Last month, following the online sharing of a facial dissection course designed to offer training to beauty therapists, a social media storm erupted amongst aesthetic professionals. The national press quickly picked up the story, extending its reach to the general public as well as the aesthetic community. Cosmetic Couture, a company that offers aesthetic training to beauty therapists, ran the two-day course in December with the aim of raising the safety standards of those participating in aesthetic training and increasing the anatomical knowledge of practitioners. The company later released a YouTube video, which has since been removed, in which four beauty therapists and the director of Cosmetic Couture, Maxine McCarthy, discussed their learning experiences following the training.
Alarmed by the video, the Safety in Beauty campaign shared it via social media to the medical aesthetic community, which led to many practitioners voicing their concerns with beauty therapists receiving training using a cadaver and subsequently offering injectable treatments. Upon hearing the news, president of the British Association of Aesthetic Plastic Surgeons (BAAPS) Mr Fazel Fatah commented, “A cadaver dissection course geared towards non-medics beggars belief. How is a beauty therapist qualified to perform invasive treatments that require anatomy training? Nonsurgical doesn’t mean non-medical!”
A bigger issue
While many people were quick to criticise McCarthy and the beauty therapists who undertook the training, others recognised that the issue raised a wider concern with the lack of regulation of the aesthetic industry. As there is currently no restriction on beauty therapists administering injectable treatments, providing a nurse prescriber or doctor has written a prescription following a face-to-face consultation, as recommended by the General Medical Council, it could be argued that beauty therapists who are intending to offer treatments should seek thorough and comprehensive training at every opportunity. McCarthy, who has 20 years’ experience as a beauty therapist, explained, “The two days provided an invaluable resource for a small number of practitioners to study, in depth, the nerve structures of the face and to ensure that the highest level of safety and protection is offered to clients undergoing cosmetic procedures.” However, much to the concern of many aesthetic professionals, the anatomist who conducted the dissection and training did not have experience in treating aesthetic patients. Consultant aesthetic and plastic surgeon, and founder of Facial Anatomy Training, Mr Dalvi Humzah said, “It is important courses are run for practitioners to uphold their skills and knowledge, however the problem lies with who is teaching it. A person who is performing a dissection should be qualified not only in the anatomy but also in the techniques of injection and problems that one may see when performing non-surgical treatments.” Chair of the British Association of Cosmetic Nurses (BACN) Sharon Bennett added, “Although I applaud the initiative to expand on education and training, it is of grave concern that this course has been taught to beauty therapists by someone non-medical.” Consultant plastic surgeon and former president of the BAAPS, Mr Rajiv Grover, also voiced his concerns, stating, “This is not just about teaching how to inject – anyone can wield a needle – it’s about those injectors not being equipped to deal with consequences should something go wrong.”
HEE: qualification requirements
In the same week as the social media furore, Health Education England (HEE) published two reports aimed at improving and standardising the training available to aesthetic and cosmetic practitioners. Commissioned by the Department of Health (DoH) following the 2013 Keogh Review, the guidelines were developed by a group of industry professionals with advice and support from an advisory group and representatives from the regulatory bodies. The reports set out recommendations for qualification requirements for practitioners in the non-surgical cosmetic sector. The requirements laid out in Part One of the report state that only practitioners of postgraduate level (Level 7), who have successfully completed modality specific training, should administer botulinum toxins and dermal fillers, providing an independent prescriber oversees their work.
HEE suggests that all practitioners demonstrate that they meet the standards for the treatments they wish to deliver by September 2018
Practical skills training for the administration of botulinum toxins and temporary/reversible fillers would begin at degree level (Level 6), again, under the supervision of an independent prescriber and clinical oversight. The requirements suggest that the practitioner should have, amongst others, an indepth understanding of facial and neck anatomy, be able to identify contraindications, have an understanding of the biochemistry and pharmacology of various botulinum toxins and dermal fillers, the ability to recognise and correct suboptimal outcomes using knowledge of facial muscle interactions in the case of botulinum toxin, and be able to recognise and manage complications relating to dermal fillers. HEE recommends that practical skills training for the administration of botulinum toxins should include 10 treatments to the upper face for 10 different patients, while training for the administration of temporary/reversible fillers for lines and folds (precluding complex zones) should also include 10 treatments for 10 different patients.
Part Two of the report describes the results of a one-month stakeholder consultation on the draft qualification requirements and HEE’s recommendations for accreditation and implementation. Eight recommendations are made, of which, HEE suggests that all practitioners demonstrate that they meet the standards for the treatments they wish to deliver by September 2018. The report also recommends that a joint professional council should be established to assume ownership of the cosmetic industry standards for education and training, with lead responsibility for accreditation, further development, future proofing and continuing validity of the qualification requirements.
The Joint Council for Cosmetic Practitioners: a way forward?
In response to HEE’s recommendation, the BACN and the British College of Aesthetic Medicine (BCAM) announced they would work together on the establishment of a joint council for the nonsurgical aesthetic sector. With support from the DoH, the Joint Council for Cosmetic Practitioners (JCCP) will aim to oversee the delivery of safe treatments to the public. Bennett explained, “We are looking to standardise and harmonise the industry and bring together everyone who delivers cosmetic treatments so they’re all working to the agreed standards.” The president of BCAM, Dr Paul Charlson, added, “The support of the DoH in this area has been fundamental in order to give this initiative credibility. It can only work with the full support of all parties and we will be as inclusive as we can in order to achieve an outcome that will be credible and workable.”
According to the pair, the BACN and BCAM will work together on the implementation of a framework for the JCCP with a clear remit, structure and sustainable financial model. They will also aim to establish a Professional Standards Board under the guidance of the newly appointed independent interim chair, Professor David Sines CBE. Despite the concerns and challenges faced by the growing aesthetic community in recent years, the developments this year offer new hope to those working hard to ensure patient safety is of principal importance to those practising aesthetics in the UK. Speaking of the JCCP, Bennett concluded, “It has been a long time coming and will not happen over night, however it will put an eventual stop to unsafe practice.”