On 1st April, Sam was due to fly to Turkey for £15,000 worth of cosmetic surgery. “The plan was to have fat taken from my belly and love handles and put into my bum. Then have my abs ‘etched’ with targeted liposuction to make them look more contoured.” Of course, the global lockdown meant he never got on the plane.
His surgery has been postponed indefinitely.
Aa a self-confessed cosmetic surgery “addict”, the fat transfer and abdominal etching would have been the latest additions to a long list of cosmetic surgeries that Sam’s racked up by age 28”: “nose job, lipo, hair transplant, eye lift… I’ve lost count of how many procedures I’ve had.” He’s spent roughly £70k having work done.
“I’ve not got a new date for the surgery yet and I feel really down about it. There was a week where I was very low. I’m trying hard not to spiral,” he says. “I’d intentionally put on a bit of weight for the surgery – more fat equals a bigger bum – but now it’s just made me insecure.” As a qualified aesthetician with his own clinic, he’s taken to injecting his own stomach at home with “fat dissolving” injections, which use deoxycholic acid to break down the membrane on fat cells.
For years Sam’s done his own Botox (on the forehead and around the eyes) and fillers (in his cheek, chin, lips, and jaw). “I’ve probably got more in now than I would usually because of the boredom of lockdown,” he says.
Having had training, and performed many procedures in his clinic, he feels safe injecting himself (there are other aestheticians that self-inject, but not all agree that it is entirely safe). But with cosmetic injectables classified as a “non-essential service” since 23rd March – and with businesses offering personal care which requires close proximity not due to reopen until 4th July at the earliest – ordinary people with zero experience in injectables have been driven to a DIY approach.
Dr Sabrina Shah Desai, a reconstructive and cosmetic surgeon in London, is seeing the fallout from amateur self-injecting during lockdown. “It’s scary. I am hearing about patients just watching a YouTube tutorial and then injecting,” she says. “One woman injected her own lips with filler she’d bought online and suffered a vascular occlusion – blindness.” (In rare complications, dermal fillers can block blood vessels in the face leading to loss of vision). “You have to remember fillers are essentially biodegradable implants. Botox is a chemical neurotoxin that can cause facial paralysis if administered incorrectly. An infection is the least of your worries.”
So why are people willing to take such a huge risk?
“In these cases I think there’s almost certainly an element of dysmorphia,” says Dr Shah Desai. Dysmorphia – an anxiety-based mental illness where sufferers develop an excessive, negative preoccupation with a part of their appearance – is thought to affect between 1 – 2% of the population, but between 7% and 15% of people seeking cosmetic surgery. The stress and anxiety of lockdown may exacerbate some people’s dysmorphia. “If you are recklessly self-injecting like this, there could be an underlying mental health problem. It affects your capacity to analyse or understand the risks.”
It’s not just blackmarket injectables that people are experimenting with during lockdown.
Plastic surgeon Dr Olivier Amar is concerned that those who have regular clinical treatments may overestimate their ability to administer potentially dangerous treatments themselves, buying chemical peels and cosmetic devices – radio-frequency machines, LED lasers – from dubious online sources, some of which are not properly regulated and can seriously damage the skin causing burns and scarring. “You can’t become a cosmetic doctor overnight,” he says. “Being unable to access your usual clinical treatments can have a negative impact on people’s self-confidence and mental health, but when people try and perform these home alternatives it can be incredibly dangerous. Particularly when people try to “boost” the efficacy of a device using settings that are too intense.”
For patients who don’t want to risk a DIY disaster, but are still determined to get their fix, some are seeking “underground procedures” by “unethical practitioners”, says Dr Shah Desai. “I’ve seen adverts for drive-thru Botox, where it’s administered through an open car window. It’s crazy.” The timing of lockdown may have amplified the demand for blackmarket procedures, too, she says. “A lot of people have their Botox pre-Christmas; October, November, December are insanely busy for most aesthetic practices. Botox starts wearing off between three to five months. Many people would have come back in March, April, May for top-ups. So it’s the perfect storm.”
Dr Shah Desai has even had individuals contacting her clinic asking for off the books work, which she has refused.
Sam’s clinic had similar enquiries. “I’ve had people offer me double, triple the usual fee to break lockdown and visit their homes for treatments,” he says. “I was even contacted by a woman who was desperate to have vaginal tightening [where a rotating “wand” emitting high-intensity ultrasound contracts the muscles] during lockdown. But I would never do blackmarket procedures.”
There are clearly practitioners who will, though.
In mid-May the All Party Parliamentary Group on Beauty, Aesthetics and Wellbeing (APPG BAW) launched an inquiry into non-surgical procedures in the UK due to reports that “rogue operators” have been flouting government restrictions during the pandemic, and alarm over the increased risk during lockdown of people buying “aesthetic kits” containing prescription-only substances for DIY use.
Of course, when it comes to more invasive surgical treatments requiring a general anesthetic and operating theatre, there are no “backstreet” options. And international travel restrictions have had a significant impact for many cosmetic surgery patients who have scheduled procedures abroad, where costs are often lower and the only way they can afford to do them.
Border closures have derailed Star’s surgery plans this year. At 32, she has “probably been under the knife 30 or 40 times”. Adamant her plastic surgery is not fuelled by dysmorphia (“I’m just addicted to looking sexy and young and nice”) her surgeries include a brow lift, breast and bum implants, liposuction and four nose jobs. She was meant to fly to Brussels a few weeks ago for a facelift and necklift, which has been cancelled.
“I’m really pissed off about it to be honest,” Star says. But she also has to contend with urgent maintenance issues. “Once you start changing the structure of your face and your body, you’ve got to maintain it. My boobs are a right mess at the moment, they’ve tripled in size and are so heavy. I look terrible. I look weird. And I need my bum implants removed too, they’re dragging on my spine and it’s painful.” She is waiting for Colombia to open its borders in August so she can travel immediately for the bum implant removal.
There has been one silver lining in lockdown for Star: “My face looks better because I haven’t been on all the fillers. My lips and my cheeks have gone down which I’m happy about. I look better, facially.”
For dedicated “tweakment” fans, the forced break in their regime has been the first time they’ve seen their face naturally in years. Tracy, 32, has spent £60,000 on cosmetic procedures – including rhinoplasty, labiaplasty, and three breast augmentations – and has had regular Botox for almost six years, with top-ups up to every month if she has lots of events in her diary. The last time she had Botox, a “mini” dose, was 12th March.
“I have missed not having it. I have noticed a difference in my face. I can screw up my forehead and create several frown lines.” But surprisingly, she’s not hating it. “I’m able to be more expressive with my features. It’s nice to see what I look like without Botox. It’s a way of peeling back the layers,” she says, adding, “I don’t feel as false. And people are a bit nicer to me, because I don’t look as outrageously different.” Still, she will be “first in the queue” for Botox after lockdown is fully lifted. “I hopefully won’t turn into a robot when I go back. But I’d definitely like a spruce up.”
Post-lockdown waiting lists for cosmetic procedures are growing longer and longer. Dr Shah Desai’s waiting list for both injectables and surgical procedures is “insane”, with 200 people and counting. She can understand some of her patients’ impatience. “You can get gelato and a Starbucks – but you can’t get Botox. Patients can’t understand if they’re having a procedure by a medical professional who is taking all the right precautions, why it is being controlled. Some of them are really upset. They get used to looking a particular way. Yes, these lines and wrinkles wouldn’t bother many of us but we can’t ignore there is a huge group of people who it does bother – quite significantly.”
Sam’s aesthetic clinic now has “well over 300 people” on its waiting list. In fact, he plans to create two new treatment rooms post-lockdown to deal with the spike in demand. In terms of his own relationship with cosmetic procedures, despite his regular self-injecting regime lockdown has made him examine his motivations. “I realised because I’m not in social situations, I’m not around people, I don’t feel so judged about my appearance. So all this time I’ve been saying this is for me, maybe I do do this for other people.”
However, this won’t be the end of his plastic surgery odyssey. “Ultimately, it’s something I will never stop, it’s something I enjoy. I can’t wait to get back under the knife.”
Read next: This is what 10+ years of Botox looks like