News Special: Aesthetic Complications

Complications from non-surgical aesthetic treatments are constantly in the spotlight, with almost daily reports in the consumer media. But, as we know, there is limited data available that indicates the rate of complications occurring across the UK.

In 2019, however, there has been an improvement in this data collection. Earlier this year, independent accreditation body Save Face and the Aesthetic Complications Expert (ACE) Group released reports on complications and patient complaints across the specialty.^1-3 Hamilton Fraser Cosmetic Insurance also shared data on complications experienced by its customers⁴ and The British Association of Cosmetic Nurses (BACN) also released data from its members earlier this year^.5

In February, the British College of Aesthetic Medicine (BCAM) provided statistics from its annual review of 344 members that highlighted the instances of adverse events that they have experienced. The overall findings were that BCAM members have a low incidence of complication rates, with a rate of 4.0, 3.3 and 2.8 events per 1,000 treatments for toxin, dermal fillers and lasers, respectively.⁶

BCAM has since released results from its annual audit, which brings to light new statistics that reflect complication rates outside of the association.⁷ This pooled data represents analysis of more than 225,000 individual treatment episodes reported by 270 members of BCAM, who are a mixture of doctors and dentists, over the last year.

BCAM’s latest findings state that:

• 77% reported treating other practitioners’ dermal filler complications
• 64% reported treating other practitioners’ toxin issues
• 25% reported treating laser/IPL problems
• 25% reported treating thread lift problems

BCAM president and aesthetic practitioner Dr Paul Charlson comments, “Due to the unregulated nature of the industry, the complication results we have gathered aren’t really surprising, and my own clinical experience does reflect these results. I do believe there is an increasing number of complications happening in the industry, which needs to be addressed.”

Aesthetic practitioner Dr Martyn King, co-founder and chairperson for the ACE Group, said that the recent findings reflect their own. However, he notes, “What is quite alarming is that the statistics are so high; if we compared these findings to 10 years ago, I am sure that this would not have been the case.”

What do the latest results suggest?

According to Dr Charlson, the latest complication statistics don’t necessarily indicate that the overall complication rates in the industry are high, but he says, “From an industry level, I think these stats are saying that basically there are many practitioners who are not dealing with their own complications. For one reason or another, patients are going elsewhere to sort out their complication, which I don’t agree should be happening.” Aesthetic practitioner and director of the International Association for Prevention of Complications in Aesthetic Medicine (IAPCAM) Dr Beatriz Molina, adds, “What I think is significant is that previous BCAM stats show there is a very low instance of complication rates from members, but up to 77% of them are treating other people’s problems, which is very high. To me, this highlights that there is a group of inexperienced practitioners who can’t deal with adverse events. I think it will be interesting to see more stats to really identify what group or types of practitioners are causing these issues.” As an example, data released by the BACN indicated that out of the members who received complications, 93% were able to manage it themselves.⁵

Dr King believes the latest BCAM figures are due to a combination of factors, including treatments being performed by people without any medical background, the fact that treatments are now far more popular and available than before, and the general public looking for the best bargain price. “To meet this demand, treatments are being performed by practitioners with very little experience in their own field, often being newly qualified, as well as lack of experience in aesthetic medicine. In previous years, practitioners often were very experienced in their own discipline and treatments were more conservative and these practitioners were able to manage their complications without needing the assistance of another practitioner,” he explains. Dr Charlson believes there is a common scenario in which complications are occurring. He states, “Generally, what we find is happening is that a patient might first get treated by an inexperienced or poorly-trained practitioner and then get a complication, whether it be an unaesthetic result or something more serious. They then either realise that their original practitioner is not able to handle the situation, or sometimes they might even be completely uncontactable, so find another practitioner, often who is a medical professional, who has the training and expertise to handle the complication,” he explains. The positive thing about these statistics, Dr Charlson believes, is that he thinks they indicate that the public are choosing highly experienced practitioners to finally assist them.

Reducing complications

All interviewees are passionate about endorsing best practice and ensuring high levels of patient safety, agreeing that there are developments that can be made to improve the number of complication taking place in the UK. Dr Molina says, “For practitioners, the more training they do the better. They also need 100% accountability for their procedures, otherwise they shouldn’t be treating. More patient education is also needed, so they aren’t trivialising these treatments and going to someone with inappropriate skills. Associations are attempting to increase this at the moment, but it’s a huge challenge to get the message across.” Dr King adds that more complications’ data and statistics are essential to better educate the public to choose their practitioner wisely. “If the public were aware of the extent of some of these complications, I am sure many would not even entertain having treatment, but if they were to do so, would certainly spend more time researching their practitioner and not just looking at the cheapest option,” he explains, adding, “The ACE Group also strongly encourages practitioners to report complications to manufacturers and the MHRA to provide more evidence for the safety of products that are used. Finally, complications’ data may help to gain greater regulation within the aesthetics industry which is very much needed.” Dr King also suggests that manufacturers and suppliers play a role. “This is to ensure that practitioners using their products are appropriately qualified, appropriately trained and products are purchased from legitimate sources,” Dr King explains.

Dr Charlson summarises, “The reality is that everyone gets complications, but if you can’t deal with your own; for example, if you are administering dermal fillers but can’t prescribe hyaluronidase, then I would question if you should be operating independently. Instead, I would suggest that practitioners should be under the wing of somebody who can sort the problems out, should they arise. The industry needs to be regulated, which is what many people continue to highlight.”