Delving into the aesthetics field can be daunting, but you’ve got to start somewhere. Everyone starts their journey differently, and everyone’s journey is unique. It depends on many factors including your current job, family status, finances and how you will manage extra work, training, study, responsibility, and pressure. It’s a juggling act!
There is no ‘right way’ but hopefully this article will help you cover what I believe to be the most important aspects to ensure you are safe and, most importantly, so are your patients. Take your time, do it right and do it safely. It does not matter if it takes two or 10 years to have 50 regular returning patients or if it doesn’t go to plan the first time – that’s how we learn and make patient care standards and business even better.
The importance of training
Arguably, the most important aspect of patient safety is training. Let’s say you have completed a foundation day course – this is a great place to start. Hopefully you liked it and have decided aesthetics is the specialty you want to pursue, and you’re willing to put in the time, money, and of course the extensive training it takes to become a top aesthetic practitioner with patient safety at the forefront.
So, how do you gain competence in order to feel confident and safe to practice as a sole clinician or get enough experience to get a job in a clinic? The answer… book more training. This is a specialty, and although there is no law on minimum training requirements to practice aesthetic medicine, a one or two-day course is not enough to become a leading practitioner in the field.
Look for training that will give you continued learning and mentorship so you can develop steadily and safely. Learn your anatomy and know the products you are going to use inside out! How do they work? How are they administered and why? What dermal layer are your products injected into and again why? Think, correct training, product, tool, dose, technique and aftercare.
If you decide you are committed to a career in aesthetics, I suggest checking the training providers on the Joint Council of Cosmetic Practitioners’ (JCCP) website.1 A Level 7 Diploma in Injectables for Aesthetic Medicine is a great route to take. Some Level 7 courses are JCCP-approved, and others are not, but I would recommend looking for one that is as they own the original Health and Education England (HEE) guidelines. Finding one that is regulated by The Office of Qualifications and Examinations Regulation (Ofqual) is also strongly recommended.
Each Ofqual Level 7 course will be different and can take six to 36 months to complete, but typically it will include safe use of needles and cannulas, business advice, in-depth knowledge of skin and facial ageing, anatomy, complication management, and the psychological driving forces and issues for patients considering cosmetic treatments.
You can also look to complete a Master’s in aesthetic medicine which is similar to a Level 7 and can be a good choice for furthering your academic career, although it can be a bit less practical and more academic. The University of Manchester, for example, offers a part-time MSc in aesthetics, incorporating online learning, group work, and written assignments, two five-day residential sessions and a final dissertation over 36 months.2 Although it’s not formal training, attending conferences like the Aesthetics Conference and Exhibition (ACE) and CCR is a great way to keep track of industry updates, further your learning, network and attend talks and demonstrations from some of the best practitioners out there.
An essential way to ensure you are a safe practitioner is to complete a complications management course. For example, you should look to complete a course on how to manage injectable complications like botulinum toxin and the undesired effects of fillers, granulomas, nodules and post-inflammatory swelling. I highly recommended this not just for patient safety but for insurance purposes too. You can never do enough of these, and I encourage practitioners to attend and complete one course annually alongside your basic life support (BLS), intermediate life support (ILS) or advanced life support (ALS) resuscitation training.
As well as training mentioned above, join an emergency complications group for 24/7, 365 days a year support and expertise such as the two main complications groups: the Aesthetic Complications Expert Group (ACE) World and the Complications in Medical Aesthetics Collaborative (CMAC).3,4 They both offer clinical guidelines for aesthetic practice, as well as share research, support, templates, webinars and much more. Joining these groups is invaluable to have such experts at the end of the phone when you need them and is excellent value for money when you consider how they can support you. Another way to ensure you are practising safely and to reduce the likelihood of complications is to make sure you only use well-established, well-researched quality products – this is essential. Do not purchase products from unmonitored or unauthorised parties as they may be counterfeit and may not contain the ingredients they state, putting your patients and you at risk from undesired complications and potentially irrevocably damaging your brand. I recommend using reputable product distributors and regulated pharmacies or go direct from the manufacturers.
As well as taking all the necessary steps to avoid a complication, it is also essential to know what to do when one does occur. Ensure you have the recommended emergency drugs kit prior to any treatment, that all drugs are in date, stored correctly and you have enough as per the ACE Group World emergency drug kit list and policy.5
Look for training that will give you continued learning and mentorship so you can develop steadily and safely
Vials of adrenaline are recommended instead of adrenaline branded pens due to the Medicines and Healthcare Products Regulatory Agency (MHRA) report that one failed to auto inject in the last few years.6
Make sure you have a medical fridge for emergency drugs and botulinum toxin storage and monitor the temperature daily. In a 2021 US study, out of 370 participating dermatologists, 106 (28.6%) reported at least one vascular occlusion, so it is essential to have hyaluronidase on site in case of a vascular occlusion.7 ACE Group World recommends to store your hyaluronidase at a temperature between 2-8°C to maintain the quality of the product.8 CMAC recommends using 1,500 units of hyaluronidase in the case of a vascular occlusion, and once opened the remaining contents needs to be disposed of, so bear that in mind when thinking about amounts to store in clinic.9
You should also consider the importance of sharps disposal and clinical waste. There are many companies out there that can assist with this, and you need to find which is right for you and your business. The best place to search for this is online, as not all companies cover the whole of the UK. PHS who supply the NHS have been known to be very good. Some local councils also request you have a sharps license so check this with your local council too. JCCP, ACE Group World and CMAC provide clinical policies and procedures for safe practice within aesthetics as well as Save Face, who will also attend your clinic and complete an assessment with you.10 When you have a waste disposal service arranged, they will ask you to display your certificate within your clinic setting so the collectors can review it and also the public.11
Insurance and policies
Covering yourself and your business should anything go wrong is vital, so insurance is an absolute must. Contact some insurance companies and get quotes for aesthetic insurance and compare, ensuring it covers what you need. A few reputable insurance companies include Enhance Insurance, Cosmetic Insure, Hamilton Fraser, PolicyBee, and there are more available. I choose Hamilton Fraser as they came highly recommended by a colleague and they had the best plan to meet my needs.12 Make sure the provider covers you for onward referrals if required medically, clinical complications, each procedure you intend to carry out and the products you intend to use. You should also ensure you are clear as to how they receive a complaint.
As well as insurance, next comes policies and procedures that you should have in place for a safe practice. At a minimum, I believe you should have the following:
- Health and safety for you, any employees and your working environment, slips, trips and falls
- Fire safety ensuring there is an evacuation plan and fire extinguisher if required for your premise size
- Infection control prevention and management plans
- Data protection and GDPR
- Complaints process and recording
- Risk assessments
- MHRA medicines and prescribing
- Information Governance Policy
- Equality, diversity and disability/human rights
Don’t be put off!
It may seem like there is a tidal wave of legislation and jumping through hoops to start out safely in aesthetics, but as medical professionals, you all already understand the need for stringent procedures when dealing with human health. Don’t be put off by the overload of information at the beginning, complete training, network at events to gain mentors and helpful allies, and do as much research as you can. Patient safety is paramount in any aesthetic practice, and it’s key in ensuring the longevity of your business.
1. JCCP, 10 Point Plan for Safer Regulation in the Aesthetic Sector, 2021,
3. Aesthetic Complications Group World - <https://acegroup.online>
4. Complications in Medical Aesthetics Collaborative - <https://www.cmac.world/members-area/>
5. Aesthetic Complications Group World, Practice Standards, 2020, <https://uk.acegroup.online/policies/practice-standards/>
6. Medicines and Healthcare Products Regulatory Agency, ‘Adrenaline Auto-Injectors: Recent Action Taken to Support Safety, 2019, https://www.gov.uk/drug-safety-update/adrenaline-auto-injectors-recent-action-taken-to-support-safety
7. Alam, M. et al., ‘Rates of Vascular Occlusion Associated with Using Needles vs Cannulas for Filler Injection, JAMA Dermatol, 157(2), 174 – 180, 2021
8. Aesthetic Complications Group World, ‘The Use of Hyaluronidase in Aesthetic Practice’, https://www.bacn.org.uk/content/large/documents/members_documents/complications_guidance/acegrouphyaluronidasev2.4.pdf
9. Murray G, Convery C, et al., ‘Guideline for the Management of Hyaluronic Acid Filler-Induced Vascular Occlusion’, J Clin Aesthet Dermatol, 14(5): 61-69, 2021
10. Save Face, <www.saveface.co.uk>
11. PHS Group, ‘Sharps Box and Bin Disposal’, <https://www.phs.co.uk/our-services/healthcare-hygiene/sharps-disposal/>
12. Hamilton Fraser, <https://hamiltonfraser.co.uk/cosmetic-insurance-quote/>