Ms Margaret O'Donnell:

It is a question of regulation. The beauty therapists would have a code of practice; I do not know to what extent it is enforced. A dermal filler is also administered by injection and is put under the skin to get rid of wrinkles.

A filler is classified as a device because it is not an active agent. Although it is injected, it is a device. It is open to anybody to use because it does not require a doctor. Fillers are of great concern in the United Kingdom, where the authorities have said there is more regulation for a ballpoint pen that for dermal fillers. That is a problem.

A concern associated with people spending vast amounts of money is a condition called body dismorphic disorder. Perhaps 2% or 3% of the population have a condition whereby they do not see themselves in the way others see them, and they are attracted to more and more procedures. A number of them have body dismorphic disorder. It is part of a surgeon's training to be aware not only of the technical and academic aspects but also of the moral and ethical aspects. It involves identifying patients who give rise to concern and in respect of whom a procedure may be more harmful than good.