Jenny ReesHealth Correspondent for Wales
For Lizzie Day, Botox was as much a part of her routine as having her morning coffee.
It wasn’t until a doctor friend raised concerns about a “lipolysis” treatment she was using that the 30-year-old took stock and began to question what was happening to her body.
Up until this point, the recruitment consultant admitted she would simply be “jumping on the bandwagon” of the latest beauty treatment to be talked about on social media.
Regulator of Wales Health Inspectorate Wales (HIW) believes that a complete review of the type of services available, as well as who provides them and where, is needed.
Its chief Alun Jones said the arrangement had not kept up, creating “loopholes and anomalies”, while a GP likened the current situation to a “free for all”.
The Welsh Government has said botulinum toxin brands such as Botox and weight loss drugs can only be supplied on prescription and a scoping exercise will be carried out early next year to see if further regulation is needed.
Botulinum toxin – commonly known by the trade name Botox – is also sold under various other licensed brands in the UK, including Azzalure, Bocouture and Dysport.
“I had no idea what they were injecting me with,” Lizzy said.
“It’s just hype – it’s a trend, a bit like fashion – if everyone buys the same bag it becomes popular and I’d say it’s the same for aesthetics.”
In England anyone who prescribes anti-wrinkle or weight loss injections Mounjaro and Ozempic must be subscribed to Care Quality Committee (CQC).
However, in Wales only doctors are required to register with the Welsh equivalent, HIW.
This means that other healthcare professionals are not legally required to meet the same standards or be regularly inspected.
Still, many don’t question who’s doing the work, as Lizzie adds: “It’s just like going to get your coffee in the morning – popping a little Botox.”
Lizzie has lived in Manchester for the past decade, where she said treatments such as fillers, jawline enhancement and laser treatment are the norm for many.
It wasn’t until a doctor friend back home in south Wales raised concerns about a “lipolysis” treatment she was using that she took stock.
She is now having botox treatment with a doctor at a private clinic in the Vale of Glamorgan, who will also refuse the treatment if they don’t think it is necessary – something she was not used to elsewhere.
“I begged him for Mujaro,” she laughed.
“But he said ‘sorry, you don’t qualify.’
“But I know some people who will be told no by one person and will go anywhere to get it.”
HIW’s Alun Jones said a comprehensive review was needed.
“If you’re a non-clinical person providing Botox injections, it’s hard to understand where the oversight is coming from,” he added.
“The legislation that authorizes us to act is quite outdated.”
He said performing certain procedures requires HIW registration, but only if provided from a fixed, physical location.
“So you could provide certain services on a mobile basis and you would no longer need to be registered with us,” added Mr Jones.
He said monitoring and inspections would raise standards or identify bad practice, which would in turn keep the public safe.
“What the public may not know is that the person giving the injection has received minimal training and may not be equipped to deal with a medical emergency if there is a reaction to that injection,” he said.
Hannah Jones, from Cardiff, started using what she thought was Botox when she turned 30 last year.
But she kept coming back for a refresher every fortnight because it didn’t have the desired ‘freezing’ effect.
It was only when she was faced with conflicting advice from another provider online that she began to question what was being injected into her face as the doses had never been discussed.
She also learned she had to wait 12 weeks between those injections and Botox prescribers had to see patients face-to-face, while she had only received injections from a third party, not the drug’s name prescriber.
“It was a big red flag,” he said.
“I think it’s really important that people do their research before doing these treatments.”
These are matters of the beauty industry itself has long campaigned for changeright across the UK, with a new bill drawn up earlier this year in Scotland.
Dr Tom Kamal is a GP secretary in Barry, but also runs his own private practice in the Vale of Glamorgan, where he provides cosmetic treatments such as Botox, as well as weight loss injections – which can have serious side effects if not administered correctly.
He said he has treated many clients who had previously unnecessarily progressed to Mounjaro doses too quickly.
“Everyone seems to think that the higher the dose, the faster the weight loss, but that’s actually not the case – it’s no wonder they experience side effects.”
He said that under the right supervision the drug “can make a huge difference”, but side effects can range from nausea, constipation and diarrhoea, to more sinister things like pancreatitis and gallstones.
Dr Kamal described the situation in Wales as a “free for all”.
With the non-surgical cosmetic industry estimated to be worth £3bn, Dr Kamal said the challenge for regulators was to keep up with the pace of change in a sector driven by social media trends.
“Saying no is one of the most important things we do here at the clinic,” he said, adding that it would be easy to capitalize on trends and provide unnecessary services to clients who are willing to pay.
It’s advice like this that Lydia Cheetham from Penarth wishes she’d been given eight years ago, when the trend was “big lips, big bum, big cheeks – everything was bigger”, she said.
Lydia got her first lip fillers at 18, only to have them painfully removed a few years later.
“I wish I’d never gone so crazy in the first place because I think I’m still living with the lingering effects around my mouth and I don’t know if that’s ever going to go away completely,” she said.
“I wish someone had said ‘look, you don’t need all this.’
“There needs to be a lot more regulation to stop people doing things just because it’s trendy this year or your friends have done it.”
The Welsh Government said these drugs “can only be supplied on prescription by a suitably qualified healthcare professional who must act in accordance with the standards set by their respective professional regulatory bodies”.
“Failure to meet these standards can lead to regulatory authorities restricting or suspending the practice of healthcare professionals,” a spokesman added.
“We recently introduced a compulsory licensing regime for acupuncture, dry needling, body piercing, electrolysis, tattooing and semi-permanent make-up.
“We will undertake a scoping exercise for Wales early next year to ascertain whether further regulation is needed and will continue to work with other governments across the UK on this issue.”
