The non-surgical cosmetic industry is booming, as patients are frequently turning to non-invasive solutions that result in less recovery time.
The current market is worth an estimated £3.6 billion, with treatments such as botulinum toxin and dermal fillers accounting for 90% of the market share.1
And where there is demand, there is supply, which, in the UK, is largely unregulated. It’s my view that this lack of regulation is risking a situation where the credibility of the sector will suffer irrevocable damage if we do not change the way we do things.
But, to change the lack of regulation, I believe we need evidence to evaluate patient outcomes and ensure we put in place the most effective care. The paucity of available statistical evidence and facts is hindering our ability to safeguard patient safety and this needs to change. As clinical practitioners in the aesthetics field we should be at the forefront in adopting a recognised, centralised, system of data collection.
The Nuffield Council on Bioethics’ 2017 report titled ‘Cosmetic Procedures: ethical issues’ highlighted the urgent need for better data on the use of procedures, as well as the need for more research to improve the evidence base if improvements in the practice of the specialism are to progress.2 Similarly, the GMC recognises the importance of sharing information and states in its guidelines for doctors who offer cosmetic interventions that ‘you should share insights and information about outcomes with other people who offer similar interventions to improve outcomes and patient safety’.3
However, currently in the UK, small sample data or commercially driven data are the primary benchmarks available to practitioners. Many industry associations such as the British Association of Aesthetic Plastic Surgeons (BAAPS) are active in collecting data from their members, although this is only from practitioners who have voluntarily become members. As well as this, data collected from all parties, including associations, insurance providers, manufacturers etc. are not pooled to one centralised place. Even if this were to occur, pooling data from multiple sources can cause double reporting (the same incident reaching a central source via two different routes independently).
I also believe that, anecdotally, there is tremendous underreporting of scenarios such as complications, which I think is impacting patient safety. Practitioners may/should be aware of reporting drug/device problems to the Medicines and Healthcare products Regulatory Agency (MHRA), but they may feel defensive to report technically-dependent problems. Insurers will only record situations resulting in an insurance claim, and legal firms will only have data from those resulting in litigation. These could be the tip of the iceberg, because even relatively serious events can result in neither, especially in the non-surgical world.
A rich data set will allow us to understand the variables in the treatment outcomes. For instance, if complications are arising due to a specific product or poor hygiene standards. Currently, no one really knows the extent of the adverse event incidents caused by medical aesthetic treatments such as dermal fillers and botulinum toxin and the public is under the misconception that non-surgical means non-medical. Compiling data on adverse effects will help reinforce that treatments should only be carried out by medically-trained professionals, equipped to intervene should things go wrong.
If this data is collated in a centralised place, it can be analysed and will provide clear indications for industry improvements. Finding any patterns and correctly interpreting the results is an important step towards creating a better and safer system for practitioners to work within.
Although some industry improvements have been made in the five years post the Keogh review,5 much more work still needs to be done regarding data collection and regulation. What is needed is not just ‘some’ data, but ‘enough’ data to establish who is having the treatments in the industry (age, gender, race etc.), exactly who is providing them (the background of the practitioner – are they medically trained?), where they are taking place, together with product types, dosages and resulting complications.
Capturing data will help the sector become more open and transparent, providing the evidence to prove what works and what doesn’t. It will also help remove non-evidenced based decision making. For example, if the data reveals more complications occur when administered in non-clinical settings, then it will help strengthen the argument for legislative change.
I believe all practitioners should be active in reporting their clinic data. Although I think this reporting should continue to be submitted to a professional’s regulatory bodies and associations, I do think there also needs to be a common place to submit this data. I believe the Joint Council for Cosmetic Practitioners (JCCP) offers a unique opportunity to help to move this issue forward because there are all different types of practitioners and training providers that are eligible to join and therefore will represent a wide variety of individuals. For those reluctant to self-report adverse events, I think it’s important to view this process in a positive light. We all want to raise standards across the sector and data will help us achieve this. In the absence of a formal reporting process, I think practitioners need to report what has gone wrong to the JCCP register.
This would allow tracking and calculations to be made on the rate of incidents on a nationwide scale and would mean we could evaluate what treatments are associated with poor outcomes and help minimise risk.
As Professor David Sines, chair of the JCCP, has stated, “Nothing less than statutory regulation will protect the public.”4 I agree with this statement and as clinicians, I believe we need to drive forward this debate for legislative change. Data helps make the case for mandatory regulation by highlighting the standard of medical training required to perform treatments adequately and the importance of clinical settings to protect patient safety.
Statutory registration would require all registrants to report adverse incidents to the regulator, which would enable a rich data bank to be built in one place, that could be shared with agencies such as the MHRA, with the aim of reviewing practice standards and the provision of safe practice guidelines and products. Currently, stakeholders like the General Medical Council, the Cosmetic Practice Standards Authority (CPSA) and the JCCP are working together to drive forward the legislative debate and push for regulation. We can help protect patients and increase data collection by supporting these frameworks, so we can build our specialty based on facts, and not intuitive guesswork.
Data collection is the starting point for making much-needed improvements to the aesthetics specialty, enabling us to change the landscape and shape our profession. If we don’t have sufficient facts and figures, we will never be able to measure the effectiveness of treatment or the capability of practitioners and push for regulation.
1. BBC, Botox and fillers: Are these ‘tweakments’ all they’re cracked up to be?, 2017. <https://www. bbc.co.uk/bbcthree/article/075551b0-d866-45db-ab6a-149ce182d741>
2. The Nuffield Council on Bioethics’, Cosmetic procedures: ethical issues, 2017. <http:// nuffieldbioethics.org/project/cosmetic-procedures>
3. GMC, Guidance for doctors who offer cosmetic interventions, 2016. <https://www.gmc-uk. org/-/media/documents/Guidance_for_doctors_who_offer_cosmetic_interventions_210316. pdf_65254111.pdf>
4. Kilgariff, S, News Special: The Launch of the Joint Council, 2018. <https://aestheticsjournal.com/ feature/news-special-jccp-to-update-hee-framework>