Why more regulation and legislation in the aesthetic beauty industry is desperately needed

Find out why stricter regulation in the aesthetic beauty industry is essential to protect both patients and clinicians.

Dr Beresford, 45, is founder and director of the Olivia Beresford Aesthetic Clinic. After graduating in medicine, Olivia trained as an anaesthetist and worked for many years in hospitals across the UK.

After the birth of her second son she retrained in aesthetic medicine and launched her own Harley Street clinic specialising in anti-ageing treatments for women. In this article she shares why she believes more regulation in aesthetic medicine is needed.

Despite the scandals, regulation in aesthetic medicine is slow

Safety and regulation in aesthetic medicine is a hot topic – it seems barely a month goes by before a new scandal appears in the press with yet another story of unethical behaviour towards patients or botched procedures.

It seems as if after each revelation, nothing changes, and things just carry on until the next case goes wrong. While the issues affecting the industry are complex, I do see the main reason behind the slow change as the lack of regulation and oversight. 

Aesthetic medicine is a relatively new specialty, it encompasses the non-surgical rejuvenation and beautification treatments that complement cosmetic surgery. The range of treatment modalities and conditions treated is wide, yet the specialty is often perceived as a “poor relative” of conventional medicine.

This may be partly because the procedures are relatively safe and quick to perform and are based on ‘want’ rather than ‘need’ in case of an illness. This diminished recognition has unfortunately resulted in a branch of medicine that is open to non-health professionals and where it is all too easy to get away with unsafe practice. 

There’s no formal training programme in aesthetic medicine

The NHS provides structured training programmes for each of the formally recognised specialties. For example, a doctor wishing to become a paediatrician must spend several years in the hospital, working under supervision of more experienced colleagues. They will have to pass several rigorous postgraduate exams and treat many emergency cases before the Certificate of Completion of Training is issued. Only then is this doctor considered fully qualified in their field.

There is no such training programme in aesthetic medicine. There are various courses that teach isolated skills, but no recognised comprehensive training programme exists. There is often no control over the quality of graduates who leave these courses to start performing aesthetic treatments on their own.

While there are some reputable training providers who educate health professionals to the level of a master’s degree (the so-called Level 7 qualifications), there are plenty of courses that teach only basic skills over a weekend. Many accept students who have no medical or health background at all. 

Clearly this is very dangerous – however quick aesthetic treatments may be, these are medical procedures. They carry risks and sometimes complications do occur. A non-health professional may not have the underlying medical knowledge to avoid all the risks, let alone treat the complications.

It’s possible for a non-medic to practice after a two-day course

Sadly, current regulation does not explicitly restrict the practice of aesthetic medicine to health professionals, nor are there any restrictions on the level of training required to be able to practice. So, it is quite possible for a non-medic to go on a two-day course and offer their services to the public the day after. 

Another contentious regulatory issue is the classification of fillers. Filler injections to smooth out lines and wrinkles are one of the most performed procedures in the UK and worldwide. Currently fillers are classified in the UK as a class III medical device, which means that anyone can legally perform filler injections on patients, irrespective of their background or experience. 

Fillers are a wonderful treatment for the right patient, but despite their familiarity, they carry risks of serious life changing complications. If a filler is inadvertently injected in the wrong place, it can block a blood vessel in the vicinity of the injection or further afield. Depending on the site of the blockage, this may result in the overlying skin death or even stroke or permanent blindness. 

A well-trained aesthetic professional will not only be aware of how to minimise the risk of blockage during the procedure but can also treat the complication quickly should it occur. The recommended management protocol includes administering several drugs that are Prescription Only Medicines and thus would be unavailable to a lay person. That is why I believe that allowing non-medical professionals to perform filler injections is endangering the public. 

The Times exposed common breaches in regulation

A recent article in The Times highlighted another area of aesthetic medical practice where tighter regulation is urgently needed. Botulinum Toxin (Botox), used for wrinkle relaxing injections, is a Prescription Only Medicine, meaning that only certain types of health professionals are allowed to prescribe it. These are normally GMC registered doctors, dentists, or specially qualified nurses. 

Prescribers are required to personally assess each patient before issuing a prescription for them. Once a medicine has been prescribed, it is possible to have another person administer it, if the prescriber is confident and, in effect, can vouch, that the injector is well trained.

The Times investigation highlighted the common breaches to this regulation, where prescribers simply collect the fee for providing prescriptions remotely, without ever meeting or assessing the patient. The injections are then carried out by untrained personnel, often leading to complications. 

This is a huge safety issue. While it may be unrealistic to prevent every single case of unethical behaviour by unscrupulous practitioners, it is very much possible to make it more difficult for them to find loopholes around loose regulation. Restricting the administration of prescription medicines to health professionals with relevant training would go a long way in improving the safety profile of aesthetic procedures. 

It is not all bad news, however. After years of lobbying and pressure from doctors and patient advocacy groups, the Botulinum Toxin and Cosmetic Fillers Act has made it illegal to provide cosmetic treatments to under 18’s earlier this year.

I very much welcome this, for I believe unnecessary aesthetic treatments can cause much harm to the mental wellbeing of young people. Although it is difficult to argue for restricting the access to aesthetic to legally competent adults over 18, in my own practice I tend to be very cautious treating patients even under the age of 23, unless it is for a medical indication. 

How can you find a medical practice you can trust?

It may be a while before additional regulatory changes are introduced, but in the meantime doctors and patients can help promote safer practices within aesthetic medicine by choosing high quality providers.

Here are four tips on finding a practice you can trust.

1) Ask who is the treating practitioner

Smaller clinics will normally introduce the team and their qualifications on the website. If you are opting to attend a clinic chain, you can make enquiries at the relevant branch.

At the very least you should be treated by a registered health professional who is able to prescribe emergency medication if needed. Clinics that provide PRP (Platelet Rich Plasma) treatments, intravenous infusions and thread lifts must be registered with Care Quality Commission. 

2) Check they have relevant experience

Do not be afraid to ask where and how the doctor trained. Larger clinics provide training in house whereas standalone practitioners rely on external course providers and mentoring.

Some procedures are considered higher risk than others. If you are considering having a non-surgical rhinoplasty, tear trough filler or forehead filler injections, do check how many of those the doctor has performed previously. It may be better to get a referral to another practitioner who specialises in this area. 

3) Always have a consultation before you decide to proceed

This is the best way to assess the clinic and the practitioner. Do they spend enough time with you and take your full medical history?  Do they answer your questions in an honest and open way? You should have all risks, side effects and after care clearly explained to you, including what to do in an emergency. Does the doctor take precautions to minimise the risks? 

4) Do not be swayed by discounts or low price offers

Finally, you should never feel rushed or pressured into a treatment, this is a huge red flag. Good doctors use well established brands with an excellent safety profile. They tend to cost more but are a much safer option in the long term. Your practitioner should be able to explain to you why they are recommending a particular product/brand to you.