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Most Cosmetic Injectables 'Not Given by Qualified Doctors' 

Most dermal fillers and botulinum toxin (Botox) treatments are given by practitioners who are not qualified medical doctors, according to a new meta-analysis of the UK’s cosmetic injectables industry by researchers from University College London (UCL). 

The authors of a study, published in the Journal of Plastic, Reconstructive & Aesthetic Surgery, said they had collated the first breakdown of cosmetic injectable service providers in the UK.

Amid rapid growth in a market predicted to be worth £11.7 billion by 2026, there was "a lack of robust regulation", and little known about the background qualifications, training, and experience levels of the practitioners administering cosmetic treatments, according to the researchers. First author Dr David Zargaran, from UCL's Department of Plastic Surgery, said: "There are well-documented, yet to date unaddressed challenges in the UK cosmetic injectables market. Without knowledge of the professional backgrounds of practitioners, we cannot adequately regulate the industry."

To fill the knowledge gap, the researchers undertook a descriptive and qualitative analysis of advertised practitioners from 3000 websites identified via Google searches and cross referenced these where applicable with regulatory bodies.  

They identified 1224 independent clinics with a total of 4405 practitioners, of whom 3667 were delivering cosmetic injections. An analysis of their professional background showed these to be:

  • Doctor - 1163 (32%)
  • Dentist - 877 (24%)
  • Nurse - 470 (13%)
  • Aesthetician - 433 (12%)
  • Dental Nurse - 310 (8%)
  • Allied Healthcare Professionals - 307 (8%)
  • Trainee Dental Nurse - 77 (2%)
  • Pharmacist - 30 (1%)

Most Practitioners Not Medically Qualified

Overall, 2625 (72%) of practitioners had professional registration with the General Medical Council, General Dental Council, General Pharmaceutical Council, or the Nursing and Midwifery Council. 

Of 1163 doctors identified, 19% were on the GP register and 41% on the specialist register, particularly plastic surgery (37%) and dermatology (18%). However, two-thirds (68%) of cosmetic practitioners administering cosmetic injectables such as Botox were found to be not qualified medical doctors.

A "lack of robust regulations has led to concerns being raised regarding the safety of the industry and potential risks to patients", with those risks varying "from mild and transient such as bruising and swelling, to permanent and debilitating such as blindness and vascular occlusion". the authors noted. Affected patients also had to bear "psychological, emotional and financial consequences".

Previous research by the same team, published in the Aesthetic Surgery Journal, suggested a Botox complication rate of around 16%. 

In their latest paper, the researchers said that while complications related to botulinum toxin should be reported to the Medicines and Healthcare products Regulatory Agency, the current system of reporting via the Yellow Card Scheme was "likely to be significantly underestimating" these. Furthermore, dermal fillers are currently classified as medical devices rather than medicines and as such, adverse reactions are exempt from formal notification, they noted.

Government Licensing Scheme Planned

In March last year the Government confirmed its intention to introduce a licensing regime for non-surgical cosmetic procedures, including Botox and fillers. The move was welcomed in principle by the British Association of Aesthetic Plastic Surgeons (BAAPS), who said that the question of which practitioners would be eligibile for a licence was "key". 

The researchers said that the range of professional backgrounds and experience of those who perform non-surgical aesthetic interventions should be "an important consideration" in proposed legislation and "may have an impact on the potential risks to patients". Dr Zargaran said: "Our research highlights that the majority of practitioners are not doctors and include other healthcare professionals, as well as non-healthcare professionals, such as beauticians." 

According to Dr Zargaran: "One of the key challenges facing the Government’s licensing scheme is to ensure that practitioners granted a licence possess the skills and experience required safely to administer their treatment to minimise risks to patients."

Co-author Professor Julie Davies, director of the MBA health programme at UCL,

said that recent expansion of the UK cosmetic injectables industry had happened "largely without scrutiny or oversight". The team's findings "should be a wake-up call for legislators to implement effective regulation and professional standards to safeguard patients from complications", she added. 

Funding for the study was provided by a grant from QUAD A, a non-profit accreditation organisation led by physicians.