Unlicensed Filler Injections: The Real Risks, From Two Doctors

I'm Dr. Jong Seon Kim, a director at Gangnam HERA in Seoul, and a board member of the Korean Society of Aesthetic Surgery and of the International Petit Medical Society. In this video my colleague Dr. Jong Hoon Lee and I sat down to talk about the "injection auntie" controversy that made headlines in Korea — a slang term for unlicensed injectors who give treatments outside clinics. We both still see patients who come to us after problems from these treatments. A decade ago this was far more common, and we had hoped it had largely disappeared. The news showed it hasn't.

Our short answer: injections by non-medical people are illegal in Korea for a reason. The real dangers are infection, blood-vessel complications that can threaten sight, and no one able to deal with a problem when it happens. With so many licensed clinics available, there is no reason to take that risk.

Why do people still go to unlicensed injectors?

Because they think an injection is simple and harmless — and because it is cheaper. We think that mindset is the root of the problem: "It's just a shot, nothing serious can happen." In the past, these treatments were sometimes given in hair salons, and some people even injected products of unknown origin into their own faces. Injection treatments can be dangerous too, and that needs to be understood.

What is the biggest risk with unlicensed filler?

Infection first, and then a complication that nobody knows how to manage. Any injection must be done in sterile conditions, and doctors are very particular about it. Someone without medical training often doesn't know the small details. They think a quick wipe is enough before filler, and that can lead to inflammation, secondary infection and other problems.

The second concern is what happens if something does go wrong. If the treatment ends well, that is luck. If a complication appears, an unlicensed injector often doesn't know how to handle it, and the patient is sent to a hospital late. That delay is what turns a manageable problem into a serious one.

Can filler from an unlicensed injector cause blindness?

It can — vessel blockage near the eyes, nose or forehead can threaten sight if it is not treated immediately. When we inject filler, the complication we watch for most carefully is a vascular one. Some vessels in the face connect to the eye. If filler blocks one of these during treatment around the eyes, nose or forehead, and it is not dealt with straight away, it can lead to loss of vision. Doctors train specifically to recognize early warning signs and to respond. That anyone would take on this risk without that training is something we find hard to understand.

This is the same reason technique and placement matter so much in legitimate filler. I explain the blood-vessel side of it, and how filler can be dissolved, in why less filler looks better.

Are hospital-grade devices safe to use at home?

No. Home-care devices with low output are fine; medical devices used outside a clinic are not. There are many lifting devices now — focused ultrasound (the Ultherapy family and other HIFU), radiofrequency (such as Thermage-type devices) and more. Using a low-powered home device designed for personal care is not a problem, and can be good. But medical equipment intended for clinics carries risk. Used incorrectly, at too much energy or on the wrong spot, it can cause nerve complications and burns from excessive heat. Non-medical people using it is a problem in itself, and using medical equipment in a home rather than a clinic is a bigger one.

Can a doctor give injections at home or in a hotel?

Generally no: in Korea, doctors are expected to treat within the clinic where they are registered. The law allows home visits only in specific situations — for example, patients with terminal illness or severe disabilities who cannot reasonably come to a hospital, at the patient's request. A home visit for cosmetic treatment does not fit those exceptions.

There are practical reasons too. In a clinic, nurses and nursing assistants support the procedure, and there is a clean, sterile environment. Neither of us carries supplies around to treat people elsewhere, and if someone asked, we would recommend they come to the clinic. Some people assume famous people prefer home visits for privacy, but that is only speculation — and it doesn't change the risks.

Can I get appetite-suppressant pills without a proper prescription?

You shouldn't, and in Korea it is tightly controlled. Many appetite suppressants are classified as psychotropic medicines. They act on the same systems as medicines for mood, so proxy prescriptions are not allowed, and the state monitors them closely to prevent people collecting prescriptions from several clinics, overdosing or selling them on. They are meant to be prescribed only when criteria such as BMI are met. Taking too much, or adjusting the dose yourself, can cause real problems.

Our advice is diet and exercise first. If one area still won't respond, a local treatment such as our fat-dissolving Sok-Sok injection is a more sensible first step than starting psychotropic medication. Fat-dissolving injections in Korea explains what they can and cannot do.

Why is copying injection points dangerous?

Because doctors choose position and depth for each face, and copying what you have watched ignores both. Most unlicensed injectors haven't studied anatomy; they have watched someone else and imitate it. Even a common wrinkle-relaxing injection on the forehead is placed with position and depth in mind. Placed carelessly, the brows can drop and patients say their eyes feel heavy to open. Around the mouth there are many muscles that pull upward and downward, so shallow injections there done by imitation can twist the smile. Without anatomical judgement, the risk of complications is high.

How can international patients stay safe in Korea?

Choose a clinic, confirm the doctor, and see the product. There are now many aesthetic clinics, often just around the corner, with many skilled doctors. There is no reason to look for treatment through back channels from people who are not medical professionals. When you compare options:

1. Ask who injects and confirm they are a licensed doctor.
2. Ask to see the product and get the product and amount in writing before treatment. At HERA you receive an itemized written estimate; international patients pay the same as local patients, and an English interpreter is with you.
3. Be wary of anything offered outside a clinic — hotel rooms, homes, salons — or prices that seem too low to be real.

HERA is designated a Foreign Patient Attraction Medical Institution by Korea's Ministry of Health and Welfare. For more questions to ask, the signs to check in a Korea filler expert and the first-timer's guide to fillers in Korea are good next reads.

The honest bottom line

The word "illegal" is attached for a reason. Medical procedures are demanding, and when they go wrong they can do serious harm to the body. That is why doctors train for years before doing them. Illegal treatment is usually chosen to save a little money, but fixing the problems it causes can cost far more. Please don't do it. Even in a licensed clinic, every treatment carries some risk, and results vary — the difference is that trained people are there to prevent problems and to act fast if one appears. You can see real HERA results in our before-and-after gallery.