Key regulations, standards, codes of practice and guidance relevant to aesthetic injectables
Updated: Apr 9
Currently, it remains that both healthcare and non-healthcare professional can perform non-invasive aesthetics procedures such as botulinum toxin and dermal filler injections in the UK with no minimum requirement for training or professional malpractice insurance (Save face 2022). Due to an increasing number of complaints mainly around unlicenced products and un-qualified professionals, there have been several attempts to regulate the industry which until recently have been unsuccessful and are still largely to be implemented.
An independent review (DoH 2013) of cosmetic procedures in the UK highlighted three key areas where regulatory change was needed:
· The need for skilled and responsible practitioners delivering safe products
· Raising public awareness and ensuring public protection
· An accessible complaints and resolution authority such as an ombudsman
Unfortunately, the recommendations of this report were not implemented by the government. In 2019 an All-Party Parliamentary Group held an enquiry investigating the current state of non-surgical aesthetic procedures in the UK. The report was published in July 2021 (APPG 2021) and highlighted a broad range of requirements including requiring a legal definition of what constitutes individual aesthetic procedures; setting a minimum standard of training such as a level 7 diploma; the regulation and enforcement of national licensing schemes; the development of greater ethical and mental health standards such as psychological screening; the need for adequate robust insurance; and more responsible social media and advertising standards.
Following on from the APPG report (2021) The Joint Council for Cosmetic Practitioners (JCCP 2021) published a 10-point plan suggesting the need for regulation of aesthetic treatments outlining:
1. Statutory regulation
2. Mandatory education and training standards
3. Clear transparent information
4. Definition of medical and cosmetic treatments
5. Safe and ethical prescribing
6. More regulated advertising on social media
7. National complications reporting
8. Adequate insurance cover
9. Licensing of premises, treatments and practitioners
10. Raising consumer awareness
These recommendations have largely been an attempt to self-regulate the standards within the industry to create a safer environment for members of the public receiving non-surgical aesthetic procedures from un-qualified and un-insured practitioners. It has only been in the last couple of years that legislation has been put in place to protect members of the public under law. The Botulinum Toxin and Cosmetic Fillers (Children) Act (2021) came into force to make it illegal in England to prescribe or administer botulinum toxin and fillers to anyone under 18 for the sole purpose of aesthetic or cosmetic procedures. A new Health and Care Act (2022) has set the intention of giving the government new powers to introduce licenses for individual practitioners who deliver aesthetics procedures in England as well as a licensing scheme for premises that provide such procedures as well. However, this act has only so far placed responsibility onto the Health and Care Secretary to introduce secondary legislation and there is currently no date as to when this new secondary legislation will come in to force as there is currently a public and stakeholder consultation process taking place.
Medical professionals that carry out non-invasive aesthetics procedures include predominantly dentists, medical doctors and nurses. Each profession already has codes of conduct in place (GMC 2016, DDU 2022, BACN 2022) which specifically address the additional requirements placed upon these professionals when providing non-invasive aesthetic procedures. Allied Health professionals who also deliver these procedures do not have specific codes of conduct relating to delivery of said procedures, however they already adhere to very robust codes of conduct in their individual professions. Unfortunately, due to the lack of legislation other non-medical professionals with or without any clear codes of conduct and safety are currently able to administer non-invasive aesthetics procedures.
The importance of compliance with legislation and regulations relevant to aesthetic injectable practice.
Compliance to professional codes of conduct is of utmost importance for healthcare professionals as they outline the professional morals and ethics that are required for each profession. They outline the skills that are required to deliver non-invasive aesthetics procedures, the products used are safe and effective and patients provide informed consent before proceeding with any interventions provided (GMC 2016). Ultimately this ensures patient safety and assurance of quality of care.
A consumer complaint audit by Save Face highlights the need for regulation and compliance to codes of professional conduct. Of 934 collected cases about different aesthetic procedures in the UK, 66% of complaints related to dermal fillers and 24% regarding botulinum toxins. Of these complaints, 387 resulted in corrective procedures by other practitioners, 27 needed to visit their GPs and 11 visited A&E. Alarmingly 83% of these complaints were regarding treatments carried out by beauticians, hairdressers and lay people and often patients were not even injected with licensed products. Many of these complaints centred around treatment being delivered in the home, beauty salons or at Botox parties, a lack of informed consent and a lack of knowledge around the practitioners’ qualifications (Save face 2022). Regulation and adherence to a licensing scheme would not eliminate this risk but would significantly reduce if not eliminate such unscrupulous practices.
The majority of complaints in this small but relevant sample size presented by Save Face (2022) highlight the majority of procedures are requested by females aged 18-35 and often involved lip fillers for example. This age group is very heavily influenced by advertising and social media. Legislation proposed by the APPG (2021) around misleading advertising and social media needs to be complied with by practitioners offering aesthetic procedures and not promote abnormal or overfilled looks provided by social media app filters.
There is also a requirement to consider a patients’ psychological needs such as body dysmorphic syndrome and the proposed new legislation should expand upon this (Health and Care Act 2022) as to protect the public from exploitation. Practitioners may want to routinely use tools such as The Appearance Anxiety Inventory (Mastro 2016) as a pre-screening tool for suitability for treatment.
All-Party Parliamentary Group on Beauty, Aesthetics and Wellbeing (2021). Concluding report: Inquiry into advanced aesthetic non-surgical cosmetic treatments. Available online: https://baw-appg.com/wp-content/uploads/2021/07/APPG-BAW-Report-on-aesthetic-non-surgical-cosmetic-treatments-21.07.21-3.pdf (accessed 17th October 2022).
British Association of Cosmetic Nurses (2022). Code of Professional Conduct. Available at: https://www.bacn.org.uk/about-bacn/member-code-of-conduct/#:~:text=The%20BACN%20Code%20of%20Professional%20Conduct%20is%20an%20overarching%20document,guide%20and%20facilitate%20best%20practice. (accessed online 17th October 2022).
Dental Defence Union (2022). Cosmetic treatments and dentistry. Available at: https://www.theddu.com/guidance-and-advice/guides/cosmetic-treatments-and-dentistry (accessed online 17th October 2022).
Department of Health (2013). Review of the Regulation of Cosmetic Interventions. Available at https://www.gov.uk/government/publications/review-of-the-regulation-of-cosmetic-interventions (Accessed online 17th October 2022).
Department of Health and Social Care (2021). Botulinum Toxin and Cosmetic Fillers (Children) Act. Available at: https://www.legislation.gov.uk/ukpga/2021/19/contents/enacted (accessed 15th October 2022).
General Medical Council (2016). Guidance for doctors who offer cosmetic interventions. Available at: https://www.gmc-uk.org/ethical-guidance/ethical-guidance-for-doctors/cosmetic-interventions (Accessed online 17th October 2022).
Health and Care Act 2022. Available at:
https://www.legislation.gov.uk/ukpga/2022/31/contents/enacted (accessed 17th October 2022)
Health and Care Professions Council (2022). The ethical framework within which our registrants must work. Available at https://www.hcpc-uk.org/standards/standards-of-conduct-performance-and-ethics/ (accessed online 17th October 2022).
Mastro, S., Zimmer-Gembeck, M. J., Webb, H. J., Farrell, L., and Waters, A. (2016). Young adolescents’ appearance anxiety and body dysmorphic symptoms: Social problems, self-perceptions and comorbidities. Journal of Obsessive-Compulsive and Related Disorders, 8, 50-55.
Save face (2022a). Consumer Complaints Audit 2017-2018. Available at: https://www.saveface.co.uk/complaints-report/. (Accessed online 17th October 2022).
Save face (2022b). Laws and Regulations for the Non-Surgical Cosmetic Industry. Available at: https://www.saveface.co.uk/laws-regulations-non-surgical-cosmetic-industry/ (accessed 17th October 2022).
The Joint Council for Cosmetic Practitioners (2021). 10-point plan for safer regulation in the aesthetic sector. Available at:
https://www.jccp.org.uk/ckfinder/userfiles/files/10%20point%20plan.pdf (Accessed 17th October 2022)