It was her wedding photographs that did for Grace Stewart’s dermal fillers. By the time the 32-year-old married her long-term partner in 2022, she had been getting fillers for three years – first in her jaw, in pursuit of “that snatched look”, and latterly in her lips, cheeks, nose and chin. One image in particular made her do a double-take: a side-on candid shot in which she is being swept up in a hug by a cousin. “It was this really lovely moment, but all you can see is my chin curling up and this bulky jaw,” says the Nottingham-based social media manager. “I now think: ‘My Lord, why did I do that to myself?’”

Stewart did not get any further treatments in the two years after her wedding, but while hyaluronic acid filler is typically marketed as temporary – lasting up to 18 months – she couldn’t seem to shake the volume that had been injected into her jaw. So, this year, she made like Kylie Jenner, Courteney Cox and Molly-Mae Hague and had social media’s latest injection du jour: hyaluronidase, or dissolver. “I now know that there’s a reason why my face is the shape that it is. It’s not supposed to have this angle to it that doesn’t flow,” she says. “I feel so sad that I felt the need to adjust how I looked just to feel like the best version of myself.”

Evidence suggests that Stewart isn’t alone in forgoing the needle. A 2023 audit by the British Association of Aesthetic Plastic Surgeons (BAAPS) reported a 27% drop in people getting fillers compared with 2022. A cursory scroll on TikTok turns up hundreds of gory clips of young women getting hyaluronidase injected into their lips and jaws and under their eyes in the latest chapter of their “filler journey”. Celebrity doctors such as the cardiologist turned filler specialist Dr Roshan Ravindran – Dr Rosh to the faithful – have carved out a cottage industry from dissolving botched or regretted injections.

“There is a push towards a more natural beauty, with many people wanting to reverse that kind of overfilled look that was popular five, six, seven years ago,” says Ravindran, who has clinics in Cheshire, Manchester and London and a client list that reads like the programme for a Love Island arena tour. “People now understand that you need to do things in a much more harmonised and gentle manner.”

The risks associated with fillers, medical-grade injectable gels most commonly based on hyaluronic acid, are increasingly well documented. In September, 33-year-old Alice Webb was thought to have become the first person to die from undergoing a suspected “liquid Brazilian butt lift” in the UK. (The non-surgical version of the procedure involves filler being injected into the buttocks to make them bigger.)

Organisations such as Save Face, a government-approved voluntary national register for aesthetic treatments, continue to agitate for the regulation of an industry that, in the UK, is effectively unregulated. You do not need to be a medical professional to administer fillers in the UK, nor do you need a prescription to acquire filler from one of the many brands on the market, including Revolax and Juvéderm. Some doctors have highlighted the (rare) risk of blood vessel blockage from fillers being administered by inexperienced hands, while a 2023 BAAPS study of cosmetic surgeons found an increase in patients under 50 enquiring about facelifts, which it said could be linked to concerns about using filler.

“The market has driven the trivialisation of these procedures: ‘Have a bit of filler and if you don’t like it, get it dissolved,’” says Dr Tamara Griffiths, the president of the British Association of Dermatologists. “But it’s not like having your hair cut and letting it grow out; these are invasive procedures. Albeit they’re minimally invasive, but they’re not without risk.”

Dr Sophie Shotter, an aesthetics doctor based in Harley Street, London, says: “It really is a wild west.” Although administering filler to under-18s became illegal in England in 2021, no such ban exists in Scotland, Wales or Northern Ireland – and children in England are free to travel elsewhere in the country for treatments. “It’s not even just beauty therapists doing filler courses any more – it’s personal trainers, teachers, whoever. It’s treated like going to get your nails done,” says Shotter, who is on the board of the British College of Aesthetic Medicine. “It is available on every street corner. So, of course, your average consumer thinks it must be OK.”

The former Love Island contestant Faye Winter says the first time she got lip filler, at 21, was OK. In fact, she says it was great: “She was a nurse and she only put half a mil [0.5ml] in my lips.” But when that practitioner stopped doing it because, in Winter’s words, she “felt it was only a matter of time before something went wrong”, she found someone on Instagram who had done a one-day training course while working at a fast-food restaurant.

“She was the cheapest out there,” says Winter, 29. “I remember the first time she did my lips, she was getting ready to go on a night out. I was sitting at the dining-room table in her house with my head back while she was drinking wine. And I just thought that was totally normal.”

The non-surgical cosmetics industry in the UK is thought to be worth at least £3.6 billion (although it is hard to be precise, given the lack of oversight). Of the 2,100-plus complaints received by Save Face about fillers last year, the vast majority related to beauticians, hairdressers and laypeople that customers had found on social media. “The problem is that many of the issues that can arise from filler treatment require medical knowledge and an ability to prescribe to address and fix them,” says Shotter.

The cost of dissolving fillers can range from £60 to thousands of pounds. “It wasn’t really a thing people researched when I first started having it done,” says Winter, whose overfilled lips and explosive temper led to her being subjected to brutal online trolling after Love Island. “I think we were the first generation to grow up on Instagram. I can remember the whole ‘suck a cup to get Kylie Jenner lips’ trend. Social media really shone a light on what A-list celebrities were doing to their faces. Of course, we know now that Instagram is just the highlights reel.”

Just as influencers led ordinary people to the filler trough, so they are driving us away again. As the 25-year-old TikToker Ellie Scales says: “Duck lips aren’t really a thing any more.” But how easy is it to undo the look that people have spent a decade inculcating and injecting?

“We do know now, from clinical experience, that the filler can stay present for a much longer period of time,” says Griffiths. Cosmetic surgeons have reported that, when performing facelifts on people who have been having fillers for a while, “when they cut the skin and look at the soft tissue, there is some residual product, even though it’s been years since the last injection. So there is evidence to suggest that it’s not completely dissolvable naturally, as we thought initially.”

On paper, the process of having filler dissolved sounds relatively simple: hyaluronidase, an enzyme able to break down hyaluronic acid, is injected into the filler. But it is not always straightforward. It can take several weeks and several sessions to dissolve filler correctly. “Hyaluronidase is like any product – you can have an allergy to it,” says Griffiths. There is also the matter of hyaluronidase breaking down the naturally replenishing hyaluronic acid found in the skin. “Patients who have too much hyaluronidase can also have absorption of the normal tissue. If the area is flooded with hyaluronidase, that can leave soft tissue defects, which is very distressing. So my main message is: don’t have filler unless you’re very intentional about it; and don’t have hyaluronidase unless there’s a clear clinical indication [that it is necessary].”

In a study published in April, a group of leading cosmetic surgeons uncovered “post-hyaluronidase syndrome”. Their review of 90 patients treated with the enzyme said 18% had complained of facial changes including hollowing. “Essentially, the collapse of the face can happen after aggressive dissolving – particularly in people who’ve had large amounts, stretching the skin,” says Shotter. “Unless hyaluronidase is absolutely necessary, we should not be doing it.”

For women such as Stewart, who is happy with the results of the treatment, dissolving can be a satisfactory fix for an overfilled face. But a growing number of women are living with the hellish aftermath of hyaluronidase gone wrong.

On Facebook and Reddit, forums feature thousands of women sharing horror stories, advice and messages of solidarity. “Most people thought they were the only ones and that they were going mad,” says Lana Hristovski, the moderator of a hyaluronidase damage support group on Facebook, which has nearly 14,000 members. The 49-year-old, who lives in Victoria, Australia, got her fillers dissolved in 2015 – with disastrous consequences. “My cheeks and lips caved in and my under-eyes were left with deep hollows,” she says. “These celebrities make it sound so wonderful, like you’ll look amazing, but it’s really not worth it.”

After a practitioner convinced Ashley, a 25-year-old from London, to undergo what the aesthetics industry calls “facial balancing”, she quickly sought reversal. Ashley had been getting lip filler since she was 19 and had been mostly happy with the results. But when her practitioner injected her chin, cheeks and smile lines, she no longer recognised her face. “I asked for something natural,” she says. “I told her to do whatever she wanted. I was too trusting.” When she returned in February to get it dissolved, she thought it would be done bit by bit. But soon into her appointment, the practitioner started injecting large swathes of her face with hyaluronidase.

“Every time I talk about it, I want to cry,” says Ashley. Another dissolving session followed, when she hoped her practitioner would correct one side of her chin, which had been unevenly filled and then poorly dissolved. “The whole texture of my skin changed,” she says.

Then the body problems began. Ashley says she has experienced intense pins and needles and “immense pain” all over her body since the procedure. Other than referring her to mental health services and prescribing amitriptyline for pain management, doctors have been unable to offer much help. “A lot of the time, they ask me: ‘Do you get a visible rash?’ No, this is all an internal feeling. It’s like I’m on fire.” Another woman I speak to describes similar burning sensations accompanied by sciatica-like pain and hair loss.

Ashley has come off social media and quit her public-facing job in the fitness industry. “It feels difficult, because I can’t really talk to anyone about it. It feels like such a vain thing to speak about,” she says. “When you have a diagnosed condition, you get a bit more empathy and understanding from people. But when you have all these symptoms and you’re in so much pain, but you can’t get a diagnosis, you’re left to deal with it on your own. It’s been a lonely experience.”

Practitioners are at odds over what regulation of the aesthetics industry would look like. Ravindran says that the proliferation of amateur injectors should be treated as a public health problem. Non-medically trained practitioners I speak to argue that aesthetics is an art form and those trained in injecting an arm don’t necessarily have the requisite skills to inject a face. One salon owner says the debate “infuriates” her, because the filler training she received from an NHS doctor was shoddy.

Griffiths is part of a growing group of doctors pushing for regulatory frameworks in the industry – specifically, a traffic-light system that would require the most high-risk procedures to be done at a premises regulated by the Care Quality Commission. “At this time, if you’re a doctor or a nurse, that’s considered good,” she says. A traffic-light system would provide more clarity on what training was required to perform which procedures. “Many of us are working very hard to get this over the line.”

For all the horror stories, there are many women who love the effects of cosmetic injectables – or, to use industry parlance, have had a “successful aesthetic journey”. Megan Jones, the 24-year-old owner of Boss Babes Aesthetics in Manchester, says that demand for nose filler (a non-surgical alternative to rhinoplasty) is surging among her gen Z clientele. Many TikTok videos in the dissolving sub-genre of aesthetics end with women getting their lips freshly refilled, only more subtly. Winter, after having her filler dissolved, had “half a mil” put back in, although she says this has since naturally dispersed. Even Stewart concedes: “After all that, I would happily have my nose done again, because I liked the side profile it gave me.”

Things are moving slowly for Ashley, but she lives in hope that her symptoms will begin to improve. She thinks all the time about what she would tell her pre-filler self. “I’d say: ‘Don’t be ridiculous. Don’t let anyone try to tell you that they can make you perfect. Perfect doesn’t exist.”

Ashley is a pseudonym