Our new series, Closer Look, takes a deeper dive into the controversial, critical, and of-the-moment issues facing doctors and patients in aesthetic medicine.
Like many beauty influencers of her generation, 21-year-old Genesys Skye uses hyaluronic acid fillers to achieve full, plump lips. “I’ve been getting my lips done for a while,” she says. Until earlier this year, she’d normally schedule an appointment at her local medspa for a lip top-up. But one day, while scrolling through Instagram, she saw an ad for Foxy Fillers, a U.K.-based supplier of dermal fillers. “When I realized I could legally buy legitimate filler at a good price, it appealed to me,” she says.
Michael Byrd, a Dallas-based attorney specializing in medical aesthetics, takes issue with the terms “legally” and “legitimate,” however, explaining that “filler, in the United States, is a prescriptive drug—and some states have laws against possessing a prescriptive drug without a prescription.” Moreover, Byrd says, “it’s illegal for Foxy Fillers to sell and dispense fillers to people in the U.S. without a valid prescription.” Plus not every product sold by Foxy Fillers is FDA-approved, so “there can be no certainty that [what one buys online] is a legitimate filler.”
Nevertheless, Skye ordered two syringes of Juvéderm Ultra from the site. Three weeks later, armed with medical-grade numbing cream and guided by hours of YouTube tutorials, she injected her own lips at home. “I honestly had been watching YouTube videos on it for years, and I’d also ask [my injector] a lot of questions whenever I got my lips done professionally. I’d hold up a mirror and watch them inject and ask what techniques they liked or why they’d aspirate—which is when they kind of pull back the syringe right before injecting, to see if they’re in a vein.”
“I’m really happy with my results,” she says. “It came out exactly how I want it.” Based on the results in her lips, Skye has gone on to inject her under-eye area with filler too. “It was scary at first, but now I’m not scared at all to inject myself,” she says. “Nothing’s ever gone wrong while I was doing it.”
Skye is one of a growing number of self-proclaimed DIY beauty enthusiasts who perform their own professional-level procedures. Compared to the millions of people who see healthcare providers for these treatments, the DIY community is tiny. Still, it’s larger than you might think: one private Facebook group has nearly 10,000 people, discussing everything from injecting botulinum toxin to inserting threads into their cheeks.
One of the best-known figures in this digital subculture is Kimberly Pratt, aka Natural Kaos, who looks more like a college student than the 37-year-old mother of four that she is. (If you met her, you’d absolutely ask for the name of her dermatologist.) Her curiosity about DIY cosmetic treatments was piqued in 2013, when she realized that professional-grade products were only a few clicks away. “I’d been having TCA peels done with Dr. Suzanne Kilmer [in Sacramento, California,] and lower-grade peels in aestheticians’ offices, but I’d just had my fourth baby and was tired of trying to schedule appointments,” she recalls. “My sister is a hairdresser, and she said, ‘You know, you can buy that acid online.’ Sure enough, I was able to. That was the gateway drug.”
Since then, Pratt has become a leader of the self-serve nonsurgical beauty movement. More than 51,000 subscribers follow her YouTube channel, where she shares videos of herself performing various DIY “rebellious skin care” treatments like microneedling, platelet-rich plasma (PRP) injections, and hyaluronic acid lip-filler injections with Belotero. She emphasizes that she’s not dispensing medical advice or providing training. (Practicing medicine without a license is illegal in every state.) “I look for things that are available to anybody who could go online and buy them,” she says. “I bring them to my house and I troubleshoot them, just like anybody else would. I think sharing that journey, and making it extremely relatable, is why people are so loyal.”
Her videos have garnered attention, not only from subscribers but also from at least one pharmaceutical company. “The only reason I don’t have my Botox or lip injection videos up on YouTube anymore is because the pharmaceutical companies and the injectables nurses didn’t like it,” Pratt says. In June, an attorney from Merz Aesthetics sent her a message advising her that the product she used in her video, Belotero Intense, is not FDA-approved and requesting she remove the content from her channel. Pratt declined to do so, but within days, she says, YouTube notified her of its removal due to a copyright claim by Merz. “The pharmaceutical company didn’t like the fact that I showed the loophole in how you could get their filler, because they want [the filler] to be FDA-approved,” she says. “What I’m doing is not illegal.”
In truth, legality here is a bit of a gray area. In some states, such as Washington, possession of prescription medicines without a proper prescription (and no intent to sell) is actually a misdemeanor, explains Byrd—though not a popular one to prosecute. “I’m not aware of a consumer getting into trouble yet.” For consumers, he notes, the main issue is not the potential legal risk but the clinical one.
Still, thousands of DIY diehards are willing to take a chance if it means being in control of their skin-care destiny. “I’m never going to say that there’s not a risk,” Pratt says. “But if you find statistics on vascular occlusions, they are crazy low. The risk of dying in a car accident is far greater, and people are still getting in that car and driving every day.”
One could argue, however, that such figures are based on filler injections administered by healthcare professionals—not DIY amateurs devoid of training.
Some people are drawn to DIY beauty for the empowerment factor, but the biggest draw is that, well, it’s cheaper. “The price difference is absolutely crazy,” Skye says. “At LaserAway [a medspa chain], I used to pay $650 for one syringe of Juvéderm, compared to $330 for two through Foxy Fillers.” Neurotoxins imported from Korea can cost as little as $1 per unit—a small fraction of the price of FDA-approved drugs like Jeuveau and Botox Cosmetic through a doctor’s office.
As thrilled as DIY devotees are about taking matters into their own hands, doctors are exponentially more outraged by the idea. “The do-it-yourself route is the most alarming new trend in the aesthetics industry,” says Dr. Jessica Weiser, a board-certified dermatologist in New York City. “If a patient, friend, or anyone were to inquire about these practices, I would absolutely instruct them to avoid this at all costs.” She adds that potential complications—everything from skin death to infection to loss of sight—are drastic enough to far outweigh any potential benefits.
Ironically, the DIY movement may owe much of its growth to well-intentioned doctor-helmed social media accounts that inform and educate. But if an experienced dermatologist or plastic surgeon makes an injection look easy on Instagram, it’s likely because they’ve done it thousands of times. “Social media, especially YouTube and Instagram, make it seem like anyone can do anything,” says Dr. David Colbert, a board-certified dermatologist in New York City. “It doesn’t take into account the 12 years of training that a real dermatologist goes through.”
Moreover, as injectables become increasingly mainstream, many people view these aspects of their beauty routine as little different from, say, a brow wax or root touch-up. “By seeing injectable treatments be made more and more casual, akin to hair blowouts, there is an extremely false sense of ease associated with neuromodulators and filler injections,” says Dr. Weiser. “But buying injectables online is incredibly dangerous. You cannot ever know if the product is authentic, if it is pure, if it is sterile or contaminated.”
Some DIY enthusiasts perform a “patch test” on their arm, to see if their skin reacts to filler, but there’s no way for the average person to lab-test Internet-purchased products. Essentially, you have to have faith that what you’ve ordered is what you’re getting. (Yet anyone who’s ever added a name-brand lip kit to her cart only to tear open a knock-off two days later knows how common counterfeit everything has become.) Glowing online reviews can be faked; products can’t always be traced to a manufacturer.
Dr. Gary Linkov, a board-certified facial plastic surgeon in New York City, recalls a patient who purchased hyaluronic acid filler online and wound up with what was likely a counterfeit formula. “Everyone told her that it wasn’t legitimate, and so she couldn’t find someone to inject her,” he says. “When she went to return the product, surprise—the site no longer existed.”
That patient, he says, took a financial hit, but she was fortunate to avoid disaster. Others are less lucky. Dr. Linkov describes encountering an aesthetician who, having watched videos online, attempted her own liquid rhinoplasty—injecting filler into the nose to give it a straighter or more proportionate appearance. Even for doctors, this is a risky procedure—so risky, in fact, that many highly qualified dermatologists and aesthetic surgeons flat-out refuse to do it. Performed incorrectly, it can lead to tissue loss and irreversible blindness.
“She texted me a photo of her nose, and from what she told me, she didn’t inject in the right location,” he says. Within a short time, the woman developed early vascular compromise—a condition that occurs when filler blocks an artery—and her skin began to change color. “I advised her to come in immediately so I could treat her with the reversal agent [an injectable enzyme called hyaluronidase], because she could lose the skin over her nose and potentially have even worse complications.” Dr. Linkov was able to save her skin, but he still sounds incredulous: “Why would you do that? Why would you inject yourself? Especially if you don’t even know for sure what material you’re injecting—God knows, it could be silicone, which is permanent.” Injectable silicone can be removed only with excision surgery—a painstaking and potentially disfiguring operation.
Related: Are Silicone Injections Ever Safe?
Dr. Linkov acknowledges that these decisions are usually driven by a desire to save money and that complications are rare—but when they do happen, fixing them isn’t cheap. “If there’s a bad complication, taking care of that is going to cost a lot more than an injection,” he says. “People save a little money up front, but it could end up being a lot more expensive, if there is a problem.”
For their part, DIY fans Pratt and Skye are adamant that they would inject only themselves, never someone else. “I would never want to hurt anyone else or cause any complications,” Skye says. “I think that would make me feel guilty for the rest of my life.” Yet for a small minority of do-it-yourselfers, the lucrative allure of injecting others is too tempting to resist. In November, a 29-year-old German influencer was found to have injected at least 35 women with filler. “This story was all over German news,” says Dr. Timm Golueke, a Munich-based dermatologist and the founder of Royal Fern skin care. “The influencer was advertising via her own Instagram account, treating ‘patients’ in hotel rooms and in her apartment, and injecting without any insurance”—and earning an estimated $500,000 in the process. The influencer, whose name was withheld by authorities, did not use proper sterilization measures, which led to post-procedure complications. She’ll soon begin serving a four-year prison sentence.
All the doctors interviewed for this story strongly discourage doing injections and other professional-level treatments at home—no matter how simple they may appear online. “Nobody is voluntarily performing orthopedic surgery or colonoscopies on themselves because it looks easy,” Dr. Weiser says. “Medical injectables should be seen as similarly dangerous and treated with similar caution and respect.” For self-injectors like Skye though, the absence of complications (so far) is evidence of safety. “A lot of people may think I’m crazy, or say that it’s really bad to inject yourself,” she says. “But I’ll probably stay DIY for the rest of my life, when it comes to fillers.”
