Beauty therapists to be banned from offering fillers unless qualified

Clampdown follows a review by NHS chief Sir Bruce Keogh which found the sector is full of cowboy practices
A woman receiving a treatment at a cosmetic surgery practice
A woman receiving a treatment. Photograph Jose Jordan/AFP/Getty Images

Beauty therapists are to be banned from offering injectable dermal fillers to smooth out wrinkles and rejuvenate faces unless they have been properly trained and hold a formal qualification, as part of a major review into cosmetic surgery.

The clampdown is a first shot across the bows of the industry, which an independent review led by NHS medical director Sir Bruce Keogh has found is inadequately regulated and full of cowboy practices.

Although facelifts, breast implants and other forms of surgery catch the headlines, 90% of the £2.3bn business comprises smaller, cheaper procedures such as dermal fillers, which are substances injected under the skin to plump out lines, and laser treatments for hair loss and wrinkles.

There are few controls over who can carry out these procedures. Yet Keogh's review heard that some clients had suffered real harm when things went wrong. The injection of dermal fillers under the skin, for instance, can lead to bruising and swelling.

There have also been reports of skin necrosis – the death of skin tissue because of the blockage of blood vessels – and even of blindness.

"All too often we hear of cases that shine a light on poor practices in the cosmetic surgery industry," said Keogh. "I am concerned that some practitioners who are giving non-surgical treatments may not have had any appropriate training whatsoever. This leaves people exposed to unreasonable risks, and possibly permanent damage.

"Our research has shown that the public expect procedures that are so widely available to be safe, whereas they are largely unregulated.

"There is a clear need for better quality, recognised training for the people performing these operations. My review will make a number of recommendations for making sure people who choose to undergo these procedures are in safe hands."

The review will recommend that anybody offering non-surgical cosmetic interventions must either be properly trained and qualified to perform and supervise them or else qualified to carry them out under the supervision of a clinically trained superior. What those qualifications will be and who will be able to train for them has not been decided.

The British Association of Aesthetic Plastic Surgeons (BAAPS) gave the news a cautious welcome, saying it would like to see all such treatments restricted to medical professionals. "Non-surgical does not mean non-medical," said consultant plastic surgeon and BAAPS president Rajiv Grover. "Treatment with dermal fillers has clear benefits but also risks – it is not just about who can wield a syringe but who will have the capabilities to deal with any possible complications.

"We agree that specialised training is required and [it should be] certainly more extensive than the many widely-promoted weekend courses currently available, but aesthetic injectables should only ever be provided by medical professionals.

"It is known that dermal fillers have a physiological ('biological') effect on skin — such as stimulating the production of collagen, and many of them also contain local anaesthetic. These factors make these substances, in essence, a medicine."

BAAPS says many of its member surgeons have had to sort out the consequences of botched filler treatments. A recent survey found that 69% of surgeons saw patients suffering complications even from temporary fillers, while 49% saw problems with semi- or permanent fillers. Out of those patients who suffered problems with permanent substances, 84% required corrective surgery or were deemed untreatable due to the damage caused.

Keogh's review looked at all aspects of the cosmetic surgery industry following the PIP breast implant disaster, which led to massive anxiety and thousands of women having implants removed, often on the NHS. Its full report is expected at the end of April.

"I await Sir Bruce Keogh's recommendations in full, but am clear that we must ensure that people undergoing cosmetic procedures are in the hands of someone with the right skills and training," said health minister Dan Poulter. "The days of cosmetic cowboys must become a thing of the past."