Non-surgical facial aesthetic treatments such as ‘Botox’ (botulinum toxin type A) and dermal fillers account for around 90% of cosmetic procedures in the UK, in an industry that is worth around £2.75bn a year. In 2013, the Medical Director of the NHS, Sir Bruce Keogh, stated that the facial aesthetics industry was “almost entirely unregulated”; and that "a person having a nonsurgical cosmetic intervention has no more protection and redress than someone buying a ballpoint pen or a toothbrush".

Furthermore, the UK government has stated that there was "support for the principle that dermal fillers and other non-surgical products should be prescription-only, or otherwise that there should be some control over who may administer them"; however, despite this, no further government action has been taken to address the issue. Moreover, Ken Stewart, plastic surgery adviser to the Scottish Government, likened the facial aesthetics industry in the UK to the “Wild West”. Similar to Ken, I have seen first-hand the potentially damaging results when patients receive treatments from non-professional, poorly trained ‘Cowboys’. Bearing in mind the potentially dangerous and unpredictable UK facial aesthetics landscape, I have written this article with the aim of providing some tips and advice for those who wish to safely navigate their way through the ‘Wild West’ for the first time.

Pick your practitioner

As with other aspects of healthcare, it is important to find a practitioner that you can trust to provide ethical, appropriate and high quality treatment. Currently, the law in the UK requires that Botox is a medically prescribed treatment i.e. it must only be administered following a written prescription from a licensed prescriber. The same is not true for dermal fillers, which can be obtained without a written patient prescription.

There are 4 types of licensed prescribers in the UK – medical doctors, dentists, nurses and pharmacist prescribers. These 4 groups are similar in so far as they are all legally bound and regulated by professional bodies:

• The General Medical Council (GMC),
• The General Dental Council (GDC),
• The Nursing and Midwifery Council (NMC) 
• The General Pharmaceutical Council (GPhC) 

However, due to the unregulated nature of UK facial aesthetics, it is possible for non-professional, unlicensed individuals to set up and practice as facial aesthetic practitioners. Despite the fact that such practitioners are not legally allowed to prescribe Botox, there is nothing to prevent them from administering the treatment to patients. Rather unscrupulously, unlicensed practitioners can get around this protection by having a licensed prescriber issue a prescription on their behalf – very often this would be without the prescriber having spoken to or assessed the patient – which can be described at best as poor healthcare practice and at worse negligent.

One may ask, what is the difference between a licensed practitioner and an unlicensed practitioner in the context of facial aesthetics? Although both groups can obtain indemnity insurance (insurance that covers the practitioner in case of litigation from a patient), there are 2 basic differences between the professional and non-professional facial aesthetic practitioners:

• Licensed practitioners have all received comprehensive, robust and quality assured background training that underpins their ability to safely treat patients; particularly in the areas of: knowledge of facial anatomy, safe use of medicines, and how to recognise and treat complications. Indeed, many practitioners, such as plastic surgeons and dentists, have received very in-depth training in facial anatomy and surgery. Non-professional practitioners will not have received any such training.

• Licensed practitioners are all regulated by professional bodies, who guarantee the quality of their registrants’ background clinical training, and ensure that their practitioners continue to adhere to core ethical values and professional behaviour; non-professional practitioners have no such professional regulation or quality assurance. 

There are some online resources available for patients who are looking for accredited facial aesthetics practitioners - Save Face and Consulting Room are two such resources, providing a searchable register of practitioners and clinics, with some degree of quality assurance and accreditation.  In my opinion, when looking for a facial aesthetic practitioner for injectables, due to their background training in anatomy and treating patients, you should only choose a practitioner who is either a registered doctor, dentist or nurse. 

Research and reflect before you rush in

Currently, due to the COVID pandemic, most practitioners are conducting new patient consultations using videoconferencing platforms. This is a great way for you to safely meet your prospective clinician and to talk through your treatment options. Personally, I think the use of videoconferencing is a great addition to my practice; I know that I and many of my colleagues will continue with this set up, even after COVID.

As a prospective patient, there are a few basic things that you should expect from your facial aesthetics practitioner ahead of starting treatment:

• Period of reflection - ideally, you should have your initial ‘treatment planning’ consultation at a separate time to the treatment. This ‘pause’ allows you a period of time to think and reflect; whereby you can iron out any uncertainties in your own mind and become more comfortable with your chosen treatment options. With the ongoing use of the aforementioned videoconferencing consultations, this approach is not likely to be optional in any case.

• Estimate of treatment cost – all patients should be aware of the cost of any proposed treatment; this usually will take the form of a written estimate provided to you ahead of the procedure.

• Written information – all practitioners should be able to provide written information to you about the proposed treatments. This can be provided through information leaflets, or online resources. Patient information material is an important way of ensuring that you have as much information as you need in order to make good decisions about your treatments.

• Consent form – all healthcare professionals are trained in how to properly consent patients for any given treatment. In summary, the consent process is when the practitioner and patient discuss the different treatment options available, the relative risks and expected benefits of the treatments. Prior to embarking on a treatment, you have to be comfortable and satisfied that you are aware of the risks, have realistic expectations about the outcomes and have been given ample time and space to ask questions. The consent process should be formalised and documented by use of a ‘consent form’ – a written document signed by you and the practitioner, a copy of which should be provided to you ahead of the treatment. 

Following on from this, I am confident that should you take into the account the advice contained within this article you will probably make good choices, and have a very fulfilling experience within the Wild West of facial aesthetics.

Want to keep learning?  Read more about the author, Dr Maryam McMillan - Ambra Aesthetic Clinic