Every week patients come to my office with the same story. A friend recommended a “really good and cheap” place. A “very skilled” girl who works from her apartment, or from a hair salon, or from a place that presents itself as a beauty center. They put filler in her lips, or in her nasolabial fold, or did rhinoplasty. And something went wrong. Sometimes it is an asymmetry that does not go away. Sometimes it is an infection that progresses. Sometimes it’s something worse: a necrotic area, tissue that begins to die because the product was placed in the wrong place by someone who didn’t know what they were doing.
I write this not to scare, but because I believe that there is information that people deserve to have before making a decision that can mark them for life. Aesthetic medicine has become a territory where serious and trained professionals coexist with a parallel market that operates without controls, without authorizations and, in many cases, without the slightest notion of the risks it is generating. And this parallel market is growing, among other reasons, because no one speaks clearly about what can happen when things go wrong.
Let’s start with the basics: any procedure that crosses the skin barrier is a medical act. It doesn’t matter what it’s called, it doesn’t matter how it’s promoted on social media, it doesn’t matter if the person doing it has years of empirical “experience” or a weekend course. Injecting hyaluronic acid, applying biostimulators, performing rhinomodeling or lip augmentation are procedures that are performed on living anatomy: blood vessels, nerves, deep tissues of the face. The difference between a well-placed injection and a poorly placed one can be measured in millimeters. And those millimeters, in areas such as the forehead, between the eyebrows or the nasal region, can mean the difference between an aesthetic result and a medical emergency.
When I talk about a medical emergency I am not being dramatic. Serious complications exist and are documented. Poorly applied fillers can cause vascular occlusion: the product blocks a blood vessel and the tissue supplied by that vessel begins to die. The result can be visible necrosis, a permanent scar. In the most extreme cases—which occur, although they are rare—a poorly placed injection in the forehead area can lead to temporary or permanent blindness, or a cerebrovascular embolus. In any of these situations, the person who must act in the first minutes is the professional who performed the procedure. You need to know how to identify the condition, have the hyaluronidase to reverse the filler, know how to apply it and know when to call an emergency. A cosmetologist, a stylist or an eyelash applicator converted into a “filler specialist” does not have that training. Not because he is a bad person: because he never received it.
The legal framework in Argentina is clear. Cosmetologists and cosmiatricians have a defined field of practice and can be valuable assistants within a medical team, but responsibility for invasive procedures always corresponds to the licensed doctor who leads that team. What is happening in thousands of hair salons, departments and premises without health authorization is not a gray area: it is the illegal practice of medicine. The Argentine Society of Dermatology receives complaints every day. The ANMAT has intervened on repeated occasions, seizing products without health registration found in beauty centers: Chinese-made fillers without a declared responsible importer, supplies that do not appear in any national registry, that no one controlled, and that someone injected into the face of a patient who believed he was in good hands.
I understand the price argument. I know that medical treatments have a cost that is not always accessible, and that in the face of a tempting promotion on social networks it is difficult to stop and ask questions. But I want those reading this to understand something concrete: the low price of a casual cosmetic procedure does not reflect a discount. It reflects the absence of everything that makes that procedure safe. Without an authorized office, without products with ANMAT approval, without a licensed doctor, without an emergency protocol, what is being paid for is the illusion of a treatment. And when something goes wrong—and sometimes it does—the real cost appears in the form of a complication that no price can cover.
My request is simple. Before undergoing any invasive aesthetic procedure, verify three things: that the person performing it is a doctor with qualified registration and specific training in aesthetic medicine, that the products used are approved by ANMAT and that the space where the work is performed is authorized as a medical office. It is not bureaucracy: it is the difference between a medical act and Russian roulette with your own face.
Patient safety cannot be subordinated to a trend, a price or blind trust in someone who knows how to handle a syringe well. Behind every treatment there is a medical act. And a medical act requires training, experience, responsibility and the ability to respond when something goes wrong. That is not improvised, it is not learned in a weekend course and it is not replaced with good intentions.
Cintia Burgos is a specialist in aesthetic medicine. (MN 170198)
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