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The cosmetic surgery crossroads

April 25th 2013 / Anna Hunter


This week there have been calls for the cosmetic surgery industry to be regulated in the UK and it's not before time, reports Anna Hunter

Cosmetic surgery has been sparking debate on news channels, discussion forums and newsstands for a while now; it’s undeniably a contentious issue. Fears about its safety and lax social attitudes towards cosmetic treatments are now firmly at the forefront after the results of an independent review commissioned by the Department of Health in England warned that cosmetic surgery has been ‘trivialised’.

With dermal fillers covered by the same level of regulation as biros and toothbrushes and the rise of ‘Botox beauty parties’, it’s high time we took a long hard look at the legislation surrounding cosmetic procedures. It seems that last year’s PIP implant scandal was the tip of the iceberg in terms of bad practice, aftercare and regulation within the industry - just look to any chat show or news programme today and you are likely to see contributors who have fallen foul of cowboy surgeons, pushy salespeople and sensational financial offers.

The review's findings will be passed on to health ministers throughout the UK, and it will recommend that the following criteria is introduced:

  • Legislation to classify fillers as prescription only
  • Formal qualifications for anyone who injects fillers or Botox
  • Register of everyone who performs surgical or non-surgical cosmetic interventions
  • Ban on special financial offers for surgery
  • Formal certificate of competence for cosmetic surgeons
  • A breast implant register to monitor patients
  • Patients’ procedures must be approved by a surgeon not a salesperson
  • Compulsory insurance in case things go wrong
  • A pooled fund to help patients when companies go bust

We asked our experts for their views on the issue and proposed changes:

Rajiv Grover, President of BAAPS

"The review is long overdue, but sadly comes as a result of the PIP crisis where 40,000 women were given defective implants. This shone a light on the many aspects of the industry that required improvement.

"The review looks at the whole procedure from the patient's perspective from seeing adverts, to who performs the procedure to the consultation and consent process and the checks and balances required for good aftercare.

"The key elements of the review are: there should be proper qualifications for people who want to carry out cosmetic procedures and the registration of practitioners who have those qualifications, so that any member of the public can find a safe practitioner more easily than before.

"With regards to dermal fillers, the review states that they should be available only with a prescription, which will kill three birds with one stone: firstly, regulating the quality of the fillers used (so they are treated like medicines), who performs the procedures and also regulation of advertising as well (as anything with a prescription has to adhere to strict guidelines).

"These are just recommendations for now and what is required at this stage is for Parliament to pass legislation so that the regulations can become enforceable. Almost all of the recommendations stated have been practised by BAAPS for many years and it is important that the rest of the industry catches up with that standard."

Dr Nick Lowe, Professor of Dermatology, Cranley Clinic

"I am very pleased with the recommendations that injectable fillers will be regulated as prescription items.

"Firstly, this is because there will be greater control over which ones are used in the UK. At the moment, 190 are available in Europe in comparison to around 20 which are approved in the US due to the fact that not as much testing goes into some of them and they aren't as heavily regulated. (The ones that we use in my clinic are all FDA approved as well as being approved in the UK too).

"Secondly, there will be greater regulation for those who are able to inject them. At the moment, anyone can inject dermal fillers which carries with it potential risks. Whoever injects them, whether they be a plastic surgeon, specialist cosmetic doctor, trained nurse or beautician, will have to be under a greater degree of supervision. This will ensure a greater degree of safety for the public. Once dermal fillers are made into prescription injectables, this will also lead to better training, and the sort of training involved will be more easily controllable.

"The framework that I would advocate would be professional responsible bodies who are put in charge of dermatologists, such as BAAPS, BAD, British Association of Cosmetic Doctors and a body for nurses too (I believe that they are putting one together already). There will also be training outlines created by the end of the year and there is a group being put in place working towards this too, also taking into consideration that training times will need to be adjusted depending on whether a beautician or dermatologist is being trained. Training workshops and relevant certification will hopefully be included too."

Dr Mica Engel, Resident Aesthetic Doctor at Waterhouse Young

"As a professional clinic that has only ever employed highly trained aesthetic doctors and nurses to carry out our non-surgical treatments, we entirely welcome the report's findings. Every day we see first hand how our holistic approach to skin care can have a positive effect in boosting self esteem and confidence. But we are also regularly asked to repair the damage done after patients have received poor advice and treatments. Tighter regulation can only be a good thing for patients and the industry as a whole.

“For too long it has been the case that women (and men) considering a non-surgical procedure, whether to fight the signs of ageing or for a medical issue like hyperhidrosis, have been able to undergo treatments in environments such as hair salons/Botox parties where there is no guarantee the practitioner will be medically qualified.

“We welcome the recommendation that dermal fillers should be administered on a prescription only basis and be carried out by a formally qualified professional doctor or nurse. We need to think about these procedures in the same way we would any other medical procedure. It would be unfathomable that we undergo any other type of medical procedure in a non-medical environment - Botox and dermal fillers shouldn’t be any different.

“A lot can be learnt from the US market where dermal fillers are regulated by the Food and Drink Administration. Only fourteen types are available on the market from brands such as Allergan who produce Botox. In contrast, there are between 140-190 on the almost entirely unregulated, UK market. Only by receiving a prescription from registered practices made up of trained professionals can you be sure you are receiving quality treatment.”

Dr Frances Prenna Jones, Aesthetic Facialist

“Regulating cosmetic procedures and protecting patients is now so difficult as the horse has bolted so to speak. There are so many people doing treatments in their front room or even garden sheds for cash, it would be impossible to even find them to enforce regulation. I think patients need to drive the change by choosing their practitioner carefully.

"I see no harm if a patient has to have a number of treatments in order to get the required outcome, eg, severe acne scarring. I see no problem with a little discount for a course like this, vs a single treatment that a patient may have just for rejuvenation. But incentives that trick people into having things done without due time or consideration should absolutely be banned."

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