Exeter Uni student Nicole Barros Vardanega discusses the British government’s light-touch regulation of non-surgical cosmetic procedures and the dangers this might pose to consumers
Non-surgical cosmetic procedures have rapidly gained popularity and become a multi-billion-pound market in the United Kingdom. Notably, it is important to distinguish between non-surgical and surgical procedures, which require the consumer to assume different levels of risk.
The non-surgical cosmetic procedures market is expected to reach a value of £11.7 billion by 2026. This is largely due to the increase in two procedures: Botox and filler. According to Statista, in 2022, Botox was the most-performed non-surgical procedure in the world. A growing trend among those in their 20s is preventing ageing (not only reducing visible signs of ageing), giving rise to a phenomenon called “preventative Botox.” According to the UK government, these procedures have grown in popularity due to their increased accessibility and affordability.
The current UK regulations
In England, non-surgical cosmetic procedures are loosely regulated, especially compared to surgical procedures. Non-surgical cosmetic procedures do not require licences, whereas doctors conducting surgeries must be registered with the General Medical Council. This is likely because of the more invasive nature of surgical procedures. Governments have seemed hesitant to introduce a licensing scheme for non-surgical cosmetic procedures. Only recently, in February 2023, the government rejected calls brought forward by MPs demanding a licencing scheme. It is still unclear whether Kier Starmer’s new government will approach the issue differently.
Although licenses for non-surgical cosmetic procedures are not legally obligatory, they are highly recommended by professional organisations. In 2013, the Royal College of Surgeons England published the Professional Standards for Cosmetic Practice written by the Cosmetic Surgical Practice Working Party. This guidance indicates that despite the lack of legal requirements for licences, they should preferably be acquired. Significantly, however, guidance is not legally binding so it is not a sufficient replacement for legislation. It is a temporary solution.
On the upside, Parliament has enacted three provisions to mitigate the danger to consumers of non-surgical cosmetic procedures: section 180 of the Health and Care Act 2022, the Botulinum Toxin and Cosmetic Fillers Children Act 2021 (the 2021 Act) and the Consumer Rights Act 2015 (the 2015 Act). The former gives the Secretary of State for Health and Social Care the option to initiate a licensing regime for non-surgical cosmetic procedures. This power remains unexercised. Meanwhile, the 2021 Act provides that it is illegal to administer Botox or filler to individuals under 18 years old in England. Although seemingly insignificant, this could be seen as a first step. People under 18 years old are less likely to conduct adequate risk assessments before undergoing procedures that could have long-term effects. The 2015 Act has a more general application, providing the rights of all consumers in the UK. It is worth remembering that more likely than not non-surgical procedures are conducted following the formation of a contract—whether written, oral or implied—and business-to-consumer contracts might be subject to the 2015 Act.
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Find out moreUnlike England, Scotland and Wales do not have an age requirement barring those under 18 from receiving Botox and filler. This laxity has prompted robust criticism. The British Association of Cosmetic Nurses (BACN), the largest Professional Association for nurses carrying out medical aesthetic treatments in the UK, has labelled Scotland’s aesthetics regulations the worst in Europe. Alarmingly, this discrepancy means that children residing in England may travel to Wales and Scotland to get non-surgical cosmetic procedures done. There is no doubt that legislation in Wales and Scotland is especially needed.
Why should licences be mandatory?
Since licences are not required for Botox and filler by law, it is becoming increasingly uncommon for those choosing to carry out these procedures on others to obtain them. A study by the University College London (UCL) found that approximately two-thirds of those administering injectables, like Botox, do not have a medical qualification. The lack of mandatory licencing for non-surgical cosmetic procedures is largely problematic because licences ensure consumers’ safety. Licensed professionals are held to higher standards because they are obliged follow the standards set out by the General Medical Council. They must ensure their medical knowledge is sharp and up-to-date in order to comply with the process of revalidation. Upon being granted a licence, a practitioner must revalidate it every five years. This practice is important because procedures, including those seemingly minor ones like Botox, can have lasting negative psychological and emotional effects when there is a complication or counterfeit products are used. Although these effects are currently under documented, victims of botched procedures report blurred vision, difficulty breathing and slurred speech as well as damaged confidence and social embarrassment. Earlier this year, the Centre for Disease Control and Prevention (CDC) released a report which revealed that 17 women had recently suffered “harmful reactions” to misused Botox. Eleven of these were hospitalised.
The need for licences has become apparent to organisations like Save Face who have received a large amount of complaints due to low-quality procedures. According to Save Face, a government-approved register of accredited practitioners, they received almost three thousand complaints related to cosmetic procedures in 2022. Of these complaints, two-thirds were related to fillers and nearly one-fourth to Botox. This shocking statistic calls into question the government’s relaxed approach to regulation of non-surgical procedures and creates doubt about whether people in the UK should still feel confident and comfortable undergoing these procedures.
The way forward
The regulation of non-surgical procedures has fallen to the bottom of the government’s agenda on cosmetic procedures. Since 2019, twenty-eight Britons have died from cosmetic procedures in Turkey. This has dominated the conversation around the safety of cosmetic work and the government is currently working with Turkish authorities to prevent any further deaths. However, collaboration with the Turkish government, attempting to persuade them to regulate their lucrative health tourism industry, may be a challenging task. In the meantime, the British government should take a closer look at our own regulation of cosmetic procedures and ask itself how it can better protect those undergoing non-surgical procedures in the UK.
Nicole Barros Vardanega is a final-year Law LLB student at the University of Exeter. She is interested in the construction and infrastructure sector and regulatory law. Outside of her law degree, she actively participates in university societies and recently founded the Current Affairs and Business Society