Why Britain’s first BBL loss of life was a catastrophe ready to occur

For years, it has been a ­tragedy waiting to happen. The awful news of the death of Alice Webb, a 33-year-old mother of five, after complications following a non-surgical ‘Brazilian butt lift’ ­procedure known as BBL, has left me horrified – but not, I am sorry to say, as shocked as most ­people might be.

Why? Because, frankly, the dire lack of ­regulation around who can legally perform such treatments in the UK has long left ­people at risk of harm. For years, there has been a simmering anxiety among the Botox doctors and cosmetic surgeons that ­something terrible like this would happen.

Behind this tragedy lies a complex mesh of factors. They include injectable fillers and equipment that’s too easily available to non-medics; a blasé public attitude towards fillers, which sees them as beauty treatments rather than medical procedures; and ­continued indifference at government level despite the warning over a decade ago that dermal fillers were ‘a disaster waiting to ­happen’, in the words of surgeon ­Professor Sir Bruce Keogh, who produced a report for the ­Government after the PIP breast implant scandal.

Moves towards licensing of ­cosmetic ­practitioners and the premises they work from are finally in motion, but will not take effect for a couple of years.

As procedures go, the BBL – which ­amplifies and reshapes the backside with injections of either fat or dermal fillers – is highly ­contentious (it is thought to have been ­dermal filler that was injected into Alice Webb). ­

Having a big, shapely bum has become a ­popular goal ever since Kim ­Kardashian first flaunted her curves, and many young women see a BBL as a quick way to achieve this.

It sounds easy – just a few injections of ­dermal filler or your own fat, extracted from your thighs or stomach and injected into your bottom – and, hey presto, better curves.

But the potential for problems is huge, even if the procedure is carried out by a well-trained medical expert. There could be ­infection, ­problems from the quantity of local anaesthetic used or, more likely, an ­embolism caused by the injected fat or filler migrating into one of the big blood vessels in the ­buttocks and ­working its way up, via the heart, to the ­pulmonary arteries and blocking them.

If the procedure is done by a non-medic, the risk dramatically increases. Save Face, which offers a register of UK practitioners, has helped 500 women who have suffered ­complications after BBLs done by non-medics.

We have become almost inured to hearing about complications and indeed deaths from ­cosmetic surgical procedures carried out abroad, by unscrupulous surgeons at shady clinics. But this first death from BBL in the UK shows just how bad things have become.

Over the past 25 years that I have been reporting on aesthetic medicine, there has been an ever-growing interest in cosmetic tweakments, ranging from Botox and fillers to body-reshaping injections – yet the need for proper regulation of the whole industry has repeatedly been brushed away.

‘There’s no law against who can offer ­cosmetic procedures in the UK,’ says Dr ­Catherine ­Fairris, president of the British ­College of Aesthetic Medicine, an ­organisation of medical doctors and dentists which has campaigned for regulation for over 20 years. ‘It’s illegal to practise ­veterinary ­medicine if you’re not a qualified vet. It’s not illegal to ­practise ­medicine if you’re not a doctor, as long as you’re not ­claiming to be a doctor. That ­fundamentally is the problem.

‘There’s also a degree of ­misogyny involved. Aesthetic and ­cosmetic treatments are often ­perceived as trivial or superficial and not taken seriously. The lack of regulation has meant they can be offered alongside beauty ­treatments and, as such, their ­seriousness is dumbed down.’ And yet when they go wrong, we see just how very seriously they should be taken.

Dr Sophie Shotter, a specialist aesthetic doctor, has been ­concerned about BBLs for years.

‘Whenever I’m asked about treatments I would never have, buttock filler is top of the list,’ she says.

‘The idea that non-medics are doing this is ­terrifying. The ­problem is, people don’t know what they don’t know – and ­beauticians clearly don’t have any issue with doing ­procedures like BBL as they don’t realise the risks.’

BBL is not the only procedure Dr Shotter has found non-medics offering. ‘There are beauticians offering liposuction, and ­advertising this on social media. At least [the ones I found] were using surgical tools. But there is ­currently a woman in hospital, in intensive care, after liposuction from a non-medic using a sputum suction catheter.’

This piece of equipment, easily available online, is in fact used for removing secretions from the ­respiratory tract. It beggars belief anyone would think it could work on soft tissue. ‘I’ve seen so many things like this online,’ she ­adds.

‘There’s a beauty ­therapist in ­London doing ­blepharoplasties – surgical eye lifts – and showing this online, and patients are ending up with severe complications. For me – for most people – these are clearly surgical procedures that should only be performed by plastic ­surgeons, in clinical settings.’

Dr Sabika Karim is a specialist aesthetic doctor and fully ­qualified GP who offers body-shaping ­injections, and who works as a global trainer and lecturer in face and body injectables. She helps write the protocols for safe ­treatment and works for ­companies that only make their products available to specially trained ­medical practitioners. She’s offered ­buttock-shaping injections for a decade – though what she offers now are not ­injections of dermal fillers, but of a substance that stimulates natural collagen growth in the area to ­provide more volume.

‘I take ­scrupulous care over who I treat and how I treat and I’ve not had a single complication,’ she says.

But dermal fillers, which are used to add volume to lips and cheeks and are usually made from hyaluronic acid gel, are easy to get hold of.

‘I went to one site online to test this out,’ says Dr Karim. ‘They didn’t ask for any ­credentials and the products arrived the next day in packaging with writing that wasn’t in English.

‘Goodness knows what they contained and whether they were sterile – and no, I wouldn’t dream of injecting them into anyone.’

It is all too easy for anyone to start injecting fillers.

‘The girl washing my hair at the hairdressers told me she wanted to learn to do lip fillers,’ says Dr Karim. ‘I asked why she didn’t learn a ­specialism like hair extensions. She said, “I can’t learn to do extensions, I don’t have my level 2 in hairdressing yet – but I can book on a half day course and learn lip fillers.” I dread to think …

‘The Government still doesn’t think this is a problem,’ adds Dr Karim. ‘I spoke to two different health secretaries in the past few years and each told me that the situation was fine. They have no idea. The new Government must move fast on this.’

Problems caused by non-medical practitioners also place a sizeable burden on the NHS. How sizeable? It’s hard to say because many ­complications are never attributed to cosmetic procedures.

‘One doctor at my practice who also works in A&E told me of a patient who came to hospital with heart failure,’ says Dr Karim.

‘From his medical history, the doctors couldn’t work out what might have caused this heart failure, until it emerged that he had been having intravenous vitamin drips, from a non-medic – which can overload the kidneys with fluid. That man is now left with a non-­reversible, life-changing condition.’

One organisation that has been campaigning to raise awareness of the potential perils of BBLs for years is the British Association of Aesthetic Plastic Surgeons (BAAPS). It was its annual ­conference in London yesterday and the sad issue of Alice Webb’s death was widely discussed.

‘We – the BAAPS – have been warning of the perils of medical tourism, particularly BBL, for years, and now here it is on our doorstep,’ says Nora Nugent, BAAPS President. ‘No non-surgeon should be doing this procedure. The stakes are too high and so are the ­consequences.’

As she points out, even the best-trained surgeons can have ­complications with buttock enhancement, even when operating using ultrasound ­imaging to show them precisely where the fat they are injecting is going.

‘We’re in a very regulated healthcare environment in the UK, but there’s this huge blind spot where fillers are not regulated properly, so that people who shouldn’t be offering procedures like BBL are just flying under the radar.’

The hope across the aesthetic industry is that now the new ­Government is getting its feet under the table, it will move the issue up the agenda. As Dr ­Shotter and others pointed out to me, this tragic incident may add impetus. Let’s hope.