You wouldn't let a massage therapist remove a tooth, would you?
Brits are very trusting. We instinctively assume that most of the products and services we consume must be safe and reliable or ‘they wouldn’t be allowed to do it’. We trust so much in our societal framework and that we’re a ‘proper’ country with rules, processes, law and responsibility – that there is no way that any old Joe would be allowed to inject chemical products into people’s faces. I’ll bet my house that the majority of people in the UK have no idea that it’s an unregulated industry. I don’t think they’re stupid or naïve. I do believe they’ve been massively let down by the people who should be protecting them – our government.
We have seen the incredible rise of the Instagram generation and the commoditisation of aesthetic treatments. This has, thankfully, been accompanied by the de-stigmitisation of treatments, albeit largely fueled by reality TV stars. This general shift in attitudes means more people than ever, especially younger people, are seeking cosmetic treatments. Which would be fine, great, wonderful – do what makes you feel good – if it were within a safe and accountable industry.
The government’s response continues to be “sort this out amongst yourselves”. Leading to an industry that is de-medicalised and people with limited experience and fake qualifications injecting faces using dodgy products from eBay. When a client undergoes treatments like Botox® or lip fillers, they still have less consumer protection and recourse than if they were buying a Bic® biro. It's lunacy!
The market has tried to introduce self-regulation but quite frankly, it is now a tangled mess of infighting, protectionism and heated debate - with little progress towards genuine regulation. These tensions have been particularly high in recent weeks, with different medically-qualified practitioners interpreting the guidance from the government and industry bodies in different ways.
How did we get to this point?
In 2013, the PIP scandal triggered an independent review of cosmetic procedures in the UK and The Keough Report outlined four areas that needed to change.
- High quality care should be provided by skilled and responsible practitioners
- Safe and tested products should be used
- The public need to be informed and empowered
- Redress and resolution should be accessible if things go wrong
What progress has been made against the recommendations?
Training is still muddled and fragmented - open to everyone, regulated by no one.
The government didn't see value in insiting on one central register, instead, there are several voluntary registers including BAAPS, JCCP, SAVE FACE, BACN and BCAM. These are doing their level best, with limited budgets, to sort stuff out. They are all, largely, singing from the same hymn sheet and are pushing for medicalisation, standardisation and regulation. But the key problem: the public have almost no idea these even exist, let alone understand the differences between them.
Hundreds of dodgy products are freely available on the web or via the many online ‘pharmacies’ on social media. Toys and makeup are subject to more stringent safety testing.
The industry has tried to educate the public, but due to lack of cash, this has been through horror stories about botched treatments. The problem with this is that is has only achieved one thing…the widescale misconception that Botox® and fillers are dangerous.
The public do not make the association that an incompetent practitioner means you are at higher risk of poor outcomes.
The association they do make is that non-surgical treatments lead to poor outcomes.
And while the ASA and CAP try to enforce the rules surrounding advertising, realistically they can’t police 7 million #botox tags on Instagram and there is no real consequence for non-medics who aren’t affiliated to a statutory professional body. So we have this weird situation where the already regulated aesthetic medics, who are accountable to various statutory professional bodies, are subject to more regulation, whereas those who aren't regulated at all continue to be accountable to no one.
While insurance is now available for all working in non-surgical aesthetics, there is no mandatory reporting and collection of data relating to complications to a central body. Systematic and substantive data regarding product and practitioner safety and efficacy is non-existent.
Across the board, in the last 7 years, the government has done very little to address any of these recommendations. Throw in Brexit and a global pandemic and it seems inevitable that steps towards regulation aren't going to happen any time soon.
As with most unregulated markets, there are always winners
The aesthetics industry is estimated to be worth around £3bn a year. Anti-wrinkle injections and dermal fillers make up almost 80% of these treatments carried out in the UK. The government can collect VAT on these treatments, from VAT-registered practitioners. Many medically qualified practitioners are VAT-exempt, as they can prescribe treatments. If the government medicalise the industry, they will lose this income.
The dodgy drugs manufacturers and distributers
There are around 200 filler products available in the UK, most of which are not CE or FDA-approved. Unscrupulous injectors can source potentially dangerous products easily.
Inexperienced and unqualified practitioners
A weekend training course, some knock-off filler and an Instagram page are all you need to get set up, so why wouldn’t you give it a go? The barriers to entry are low and the demand is there. REALLY THERE.
And the losers?
The reputation of the industry is tarnished by incompetent injectors. Aesthetic medics lose twice. Not only do they lose business to cheaper unqualified practitioners, but when complications occur, the expertise needed is medical and the drugs needed are prescription only. So the NHS and medically-qualified practitioners pick up the tab.
SaveFace has estimated that sorting out complications caused by inexperienced practitioners has cost the NHS around £29m. I believe that until the pendulum swings, and the government is losing more money through sorting out complications than it gains in tax, regulation will not happen.
Around 90% of non-surgical aesthetic treatments are performed on women. We know that people who are experiencing significant life events like separation, divorce and bereavement often seek treatments. Typically, these are older, more affluent women who are seeking to make themselves look and feel better.
We also know that those who are victims of domestic violence and those who have a history of dieting index high for non-surgical aesthetic treatments. Those with Body Dysmorphic Disorder index exceptionally high for wanting such treatments. It is these groups who are really failed by the lack of regulation. It is these women who are most likely to experience poor outcomes. They are typically vulnerable, younger women, who are strongly influenced by trends and social media. Women who are typically on lower incomes, so price point is a significant determining factor when choosing a practitioner.
Add to the mix the fact that the vast majority of medically-qualified aesthetic practitioners are women.
When we break these associations down, we are led to one of the key reasons there is little impetus to regulate. The industry is in crisis and the government is acting selfishly, cowardly and arrogantly and lacks any duty of care for women of the UK. Women, generally, don't have a voice in the corridors of Whitehall, let alone the most vulnerable ones. If the problem affected affluent, white, middle-aged men, the industry would have been regulated long ago.
So what could we do?
Just as when dealing with the COVID pandemic, the UK is woefully behind the rest of the world when it comes to the aesthetics industry.
In Canada, treatments are only carried out by surgeons, doctors, nurse prescribers and nurses, using only FDA-approved products. Fillers are deemed to be medical devices. It is illegal to advertise POMS and POMDs.
The USA only allow treatments to be conducted by surgeons, physicians, physicians assistants and nurses using only FDA-approved products.
And in much of Europe, treatments only carried out by appropriately and licensed doctors. Using CE or FDA approved products.
We can and must do better, but we must be aware that if regulation comes, it may not come in the form that we wish.