Exeter Uni student Nicole Barros Vardanega discusses the UK government’s lax regulation of non-surgical cosmetic procedures and the risks it may pose to consumers
Non-surgical cosmetic procedures have rapidly gained popularity and become a multi-billion pound market in the UK. In particular, it is important to distinguish between non-surgical and surgical procedures, which require the consumer to assume different levels of risk.
The market for non-surgical cosmetic procedures is expected to reach a value of £11.7 billion by 2026. This is largely due to the increase in two procedures: Botox and fillers. According to Statista, in 2022, Botox was the most performed non-surgical procedure in the world. A growing trend among 20-somethings is to prevent aging (not just reduce the visible signs of aging), giving rise to a phenomenon called “preventive botox.” According to the UK government, these procedures have grown in popularity because of them increased accessibility and affordability.
The applicable UK regulations
In England, non-surgical cosmetic procedures are loosely regulated, especially compared to surgical procedures. Non-surgical cosmetic procedures do not require licenses, while doctors who perform surgery must be registered with the General Medical Council. This is likely due to the more invasive nature of the surgeries. Governments have appeared reluctant to introduce a licensing system for non-surgical cosmetic procedures. As recently as February 2023, the government rejected calls from MPs demanding a licensing system. It is not yet clear whether Kier Starmer’s new government will approach the issue differently.
Although licenses for non-surgical cosmetic procedures are not legally required, they are highly recommended by professional organizations. In 2013, the Royal College of Surgeons of England published the Professional standards for aesthetic practice written by the Cosmetic Surgery Task Force. This guidance indicates that despite the lack of legal requirements for permits, they should preferably be obtained. Importantly, however, the guidance is not legally binding, so it is not an adequate substitute for legislation. It is a temporary solution.
On the other hand, Parliament has enacted three provisions to mitigate the risk to consumers of non-surgical cosmetic procedures: Article 180 of Health and Care Act 2022the Botulinum Toxin and Cosmetic Fillers Children Act 2021 (law of 2021) and the Consumer Rights Act 2015 (law of 2015). The first gives the Minister of Health and Social Care the ability to initiate a licensing scheme for non-surgical cosmetic procedures. This power remains impossible. Meanwhile, the 2021 law makes it illegal to give Botox or fillers to under-18s in England. Although seemingly insignificant, this could be considered a first step. People under the age of 18 are less likely to carry out 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 non-surgical procedures are likely to take place after a contract has been formed – whether written, oral or implied – and business-to-consumer contracts may be subject to the 2015 Act.
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Unlike England, Scotland and Wales do not have an age requirement that prevents people under 18 from getting Botox and fillers. This laxity has drawn strong criticism. The British Association of Cosmetic Nurses (BACN), the largest Professional Association for cosmetic medical nurses in the UK, has described Scotland’s beauty regulations as the worst in Europe. Worryingly, this discrepancy means that children living in England can travel to Wales and Scotland to have non-surgical cosmetic procedures. There is no doubt that legislation in Wales and Scotland is particularly needed.
Why should licenses be mandatory?
Since licenses for Botox and fillers are not required by law, it is becoming increasingly uncommon for those who choose to perform these procedures on others to obtain them. A study from University College London (UCL) found that around two-thirds of those who administer injectables such as Botox are not medically qualified. The lack of mandatory licensing for non-surgical cosmetic procedures is largely problematic because licenses ensure consumer safety. Licensed professionals are held to a higher standard because they are required to follow standards set by the General Medical Council. They need to ensure their medical knowledge is clear and up-to-date in order to comply the revalidation process. Once licensed, the practitioner must revalidate it every five years. This practice is important because procedures, including seemingly minor ones like Botox, can have permanent negative psychological and emotional effects when there is a complication or counterfeit products are used. Although these effects are currently undocumented, victims of botched procedures report blurred vision, difficulty breathing, and slurred speech, as well as decreased self-confidence and social awkwardness. Earlier this year, the The Centers for Disease Control and Prevention (CDC) issued a report which revealed that 17 women had recently suffered “adverse reactions” to botox misuse. Eleven of them were hospitalized.
The need for licenses has become apparent in organizations such as Save Face which have received a large number of complaints due to poor quality processes. According to Save Face, a government-approved registry of accredited professionals, they received almost three thousand complaints related to cosmetic procedures in 2022. Of those complaints, two-thirds involved fillers and nearly a quarter involved Botox. This shocking statistic calls into question the government’s lax approach to regulating non-surgical procedures and raises doubts about whether people in the UK should still feel safe and comfortable undergoing these procedures.
The way forward
Regulation of non-surgical procedures has fallen to the bottom of the government’s agenda for cosmetic procedures. As of 2019, Twenty-eight Britons have died from plastic surgery in Turkey. This has dominated the debate about cosmetic work safety and the government is currently working with Turkish authorities to prevent any further deaths. However, working with the Turkish government, trying to convince them to regulate their lucrative health tourism industry, can be a challenge. In the meantime, the UK Government should take a closer look at our own cosmetic surgery regulation and ask how it can best protect those who undergo non-surgical procedures in the UK.
Nicole Barros Vardanega is a final LLB Law student at the University of Exeter. He is interested in the construction and infrastructure sector and regulatory law. In addition to her law degree, she is actively involved in university societies and recently founded the Current Affairs and Business Society
