If you’re tweakment-curious, finding a great clinic and specialist should be your absolute priority. We’ve been there, done that, and are here to help
Tweakments – minimally invasive non-surgical treatments – are a booming business. But if you’re tempted to start dabbling in Botox or Morpheus 8 or polynucleotides or any of the buzzy procedures that everyone is talking about, where do you start? If there are three clinics on your local high street all offering injectables, some cheaper than others, how do you pick the best of the bunch? It can be a minefield. But, worry not: I’ve been reporting on this stuff for 15 years, so I know exactly how to find a talented, reputable practitioner who can home in on the right treatment and results for you.
First things first though: tread carefully. Tweakments are not to be taken lightly. Scalpels may not be part of the equation, but non-surgical treatments do involve machines and acids that burn and ablate the skin, needles that puncture, and syringes that inject potentially life-threatening toxins, molecules and implants (which is what fillers technically are).
I have access to the best doctors in the country and have had some fabulous results over the years but I’m always honest about the reality of having tweakments. Occasionally things go wrong and there can be downtime, not to mention pain – I’ve written before about the truth about non-surgical cosmetic procedures.
It’s not that the doctors don’t know their craft, but that in dealing with living flesh and medical procedures, there are always risks involved that need to be professionally managed.
What’s more, tweakments are still entirely unregulated in the UK, which makes navigating the options harder for customers. So before you take the plunge, read my golden rules for choosing the best aesthetic practitioner for you.
Beauty editor Inge has been having tweakments for 15 years. Photography: Mary McCartney
What you need to know when choosing a tweakments specialist
1 - Your plumber can inject your Botox
Literally anyone can do a one-day course and set up as a cosmetic injector of toxin, fillers or skin boosters, if they can get their hands on the injectables. In the case of Botox and other toxins, this should involve a prescription for you from your cosmetic doctor, but non-medical practitioners get around this by getting supplies of toxin prescribed to them via internet back-channels. Fillers, meanwhile, are classed not as drugs but as ‘medical devices’, which makes them a free-for-all to inject.
“Having Botox at the salon when you're having your hair dyed has become so normalised in the UK that people don’t realise it’s not normal or safe, and it shouldn't be happening,” says cosmetic physician Dr Catherine Fairris, President of British College of Aesthetic Medicine. Hitting or blocking a nerve or artery or causing a major infection, or injecting something unlicensed and dangerous, is rather easy if you don’t have the medical skills. So injectables (which also include skin-lifting threads - basically small lengths of barbed wire) should be done by medical professionals, period (for details on which pros, see below).
Dr Catherine Fairris, president of the British College of Aesthetic Medicine (image: Instagram @drfairris_skinwessex)
2 - Lasers must be in safe hands
Lasers can be dangerous in unskilled hands, as can other energy-based devices (high-intensity focused ultrasound like Ultracel, radiofrequency microneedling like Morpheus 8, plasma like Neogen, CoolSculpting, etc). When wielded by someone who hasn’t been medically and anatomically trained, they can be ineffectual at best and cause serious burns, scars, hyperpigmentation, blindness or skin ageing at worst. So you need a medical pro - or someone who is supervised by or in direct communication with a medic at least.
Without medical supervision, Fairris believes skilled beauty therapists can competently perform skin procedures such as microneedling, superficial chemical peels, minor laser treatments such as laser hair removal and IPL, and microdermabrasion. “Many therapists are brilliant, but the key is that they should work within their scope of practice,” she says.
The government is working with professional aestheticians and the bodies representing them (such as BABTAC, the British Association of Beauty Therapy and Cosmetology) on a framework of regulation. This should guarantee specific qualifications allowing non-medics to safely perform some of the above energy-based procedures independently, but implementation, let alone enforcement, is still a way off.
3 - Dentists and nurses are often a good bet
The British College of Aesthetic Medicine recommends your tweakments should be sourced from doctors and surgeons but they also list dentists and nurses as safe bets.
Dentists can be fantastic at aesthetics, says Fairris, because “they have a lot of head and neck anatomy and training, and look at faces all the time”. When it comes to nurses, look to the senior levels: “A lot of senior nurse practitioners have great skills, plus they, alongside nurse prescribers, can dispense medication, should things go awry.”
UK doctors and surgeons must be registered by the GMC (general medical council), dentists by the GDC (general dental council), and nurses by the NMC (nursing and midwifery council).
4 - A medical qualification doesn’t guarantee beautiful results
One example of a non-medically trained but highly specialised tweakment practitioner is Debbie Thomas, who’s possibly the country’s most respected cosmetic laser expert. “Advanced specialist training and a hotline to a doctor in case of a medical emergency is a must, but don’t make the mistake of thinking just because someone has a medical degree, they’ll be good at aesthetics, or are even safe practitioners,” she cautions.
She has, she says, seen plenty of patients with un-addressed necrosis (dead body tissue) or hyperpigmentation caused by people with a medical degree who’ve done a one-day Botox or two-day laser course and set up as an aesthetic doctor. “Whether medical pro or aesthetician, what we really need is regulations on advanced qualifications for every specialism within the aesthetics industry.”
Fairris agrees with Thomas that having medical qualifications doesn’t automatically mean you have an eye for proportion or aesthetically pleasing outcomes, so, she says, “specific post-graduate training in aesthetics is another must when choosing a great practitioner”. So is ample experience to develop and refine skills, and a genuine affinity with, and interest in, aesthetics.
Aesthetic physician Dr Sarah Tonks advises you check doctors' independent reviews - doctify.com and realself.com are reputable resources for this.
She also urges that you check out medical clinics’ CQC (Care Quality Commission) rating, which tells you how safe, effective, caring, responsive and well-led the place has been deemed to be after inspection.
5 - Doctors are obliged to help if things go wrong
Doctors are not only clinically trained to resolve any unforeseen issues resulting from tweakments (including prescribing medication), they also have a legal, moral and ethical obligation to do so and are accountable to many professional organisations. Non-medics have no such skills or accountability, and aren’t even obliged to take out insurance. So ensure that they do have insurance covering them to perform the procedure – or medical indemnity if they are a doctor, says Fairris .
One resource for finding reputable practitioners working with their legal skill sets is the Joint Council for Cosmetic Practitioners (JCCP), a self-regulatory body that oversees voluntary regulation and sets practice standards. It lists both medical and non-medical practitioners but it does set out who is qualified to do what and lists them accordingly.
6 - A shoddy salon is a red flag
If you’re going to break or burn your skin, the setting should be clinical, dedicated and scrupulously clean. Someone’s kitchen isn’t, and neither is your own home or the back room at the hair salon where the dye is mixed.
7 - If you get the hard sell, run away
A famous cosmetic doctor once told me the reason he set up his own clinic was the pressure he experienced, when working for a chain of clinics, to hard-sell costly new machines. “They were suggested for any issue patients presented with – even when they were the wrong option,” he told me. It’s something that happens in many places, partly in order to recoup investments as quickly as possible.
No tweakment is good for everything, so either choose a practitioner who offers a wide range of technologies, or one who’s honest about specialising in just a few treatments and issues. And always beware of the latest ‘miracle’ treatment and practitioners who push it to the nth degree.
8 - Seek out a specialist
Consensus is rarely a given when it comes to ‘the best’ tweakments, even among doctors. So prepare to hear a range of views and do your own research. If you’re set on a particular tweakment, choose a practitioner who specialises in it or at least has performed it countless times and can show you their many great results to prove it.
In London, trustworthy specialists in their field include Dr David Jack for Morpheus 8, Dr Ash Soni for Sculptra, Dr Sarah Tonks for the full gamut of skin boosters, and Dr Apul Parikh for HArmonyCa.
Tweakment experts you can trust (clockwise from top left): Dr David Jack, Dr Ash Soni, Dr Apul Parikh, Dr Sarah Tonks
9 - Beware of bargains
Fairiss warns that a large amount of counterfeit injectables is being imported and sold through black market sources, while copycat laser, Coolsculpting and other machines without a CE mark or any clinical proof can be bought cheaply on Ali Baba.
The real stuff isn’t cheap even at cost price, so if someone offers Botox at £100 a pop, especially if it’s a small clinic and not a national chain that can buy legit stock at discounted rates, it’s probably sub-standard.
10 - Talk it through and read the small print
Minimally invasive treatments should be preceded by your clinician taking a proper medical history so they can assess whether it’s safe for you. All the risks and benefits should be discussed with you prior to the treatment, with a cooling-off period offered before you agree to push ahead. Importantly, make sure that an emergency and/or out-of-hours contact is provided, should something be amiss in the days or hours after your procedure.
11 - Listen to your gut instincts (and pore over their Instagram)
You will know what looks and feels good to you – so stay true to this. If you like things super-subtle and the customers in the waiting room or on the clinic’s Instagram show no detectable signs of ‘work’, chances are you’ve found a place that suits you. Likewise, the receptionist and often the doctors themselves will serve as a good calling card for the clinic’s aesthetic.