The cosmetics industry faces the biggest shakeup in a generation as the government looks to bring in a new licensing scheme for aesthetics practitioners performing non-surgical cosmetic procedures in England.

Ten years on from Sir Bruce Keogh’s report on the Regulation of Cosmetic Interventions that described the lucrative aesthetics industry as ‘a crisis waiting to happen’, steps are finally being taken to improve patient safety and reduce the risk of injury or harm from botched treatments.

In early September, the government launched a public consultation seeking views about how to safeguard consistent standards throughout the aesthetics industry.

The aim is to ensure that practitioners are experienced, trained, qualified, have insurance in place, and work from premises that are clean and hygienic.

Consultation ends on 28th October. If the licensing scheme is passed, it will make it a criminal offence to carry out certain procedures without a personal or premises license.


Traffic light system ratings

Plans include implementing a traffic light system which would see non-surgical cosmetic procedures categorised into red, amber and green ratings according to risk of complications. You would only be able to perform amber and red rated procedures if you have the correct license.

Injectables like anti-wrinkle treatments and facial fillers are predicted to be classified in the middle amber category. This will also include vitamin injections, radiofrequency skin tightening, platelet-rich-plasma (PRP) vampire facials, cryotherapy for blemish removal, spider vein treatment, weight loss injections and fat freezing.

The green category is set to include low-risk beauty treatments like microneedling, IPL and LED laser therapy, chemical peels, and semi-permanent makeup.

The red category will be the highest risk and treatments are more medically invasive, such as thread lifting, liposuction, and hair restoration surgery.

Not just another beauty treatment…

Treatments like Botox® and dermal fillers used to be the closely guarded secret of older women looking to turn back the clock. But they’re now increasingly used by both women and men under 30 and have become as commonplace as getting a facial or your nails done.

We are all entitled to body autonomy and, for some people, these so-called ‘tweakments’ are a confidence boost. However, it is important that consumers are aware of the side effects and risks, and can confidently make an informed choice about the treatment being safe and to a high standard.

They aren’t just another beauty treatment. Accessibility, affordability and social media marketing have trivialised what are, in reality, medical treatments.

As with any medical treatment, they are not without risk and can lead to complications. But that risk is greater if the person performing the treatment is not trained adequately, uses unregulated products, or doesn’t have the knowledge to deal with complications.

And it’s not just frozen foreheads or trout pouts that consumers should worry about. There’s the risk of, allergic reactions, asymmetry, blindness, muscle weakness, permanent lumps, and vascular occlusions.

There is also the ethical aspect. People have non-surgical cosmetic procedures for various reasons, but for most people it is to correct what they see as a flaw. Their lips are too thin, cheekbones not prominent enough, under eyes too sallow. There is an addictive element where, once that fresh off the needle look wears off, they crave more mills next time round. This can cause the face to become overfilled or the filler to migrate to other parts of the face.

The ugly side of beauty

For decades, medical negligence solicitors have dealt with cosmetic surgery medical negligence claims, helping clients who have experienced botched surgery both in the UK and abroad.

However, the exponential growth in non-surgical procedures has led to a huge rise in the number of complaints from consumers about complications or substandard treatments. The Joint Council for Cosmetic Practitioners (JCCP) saw a 400 percent increase in complaints in the last 12 months, and Save Face received almost 3,000 complaints in 2022.

Many people say their complaints haven’t been taken seriously by aesthetics practitioners. They’re told the swelling or bruising is normal and will subside, when it’s actually a blockage within an artery, aka vascular occlusion. A lack of blood flow to the area will cause the tissue to die.

Dermal fillers that contain hyaluronic acid can be dissolved using an enzyme called hyaluronidase. But not every practitioner has the kit to do so. If not acted on urgently, the damage to the skin’s tissue cannot be reversed and further treatment may be necessary.

Medical professionals such as doctors, nurses or dentists have been trained in anatomy and physiology, to recognise the signs of these adverse reactions, and to perform first aid. Not all beauty therapists, even the most experienced and competent, will have the same skills and knowledge as a medic.

A lot of complaints received have been about aesthetics practitioners who work from home or offer a mobile service. This should be a red flag to anyone considering a non-surgical cosmetic procedure. A non-clinical environment does not always ensure that the products are stored correctly, or that hygiene and hand washing practices are followed. A clinic should be equipped for emergencies and allow for the safe disposal of needles.


What does the law already say about non-surgical cosmetic procedures?

It doesn’t matter how good a deal you think you’ve got, how many thousands of social media followers they have, or whether the salon is glamorous. The competence of the person holding the needle is the most important factor in ensuring a patient’s outcome is positive.

However, there is currently a lack of regulation within the aesthetics industry. There is no legislative framework to mandate that all practitioners are required to meet training and infection control standards.

This is why both healthcare professionals and beauty therapists can offer treatments like Botox® and fillers. There are registers with organisations such as Save Face and the JCCP, but these are voluntary.

The aesthetics industry can be financially rewarding, which is why so many nurses, doctors and dentists are either leaving their roles within the NHS to set up their own clinic, or doing it alongside their paid employment.

Similarly, beauty therapists have seen the rising demand and waned a piece of the pie. Anyone can go and do a one- or two-day training course before they start injecting people. Is this really enough time to feel confident in your ability as an injector?

Botulinum toxin, aka Botox®, is a prescription-only medicine and by law you should have a face-to-face meeting with a registered prescriber before it is administered. You must be medically trained to be a prescriber and not all nurses, doctors and dentists are qualified to do this.

There have been cases where prescribers are charging extra to avoid the in-person consultation, or over-prescribing so the practitioner has extra stock. Some are by-passing the prescription and buying cheap unlicensed products online.

With dermal fillers, anyone can buy or inject it – even me or you. They come with the same restrictions as buying a ballpoint pen. Not all are tested for safety and effectiveness.

For certain treatments, such as thread lifting, liposuction, cosmetic surgery or IV infusions, a medically trained practitioner should be registered with the CQC. But, bizarrely, this doesn’t apply to non-medics.

Laser treatments also used to be CQC regulated, but this changed in 2010.

The main law surrounding non-surgical cosmetic procedures is the Botulinum Toxin and Cosmetic Fillers (Children) Act 2021 that makes it illegal to administer them to under 18s. Under the new license scheme, this age limit would encompass all non-surgical cosmetic procedures.

Based on the outcome of the public consultation exercise, the government will review the feedback received. By involving members of the public, it makes the process fairer and takes on board everyone’s opinion instead of a select few.

Once completed, the regulations that will underpin the licensing scheme can be finalised and become subject to legislative scrutiny through the affirmative Parliamentary process. This means that the new draft regulations must then be debated in, and approved by, both Houses of Parliament.

Professor David Sines CBE, Chair of the Joint Council for Cosmetic Practitioners, said: “All too often it is the NHS – and therefore the taxpayer – that has to pick up the pieces when a cosmetic procedure goes wrong. We warmly welcome this important step towards proper regulation. Nothing is more important than public protection and patient safety.”

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