How safe is the cosmetic surgery boom?

An increasing number of British people are opting for cosmetic procedures. Many are happy with the results - but the £3.6bn UK cosmetic industry is unregulated, leading to concerns about its safety.

"As soon as it was done I got in my car and cried my eyes out. I felt like I'd self-harmed."

Tina, who does not want to use her real name, is one of the thousands of young women who have turned to facial (also known as dermal) fillers as a quick fix for their self-esteem.

It is one of the easiest cosmetic procedures to have done as it does not need to be performed by a medical professional in a registered clinic.

Tina, who is 24, paid £75 for the filler in her local hair salon.

"It was almost too easy," she says.

"Before I knew it, the injection had gone in and I thought, 'Oh my God, I am having a lip job'."

"It looked horrendous straight after. Really swollen," she says.

"That night I have never been in so much pain. I was awake from 02:00 until 05:00 in the bathroom keeping an eye on my lip. I was worried it might explode. And I felt ashamed for having done it just for vanity's sake."

Tina says her partner was not sympathetic.

"He went mad. I thought we were going to break up over it. He said, 'You always say you want to look natural - why on Earth have you done this?'"

Tina is one of many young women who have felt need to improve their appearance with cosmetic procedures. A BBC poll conducted in October found that 32% of all women are considering cosmetic surgery. Among those under 35, the number rises to 45%.

The most popular surgical procedure is breast augmentation.

Sarah, who also did not want to give her real name, had this operation when she was 21.

"I was really unhappy with how my body looked," she says.

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"Around the age of 13 I developed an eating disorder. I started picking out bits of my body I really, really hated. I think the main aim of my hatred was my breasts. At 18, I decided the only way to sort myself out was cosmetic surgery."

Sarah attended a free consultation at a clinic where she says she was met by a warm and welcoming staff member who did not appear to be a medical professional.

Find out more

BBC Radio 4's You and Yours discussed cosmetic surgery on 15 November. You can listen again on iPlayer.

"She asked me a few questions about my personal health and then gave me a sports bra and some chicken fillets to fill it," says Sarah.

"I was a [dress] size four to six at this point and had a very small frame. The fillers were a size D, so even though in my head it looked right, in hindsight I know there's a reason I had no breasts. It was because I was so small."

Sarah signed up to the procedure and paid a non-refundable deposit of £500. She went ahead with the operation which involved having the implants inserted under her pectoral muscles.

Afterwards she says the pain was so excruciating she couldn't sit-up in bed without help for two weeks. She immediately felt self-conscious and completely fake. She says she has now grown to like her breasts, but is still embarrassed when she has a new sexual partner.

"I feel it is something I have to admit to. Yes I am that shallow that I went through all that and spent all that money," she says.

"The implants only last 10 to 15 years if you are lucky, so after all that you still have to go through it again to have them replaced or removed."

Since 2014 there has been a yearly increase of 13% across all cosmetic procedures, according to the annual report of the British Association of Aesthetic Plastic Surgeons (Baaps). Yet it remains one of the least regulated areas of medicine.

A scandal six years ago, when breast implants were made with industrial instead of medical-grade silicon, led to a government review of the industry.

The review highlighted facial injections or fillers, saying: "It is our view that dermal fillers are a crisis waiting to happen." It recommended the procedure should only be available with a doctor's prescription.

The former president of BAAPS, Rajiv Grover, says this would immediately make fillers safer.

"It would regulate who is able to perform these treatments - it would have to be a medical professional - and it would prevent advertising," he says.

"A lot of marketing gives the impression that these treatments are a golden ticket to a glamorous lifestyle. We feel that's completely wrong and they shouldn't be marketed at all."

The review also called for a mandatory register of cosmetic surgeons which would list their speciality, formal qualifications for those injecting fillers or Botox, and compulsory insurance if anything goes wrong. None of these has been fully implemented.

Dr Rosemary Leonard, who sat on the review panel, feels she wasted her time.

"Frankly I wonder why I bothered, so little has been done," she says.

"Even today, a filler in your face is no more regulated than a ballpoint pen. Anyone can put a filler in someone's face. I am so sad and angry that the government has done so little about our recommendations."

In her GP surgery, Leonard has seen the result of many badly performed cosmetic operations.

"I've seen some terrible scarring from breast surgery that has gone wrong," she says.

Find out more

• Cosmetic surgery check-list for patients

• I have to tape my eye-lids shut

Even when cosmetic procedures go well, people can be left with lingering doubts about them.

Sharon Dhaliwal had her nose altered when she was 23 after being bullied at school.

"It was a long nose with a hook and the surgeon said he could remove the bump," she says.

Dhaliwal says after the operation she became more extroverted and no longer cringed when she looked in the mirror.

But she now wonders whether she should have regarded her prominent Indian nose as normal, rather than subscribing to a Eurocentric view of beauty in which only a small, button nose is attractive.

"I have removed part of my identity," she says.

"I feel upset no-one told me I was beautiful even though I had a large nose."

Next year the Royal College of Surgeons will launch a new register for cosmetic surgeons. To qualify practitioners will need to prove they have completed a certain number of procedures and provide a reference.

In addition, the advisory body Health Education England has developed a post-graduate level qualification for those injecting dermal fillers.

But, for the moment, neither the register nor the qualification will be compulsory and the multi-million pound cosmetic industry will continue to operate without regulations.

Listen to Woman's Hour on BBC Radio 4 - Why do young women want cosmetic surgery?

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