Cosmetic treatments need new regulation report finds

New proposals to regulate cosmetic procedures were widely reported in the papers today, with the Daily Mail reporting the need to "rein in cosmetic surgery cowboys", and The Daily Telegraph warning that anti-wrinkle treatments are "a crisis waiting to happen".

The stories are based on an independent review of regulations governing the UK cosmetic industry, which is worth an estimated £3.6 billion. The review was chaired by the NHS medical director, Professor Sir Bruce Keogh, who said anyone having cosmetic procedures should be better protected than at present. People carrying out cosmetic procedures should be trained to a high standard, Professor Keogh said.

The review particularly highlights concerns about non-surgical cosmetic procedures, such as:

• dermal fillers (injections of an acid to reduce the appearance of wrinkles and scars)
• Botox (injections of a toxin used to smooth the skin)
• chemical peel (where chemicals are used to remove dead skin)
• laser hair removal

Under current regulations, all of these procedures can legally be performed by anyone, whatever their level of medical training. This is in spite of the fact that, if performed incorrectly, these procedures can result in a range of complications such as burning, scarring, infection and even blindness.

The review proposes that much tighter and rigorous regulation is required for these types of non-surgical cosmetic procedures to ensure their safety.

Why was the cosmetic interventions review commissioned?

The review into the regulation of cosmetic ‘interventions’ was commissioned by the government following the scandal over faulty PIP (Poly Implant Prothesis) breast implants, which came to light at the end of 2011.

The report says the scandal exposed “woeful lapses in product quality, aftercare and record keeping” in certain sections of the global cosmetic industry. 

The French-made PIP implants caused global concern after it was revealed they contained industrial-grade silicone rather than medical-grade fillers, and that they were more prone to rupture and leakage. It is estimated that nearly 50,000 women in the UK had the implants, most of which were provided privately.

The events surrounding the PIP implants scandal, says the new report, raised wider concerns about the regulation of cosmetic interventions. These concerns led to troubling questions, such as:

• why such unsafe products were on the market
• why it was difficult to trace women who had had cosmetic implants
• whether vulnerable people were put under “inappropriate pressure” to have cosmetic procedures (for example, whether women with body dysmorphic disorder, a psychological condition that causes people wrongly to perceive defects in their body, were inappropriately treated with cosmetic procedures)

The report points out that cosmetic interventions are a “booming business”. Cosmetic interventions include both surgical interventions such as face-lifts, tummy tucks and breast implants, and non-surgical procedures such as Botox, dermal fillers and the use of laser or intense pulsed light (IPL).

What did the cosmetic interventions review find?

The review committee gathered evidence from those working in the cosmetic procedures sector, the public, academics and international policymakers.

Their review report says that cosmetic interventions have become “normalised”, with men as well as women increasingly likely to consider them. It says advances in technology mean there is a growing range of – mainly non-surgical – interventions available.

The report also found that the industry is highly fragmented, with a range of different interest groups, product manufacturers and practitioners. It makes the case that the rapid growth of the sector means that quality control is hard to police. The existing laws have been developed in piecemeal fashion rather than systematically, the report says, with previous attempts at self-regulation by the industry deemed to have largely failed. As a result, someone having a non-surgical cosmetic procedure “has no more protection and redress than someone buying a ballpoint pen or a toothbrush”, the report points out.

The review found that dermal fillers are a particular cause for concern because anyone can set themselves up as a practitioner, with no requirement for knowledge, training or previous experience. There are insufficient checks in place on the quality of the products used during the procedure, the report says, pointing out that “most dermal fillers have no more controls than a bottle of floor cleaner”.

The report also found a need for greater protection for vulnerable people – particularly girls and younger women. It quotes a Guide Association survey that suggested younger people “see cosmetic procedures as a commodity – something they might ‘get done’”, this is attributed, in part, to the influence of “celebrities”.

The report also points out that:

• Cosmetic surgery is not defined as a surgical speciality with a common qualification or an organisation responsible for setting standards.
• There are no restrictions on who can carry out non-surgical procedures.
• Only some of the products implanted or injected into the body are regulated as medical devices.
• There is little reliable data to help people consider the risks and effectiveness of different cosmetic treatments, and consent procedures are poor.
• People are often offered time-limited discounts for surgery – for example, they are given a discount if they sign a binding contract at the end of a first consultation.

What recommendations have the review group made?

The review committee’s report concludes that there are three key areas in which change is needed:

• high quality care
• an informed and empowered public
• access to ‘redress’ in case things go wrong

High quality care

The report outlines the need for safer products, more highly skilled practitioners and more responsible providers. It calls for:

• EU regulations on medical devices to be extended to cover all cosmetic implants including dermal fillers, and new UK laws to make this happen sooner
• dermal fillers to be classified as prescription-only
• the Royal College of Surgeons to set standards for cosmetic surgery practice and training and to issue formal certification of competence
• all those performing cosmetic procedures to be registered
• qualifications to be developed for providers of non-surgical procedures
• surgical providers to provide patients and their GPs with proper records – and individual outcomes for surgeons to be made available on the NHS Choices website
• a breast implant registry to be set up within 12 months and extended to other cosmetic devices as soon as possible, to provide better monitoring of outcomes and device safety

An informed and empowered public

The report highlights the need for people to be given accurate advice and for vulnerable people to be protected, specifically calling for:

• the Royal College of Surgeons to develop a patient consent procedure for cosmetic operations that consists of several stages
• the college to develop “evidence-based” patient information on cosmetic procedures, with input from patient organisations – and for these to be made available on the NHS Choices website
• providers of non-surgical procedures to hold a record of their patients’ consent
• existing advertising recommendations and restrictions to be updated and better enforced
• financial inducements and time-limited deals promoting cosmetic interventions to be banned

Accessible resolution and redress

The report wants clear ways for people to be able to take action if anything goes wrong with their cosmetic intervention, calling for:

• the role of the Parliamentary and Health Service Ombudsman (the current role of which is to investigate patient complaints within the NHS) to be extended to cover the whole private healthcare sector including cosmetic procedures of all kinds
• all individuals performing cosmetic procedures to be required to have adequate professional indemnity cover
• surgeons working in this country, but who are insured abroad, to have indemnity insurance that is “commensurate with similar UK policies”
• insurance products to be developed to cover the failure of products and certain complications of surgery

What is the best way of finding reputable, effective and safe cosmetic treatments?

If you are considering a surgical procedure, such as breast implants, your GP is often the best person to contact first. As Professor Simon Kay, consultant plastic surgeon and member of the British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS) explains, “your GP knows the local situation, such as who is a well-established surgeon”.

Make sure you get as much information as you can about the surgery, its potential risks, its perceived benefits and any other relevant information before consenting to surgery. Read more about choosing a cosmetic surgeon.

If you are considering a non-surgical cosmetic procedure, it is important to realise that some people offering these types of treatment may not be medically qualified.