The All-Party Parliamentary Group on Beauty, Aesthetics and Wellbeing (APPGBAW) recently published its final report into botulinum toxin, dermal fillers and other aesthetic non-surgical cosmetic treatments.1
The year-long inquiry was commissioned to investigate how standards for undertaking and advertising cosmetic treatments and the relating regulatory and legislative structures, should be improved to support the aesthetics industry and protect public safety. This report follows the 2013 Review of the Regulation of Cosmetic Interventions led by Professor Sir Bruce Keogh, which concluded that ‘dermal fillers are a crisis waiting to happen’.2
The APPG made a total of 17 recommendations, which were based on evidence given in public inquiry sessions and submissions from stakeholders including associations, training providers, practitioners, aesthetic industry operators, health regulatory bodies and patients themselves.1 Over the last few weeks, industry groups and associations have responded to the report, outlining their opinions, and providing further suggestions. Below, Aesthetics summarises the recommendations of the APPG investigation, and reports how the specialty reacted.
The industry currently lacks a clear definition on what constitutes an aesthetic treatment, making the data available to the government patchy due to the incorrect grouping of aesthetics with other industries, such as physical wellbeing activities, retail, or hospitality. As such, the APPG has recommended that the Government should define in law what constitutes a ‘medical-related’ service and what is an elective aesthetic non-surgical cosmetic treatment; as well as advising them to collect annual data on types of aesthetic treatments, numbers of practitioners, premises, training courses and complications. This has received support from the Joint Council for Cosmetic Practitioners (JCCP), which outlined its own definitions of what constitutes a ‘medical’, ‘medically-related’ or ‘cosmetic’ procedure earlier this year, following the confusion highlighted during the COVID-19 lockdowns.3
Professor David Sines, chair of the JCCP, comments, “The JCCP believes that the Government is correct in calling for a legal definition of medical/cosmetic treatments since we believe that this will provide the opportunity for safer regulation in the aesthetics industry. This will ensure that an accurate and appropriate assessment is undertaken of an individual who is presenting reasons for seeking treatment, and that treatment is provided by suitably qualified practitioners wherever a medical/clinical or medically-related reason for applying that treatment is determined.”
Despite its potential benefits, the BACN stated in its response that aesthetic procedures, regardless of need or outcome, are medical from consultations to delivery and post-treatment management, and so believe that this should not be disputed, but rather enforced as an absolute.
Standards and qualifications
As outlined in the report, the current regulatory framework in the UK places no restrictions on who may perform aesthetic non-surgical cosmetic treatments in the private sector.1 The APPG suggest that the Government must set national minimum standards for the training that all practitioners must be required to undertake to provide aesthetic non-surgical cosmetic treatments (e.g. Level 7 qualifications), a notion that is supported by industry associations. JCCP Training and Education committee member and founder of training provider Harley Academy, Dr Tristan Mehta, welcomed this suggestion, commenting, “Being Level 7 qualified shows you have been trained to be a safe and ethical injector, and that you have received master’s level training from experts in the field. It shows you have studied not just injecting techniques but also anatomy, facial ageing, skin ageing, preventing, and managing complications… the list goes on.”
Carina Fagan, chief academic officer of qualification awarding organisation VTCT, also supported this recommendation, stating, “VTCT fully supports this report. The proposed recommendations reflect our position of raising standards and encompassing the needs of our industries. It is in the best interest of both consumers and practitioners to ensure that the industry is safe for all thorough robust training and qualifications.”
While the report discussed mandatory qualifications for aesthetic practitioners, it also looked into implementing the same for non-medics, noting that the current qualification standards hold a barrier to their progression. In particular, it states that those seeking a vocational route from aesthetics at Level 4/5 should be able to access advanced aesthetics at Level 7 courses for injectables and fillers. The APPG has also recommended that there should be a CPD framework for both medics and non-medics, suggesting that there is a need for the beauty industry and the medical professions to work together to seek solutions that raise standards and protect the safety and wellbeing of consumers.
In addition, point five of the report recommends that there be on-site medical oversight for non-medical practitioners when administering injectables.
The suggestion of allowing non-medics to access Level 7 qualifications has resulted in backlash from major industry associations such as BACN, BCAM and the JCCP; which are all in agreement that that the process of care required and understanding the risks associated with underlying medical conditions can only be appropriately achieved by having a medical or nursing qualification and cannot be taught in any vocational course. Professor Sines commented, “It is increasingly apparent that at this time, high-risk procedures like the injection of toxins and the insertion of dermal fillers should only be administered by healthcare professionals who have the necessary skills, qualifications and competence in these areas.”
Regulation and enforcement
As it stands, local authorities in England can adopt powers to register practitioners and premises providing a limited number of special procedures under the local Government, however they do not have the powers to cover at-home or mobile treatments. In addition, even when the powers are available, local authorities do not have adequate funding to complete the proper enforcement role.1 Therefore, the APPG recommends that the Government introduces a national licensing scheme to govern the oversight of advanced aesthetic non-surgical cosmetic treatments such as botulinum toxin, dermal fillers, and threads. The group has also suggested that dermal fillers be classified as a prescription-only and, in line with recommendation five, be performed under the oversight of a prescriber who has gained the accredited qualifications to prescribe, supervise and provide remedial medicines if necessary.
Dr Mehta sees this as a step in the right direction, commenting, “Through calling for fillers to become prescription-only and mandatory medical oversight for such treatments, the risk of permanent complications can be significantly reduced – the treatment for many complications with injectables need a medical prescriber.” Dr John Elder, who leads BCAM’s Aesthetic Medicine Regulatory and Advisory Group (AMRAG) agreed, noting, “With dermal fillers, the failure to recognise that something is going wrong and be able to initiate appropriate treatment – usually requiring prescription drugs – is a serious issue. Fillers should be prescription-only, and regulation is required to limit who can administer them, which will significantly reduce the risk to the public.”
Dr Martyn King, chair of the Aesthetic Complication Group (ACE) Group World and vice chair of the JCCP, also voiced his support for this particular proposition, stating, “Currently, dermal filler is classified as a medical device, which basically means that anybody can buy it. If this type of product was made prescription-only it would be a huge step to better regulation, ensuring only quality products are used and that practitioners have the medical background and training needed if complications should occur.”
Ethics and mental health
The report outlines that at present there is no regulation to mandate psychological screening of patients, and there is also no incentive for practitioners to safeguard their customers’ mental health. As such, the APPG states that the Government must work with the aesthetics industry on the development of psychological pre-screening tests to cover a range of broader psychological vulnerabilities; education for spotting these vulnerabilities must be included in national minimum standards for training; and that the recent legal ban on under-18s receiving treatments4 must be extended to PDO cogs and threads.
The BACN welcomed this recommendation, with chair Sharon Bennett commenting, “The government would be well placed to work with the specialty and develop pre-screening tests that can be performed by a medical professional (doctor, nurse, dentist). The need to identify, manage and refer those vulnerable and with psychological conditions is essential as part of our duty of care to patients. A screening tool will help give (medical) practitioners the tools to assess sensibly and sufficiently.”
Currently there is no legal requirement for non-registered healthcare professions to be insured to perform aesthetic treatments.1 The report recommends that the Government should require all practitioners to hold adequate and robust insurance cover; as well as ensuring that practitioners hold regulated qualifications for the aesthetic non-surgical cosmetic treatments they provide, alongside appropriate industry-approved CPD training in order to qualify for this insurance.
On these recommendations, Professor Sines notes that the JCCP extends its full support and agreement, stating that there needs to be a minimum threshold of indemnity for medical insurance to help with those who have a complaint or reason to raise a concern following receipt of the treatment.
Social media and advertising
For this section of the investigation, the APPGBAW partnered with the APPG on Social Media. Research highlighted that social media has driven the societal pressures leading people to seek aesthetic non-surgical cosmetic treatments.1 As such, the group recommended that social media platforms take more responsibility for curbing and censoring misleading advertisements and for the mental health impacts of promoting aesthetic non-surgical cosmetic treatments. They advised that advertising restrictions should be placed on dermal fillers and PDO cogs and threads in the same way they are imposed on botulinum toxin as prescription-only.
Bennett says the BACN agrees that there should be more regulation in this area. She comments, “We are not saying a blanket ‘no advertising’, but advertising dermal fillers should have a strict set of criteria to prevent misinformation, doctored photos, targeting the vulnerable with cheap offers, and poorly or untrained people promoting the procedures.”
The non-medic response
Maxine Hopley, CEO of Cosmetic Couture, a training academy that trains non-medics, has responded positively to almost all recommendations outlined in the report, except the suggestion to make dermal fillers prescription-only. She says, “It’s obvious there needs to be changes – we need a national qualification that’s open to all and it’s great that this report highlights that both medics and non-medics should be treated equally in the industry and be given equal access to a new qualification at Level 4 and then to Level 7. But, making fillers a prescription only is a step too far and I don’t support that.”
The future of aesthetics…
While not agreeing with every point mentioned in the APPG report, all associations have noted that the recommendations made can be viewed as a step in the right direction for regulating the aesthetic specialty. Professor Sines concludes, “The next steps should be to ensure that there is a parliamentary debate on the recommendations presented in the APPG report and to ensure that the Minister responsible for aesthetics at Westminster (Nadine Dorries) to provide a full written response with an action plan to ensure that the recommendations made and set out within the APPG report are acted upon without compromise.”
1. All-Party Parliamentary Group on Beauty, Aesthetics and Wellbeing, Inquiry into advanced aesthetic non-surgical cosmetic treatments, 2021
2. Bruce Keough, Review of the Regulation of Cosmetic Interventions, 2013, <https://www.gov.uk/government/publications/review-of-the-regulation-of-cosmetic-interventions>
3. Holly Carver, Defining a Medical Procedure, Aesthetics journal, 2021, <https://aestheticsjournal.com/feature/news-special?authed>
4. Chloé Gronow, MPs Support Children & Aesthetic Procedures Regulation, Aesthetics journal, 2020, <https://aestheticsjournal.com/feature/mps-support-children-aesthetic-procedures-regulation>