Mohammed Alshoaiby Saudi Gazette JEDDAH/RIYADH – Plastic surgeons are warning against the increased use of illegal dermal fillers, injectable substances similar to Botox, in the Kingdom. The warning comes amid a string of cases where patients have suffered substantial medical complications, leading to infection and sometimes death, according to Dr. Ahmad Bakhsh, a plastic surgery consultant at the Saudi German Hospital in Jeddah. Fillers are non-surgical cosmetic substances administered to patients in the form of an injection in areas of the face and body to combat the aging process. These fillers must be approved by the Saudi Federal Drug Authority (SFDA) and the Ministry of Health before being used in certified clinics. However, these fillers are being administered in the Kingdom by beauticians, according to Dr. Bisher Al-Shanawani, a plastic surgery consultant and clinical assistant professor at King Saud University. “Not all illegal fillers are the same. Most of them are industrial silicone but we have not been able to determine until now what the components of others are,” said Al-Shanawani. “Some patients complain of hardening at the site of the filler, pain, fevers, discharges, foul smells, weight loss and in some cases these fillers start to affect patients' immunity,” said Al-Shanawani. “Some patients become critically ill.” The worst kinds of illegal fillers are those marketed as permanent fillers. “The problem with them is that once they are in the body, you cannot take them out,” Bakhsh said. Permanent fillers make it difficult and sometimes impossible to remove infections caused by these fillers, he continued, “It might cause the death of the patient due to the severity of the infection.” Another problem contributing to these complications is the time it takes a patient to consult a professional. “These patients seek medical consultation late starting with nonprofessional physicians that treat them conservatively, which may complicate the cases and lead to the need for surgical intervention,” said Al-Shanawani. “The earlier they come the easier the solutions,” said Bakhsh. Both Al-Shanawani and Bakhsh have confirmed that these fillers are being administered in homes by “door-to-door” beauticians along with nail and hair treatments. The main incentive for having these fillers administered by beauticians is that they are cheaper, according to Al-Shanawani. According to Bakhsh, secrecy is another factor, as most women are shy or embarrassed about having these procedures done publicly in clinics. “You have to wonder what people are thinking when they agree to be injected by lay personnel,” said Dr. Joseph Niamtu III, an internationally recognized cosmetic surgeon and author, on his website. “Lately, news reports have featured several high profile cases where patients have sustained serious health problems and even death after injection of industrial substances instead of approved soft tissue fillers,” said Niamtu. According to Coral Gables Cosmetic Center in Miami, FL, a 22-year-old woman died after having a buttocks augmentation procedure done by a nonprofessional. In the Kingdom, Al-Riyadh daily reported the arrest of two Filipino women who ran an illegal filler ring after their injections caused a Saudi woman to fall into a coma. Al-Shanawani, who is also the head of Riyadh Plastic Surgery Club and is building a registry on fillers at King Saud University, said: “We don't know the exact time when illegal fillers first came into the Kingdom. “More than a year ago we started to have a lot of patients complaining of fillers that had been injected two or three years prior.” Last year, more than 14,000 Saudi women had cosmetic procedures done, according to a report from Al-Sharq daily. In a previous Saudi Gazette report, Dr. Ayman Farhat, plastic surgery consultant at Abha Private Hospital, indicated that up to 83 percent of all Saudi women resort to cosmetic procedures, both surgical and nonsurgical. “The most common beauty procedures that Saudi women are scheduling are liposuction, plastic surgery on the nose, Botox injections and fillers, and hair removal by laser,” he said. Plastic surgery is a very selective field in Saudi Arabia. Each year the Saudi Commission for Health Specialties filters hundreds of candidates, with only 11 making it through. There are over 30 hospitals in the city of Riyadh alone, most without a plastic surgeon on staff equipped to deal with these complications. “You will not find a plastic surgeon in every hospital,” said Bakhsh. Al-Shanawani urged prospective patients to undergo procedures at well-known medical centers. “You have to know what material is being injected and ask if it is registered with the Saudi FDA.” Another issue is the use of illegal dermal fillers in medical centers approved by the Ministry of Health. Bakhsh said: “Even some fillers used in centers approved by the Ministry of Health are not approved by the Saudi FDA.”
