Leo Varadkar signalled this week that tighter regulation of botox and dermal fillers has been pencilled in for the near future, which is just as well, as the law covering these problem areas has been looking a bit saggy, a touch loose, for some years now.
Unlike the riding-off-into-the-sunset statement he made two days later, the comment raised no eyebrows. The outgoing Taoiseach was, at the time, fresh out of Joe Biden’s White House. It seemed understandable that the spectre of various injectables should be on his mind.
Asked by reporters if he had used botox himself, Varadkar said, “No, not yet, I’m not quite at that stage,” which was a classic politician’s answer, not offending anybody, not creating hostages to fortune, not giving away that his face would soon be rejuvenated purely through the life-changing magic of quitting his job.
His reply was also an old-school one. Varadkar (45), our only Generation X Taoiseach to date, framed his denial in the language of a person who believes botox is something older people get because they think it will help them appear younger, not something that young people seek out because they want everyone to know they have had botox.
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That last sentence felt strange to write, yet both the accounts of aesthetic medicine practitioners and the evidence provided by social media feeds suggest it is true. Botox and fillers are increasingly obtained in order to be shown off. Among certain cohorts, there is no “stage” that must first be reached. The “done” look is the “in” look. To prove that you care about your identity, you are encouraged to choose facial conformity. Why wait?
The post-pandemic vogue is for sculpted features so defined and angular, they are said to be on the verge of the extra-terrestrial. It is now known in concerned quarters as “alienisation”. But at the risk of dating myself by plucking this cultural reference from the back of the VHS cabinet, the mainstreaming of such treatments is not exactly a case for Mulder and Scully.
A cocktail of unenforced, light and non-existent regulation has permitted a black market to flourish, democratising access at the expense of patient safety. Politicians are criticised for being in thrall to the superficial, but when it comes to mitigating the public health risks of cosmetic procedures, interest in the surface of things can wane.
As far as Botox with a capital B goes, Ireland has long had a special relationship. Allergan’s plant in Westport, Co Mayo, is the only production site in the world for Botox, the registered brand name it owns. Botox itself is licensed for use in the Irish market on the condition it is administered by a doctor, a dentist or a registered nurse under the direction of a doctor.
But botox with a small B is also a catch-all term for any product containing botulinum toxin. And, as a six-month investigation by RTÉ has found, unlicensed botox-type products, often originating in South Korea, are routinely and illegally imported into the State, then injected into unsuspecting foreheads by unqualified individuals high on brazenness and low on qualms.
RTÉ journalist Pamela Fraher documents all this in RTÉ Investigates: Botox & Beauty at Any Cost, which aired in the week of the referendums but remains available to watch on RTÉ Player. It contains grim phrases such as “I don’t necessarily need a proper steriliser” and sad ones such as “everyone was getting them done”. My heart broke for the blurred-out woman whose filler treatment left her in “excruciating pain”, corrective action only able to repair her mutilated lips so much.
The programme reveals a gamut of shadiness from surreptitious parcel collections to self-incriminating advice to remove bottle labels to avoid detection. Once RTÉ breaks cover, the retreats beaten are so hasty, they leave scorch marks.
Still, it is easy to see how back-alley botoxers might seem credible and authoritative to the uninitiated. Some of them wear clean scrubs and frame fake medical certificates. Some decorate their walls with pink neon lighting. Some manifest as uncannily blemish-free, as if they come with a pre-applied Instagram filter. These amateurs are smooth. Determined to capitalise on the chronic insecurities of paying customers, they include flattery in their skillset – no, you don’t need that today, just this and this. It’s a form of manipulation that thrives in the face of official indifference.
Maybe demand will always be with us. Maybe a black market will always be poised to exploit it. But a Government that takes the trouble to create a sprawling new regulator to protect vulnerable groups from harmful online rabbit holes should probably address the supply side of the market once in a while. A robust crackdown on unlicensed operators would help.
The promised new legislation, meanwhile, is essential. Age-related protections are currently conspicuous by their absence. Practitioners in England are banned from administrating botox or fillers to under-18s, but no minimum age requirement exists here. Teenage botox? The law says go for it.
Equally wildly, dermal fillers are classified as devices, not medicines, meaning they can be offered legally by anyone who fancies doing so. It was hoped that the Patient Safety Licensing Bill 2016 would bring in regulations governing their use, but the legislation froze in time. Eight years on, it has yet to be enacted.
Now people born even later than Simon Harris are succumbing to “perception drift”, where procedures that once loomed as extreme start to normalise. Harris, as a former minister for health, knows this stuff. He called the issue “a matter of priority” in 2019. No cosmetic intervention can alter the fact that we’ve all aged quite a lot since then.