who have undergone botched treatments, only a handful come forward for help. Most of them are embarrassed as they undergo these procedures in hotel rooms by fly-by-night doctors from overseas, without their spouses' knowledge."
How would buyers know if a product is fake?
Dr Hew explained that fillers can't be sold directly as only medical professional are allowed to administer these products. Any product bought off the Internet is either fake or unregistered.
Another clue is the filler treatment is offered at an unregistered medical facility (without a valid licence from the Health Ministry) or administered by a doctor without a licence to practice aesthetic procedures.
"Consumers should know what kind of product they are getting for treatment. There are many types of fillers and even within a type of filler, there are differences in their properties. If you are denied information of a product, treat this as a red flag that something is not right," Dr Hew explained.
Despite concerns, regular botox user Sharon Liew, 38, thinks beauty enhancement treatments are safe, provided professionals conduct these procedures.
"My mother has deep frown lines which appeared clearly when I took photos. In 2012, I tried botox to smooth out the lines and prevent more from forming on my own forehead.
After hearing so many horror stories about botched surgeries, I went to a professional aesthetician doctor and I've been happy with the results," said the marketing manager, who undergoes botox treatments once in eight months and spends about RM2,100 per injection.
Liew said it was vital to consult trusted aesthetic doctors, plastic surgeons and dermatologists for facial enhancement treatments.
"Do proper research and don't be attracted by low prices. You are injecting something into your face that could potentially scar you for life. The doctor's credentials are super important and it's best to get recommendation from a friend who's been to the doctor," concluded Liew.