The City of Wolverhampton Council has become the first local authority in England to take action against a premises offering nonsurgical Brazilian Butt Lifts (BBL).1 Last month, it issued a prohibition notice to a business offering dermal fillers for buttock enhancement, after determining that the practitioners did not have the necessary skills, knowledge or experience to be performing the treatment.
The clinic is now prohibited from carrying out the procedure. There have been growing safety concerns for minimally invasive buttock augmentation using all kinds of dermal fillers. In a study published last year assessing 12 clinical reports, the authors noted that serious complications can and do occur as a result, and that they ‘become inevitable when performed illegally by non-specialised, non-authorised and unscrupulous practitioners in non-accredited facilities’. The study concluded that only well-trained, certified experts practising legally in accredited facilities can safely and efficiently treat patients.2
First prohibition notice
After reviewing its approach for several months with the guidance from a medico-legal plastic surgeon who reviewed the capability of Clinique Modele Aesthetics clinic and its equipment, Wolverhampton Council took action.
Following an assessment, it was determined that the clinic was unable to show that its staff had enough training, skills and knowledge to:
- Undertake buttock augmentation, which meant an increased risk of pulmonary embolism and/or sepsis
- Adequately recognise and deal with complications that may arise during the procedure
- Ensure adequate consent, including recognition of the need for psychological assessment of some individuals
It was also found that there was no trained assistant present during the procedure, no access to suitable equipment including an ultrasound machine, and no ability to prescribe medication such as hyaluronidase on-site in the event of complications arising. While in an unregulated industry it is not law to have the above, the expert in the case deemed these were necessary for a safe procedure, based on recent BAAPS guidance for BBL using fat transfer.3
A spokesperson for the City of Wolverhampton Council says, “To perform the procedure we would expect a doctor who is registered on the GMC Specialist Register and working in line with the British Association of Aesthetic Plastic Surgeon’s (BAAPS) guidance. This was not the case at Clinique Modele Aesthetics. We would consider other practitioners on a case-by-case basis.” The spokesperson adds, “This would be with the underlying principle that anyone looking to perform this procedure would be expected to check requirements with their relevant registration body and demonstrate that they could meet BAAPS guidelines.”
Issuing the notice
The clinic is now prohibited from carrying out non-surgical BBL procedures from the premises and any other location in Great Britain. The council notes that this action was taken under the Health and Safety at Work etc. Act 1974 to prevent the risk of serious personal injury and potential for fatalities from the procedure when carried out by unsuitably trained practitioners.4 No appeal has been made by the clinic. Councillor Steve Evans, City of Wolverhampton Council’s cabinet member for city environment and climate change, says, “We have based our decision to issue this prohibition notice on expert medical advice and with the aim of preventing any harm coming to our residents.” He added that when such a procedure is not carried out with the required level of training and skills, it can cause serious injury, pain and even death. “We do not want anyone to suffer these terrible outcomes,” he adds.
Regulating the industry
Consultant plastic surgeon Mr Dalvi Humzah notes that the council’s decision marks a huge turning point for the industry, stating, “This is the first time that a council has looked in depth at the beauty and aesthetics industry and applied standards of clinical practice. This will allow other councils to apply similar standards to clinics performing these procedures going forward. This is now precedent so if practitioners are not doing the above, namely ultrasound, then they might be in a similar situation whether they are medics or non-medics.”
There is currently no standard licensing scheme in England for businesses offering a non-surgical BBL. While a public consultation is due to be carried out under the Health & Care Act 2022 to give the Government powers to introduce such a scheme, there is currently no determined time scale for this to take place.4 “Therefore, we have taken this action in the meantime as we believe people could be putting themselves at real risk,” says Councillor Evans.
Councillor Evans adds that this will not be the only time the Council will take action against aesthetic clinics that they deem to be unsafe, and they will be monitoring the industry going forward. He says, “We are able to issue prohibition notices where we have concerns, and we will continue to take a proactive approach. This will involve identifying and investigating other businesses offering this service.”
The announcement has the support from BAAPS. President and consultant plastic surgeon Mr Marc Pacifico says, “We are fully supportive of the decisions taken by the City of Wolverhampton Council. The risks involved in filler injection can be significant, especially when injected blindly into the buttocks. Furthermore, not being medically trained in both the procedure, and in recognising and managing risks and complications, puts patients at significant risk of harm. We hope that other councils around the UK follow this example of decisive action to protect the public.”
Next steps
Mr Humzah advises medical aesthetic practitioners that if they find a similar incidence happening in their area, they should not hesitate to contact their local council. He says, “Beauty clinics need to be registered with their local councils and it is important that patient safety is maintained for any procedure carried out. Practitioners can contact the Environmental Health Officer and discuss the standards that were applied by the Wolverhampton Council for any clinics that offer such medical aesthetic procedures.”
