Keogh review into cosmetic interventions gives us taster of recommendations to come for dermal filler providers

Posted on the 02 April 2013 at 15:31

Keogh Review says Beauty Therapists and Doctors should have formal qualification to provide dermal fillers.

The Department of Health and the review panel, headed up by NHS Medical Director Sir Bruce Keogh, into the provision of cosmetic interventions in England have announced that their long awaited report will be delayed by one month, until the end of April 2013.

Despite the announcement arriving on 1st April, it was no Fool’s Day stunt and the content of a press release chose to also highlight and give a ‘sneaky peak’ at one of the recommendations likely to come from Sir Keogh’s review in relation to cosmetic injectable products, namely dermal fillers and those currently providing them.

In a statement, the review panel noted that non-surgical treatments, such as dermal fillers and laser treatments make up 90% of the UK cosmetic intervention sector, yet it remains largely unregulated when compared to the cosmetic surgery side. This means that there are currently few controls on who can perform these treatments and where they can be carried out, something which concerns many within the industry who are well aware of the complications which can occur with use of such products, (albeit often rare depending on the temporary or permanent nature and composition of the products), including allergic reactions, lump formation, skin necrosis and some reported cases of blindness.

They went on to say that the review is expected to call for new laws to ensure that anyone performing these treatments, doctors, nurses and beauty therapists is ‘competent and accountable’.

In their own words this would mean; “...getting either a qualification to perform and supervise aesthetic treatments, or a qualification to perform aesthetic treatments under the jurisdiction of a qualified clinical professional.  Further work will be carried out to assess which professional groups either qualification should be open to, and to develop the qualifications”.

Professor Sir Bruce Keogh, NHS Medical Director, said in a statement; “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. And 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.

This ‘snippet’ or ‘taster’ of what’s to come has been cautiously received by industry participants such as the British Association of Aesthetic Plastic Surgeons (BAAPS). They agreed that specialised training is needed, including for doctors, but argued that these procedures should be administered only by medical professionals (i.e. not beauty therapists) as they are capable of not only correct patient selection for treatment but also dealing with an complications, from minor to more severe, which may occur.

Current BAAPS President and Consulting Room Adviser, Consultant Plastic Surgeon, Rajiv Grover said about the plans; “Non-surgical does not mean non-medical. Treatment with dermal fillers have 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 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.

He went on to say; “Not only should those administering these procedures be capable of handling possible complications – which can range from bruising or swelling to necrosis, which is when the skin ‘dies’ – but, perhaps more importantly, be able to properly assess and select patients. People seeking aesthetic treatments may present with medical or even psychological issues, and experienced medical professionals are able to explore their histories and expectations to ensure the most satisfactory outcome. We call on the Government to regulate who is able to perform these procedures – and in the absence of tight controls, we urge manufacturers to adhere to a ‘Moral Charter’ whereby they agree to only distribute their products to medical professionals.

Many within the industry have taken to Twitter to discuss the revelations thus far from the Keogh review.

Former BAAPS President, Nigel Mercer pointed out the obvious mistake in this ‘recommendation’; “Keogh's proposals for injectables are at variance from The Aesthetic Surgical and Aesthetic Non-Surgical Medical Services Standard.

While Dr Dan Dhunna also noted; “the Keogh report will pale in comparison with the better, tighter, stronger European CEN ruling; only prescribing medics for Botox & Fillers.

The independent review, which was commissioned just over a year ago, following the PIP breast implant scandal, will look at a variety of issues in an effort improve protection for those considering undergoing cosmetic procedures, both surgical and non-surgical. It has assessed and will report on the current regulatory framework in place (in England) for products or devices used in cosmetic interventions, e.g. breast implants or dermal fillers, practitioners of cosmetic interventions, be they health professionals or non-health professionals e.g. beauty therapists,  providers, be they large providers of surgical interventions or small high-street beauty clinics, insurance and indemnity requirements and information provision, consent and advertising of cosmetic interventions to the public. (More blogs on Keogh)

If this insight is any clue to the recommendations that we can expect later this month, I think it might be a safe bet that many within the industry will feel a mixture of emotions, as although there may be some positive steps towards better regulation, there are likely to be many compromises to satisfy all sides of the argument, leading many to be disappointed and perhaps feel a little cheated. Although, noted as an independent review, the process is still within the government umbrella and thus we do not know if there is an underlying remit to avoid any recommendations to impose statutory regulation for the industry, given that we know this is something that the country can ill afford to put into practice, particularly at the expense of more ‘worthy’ public spending initiatives. We will simply have to wait and see, so counting down the days begins again now...

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Blog Comment(s) [3]

I concur with the above comments ...only those who are medically qualified should adminster cosmetic injectables.
I find it incredible that beauty therapists are even being considered in this review.

Cathy Wallwork RGN

Spot on Rajiv and Nigel.Only appropriately trained medical and nursing personnel,also adhering to to CME etc,should be doing these treatments.We need to establish and maintain the integrity of the non-surgical ( but agree Rajiv NOT non-medical) side of this Special Interest.
Starting to see a lot of rogue practice by people feigning to be adequately trained and interestingly also usually at relatively inflated prices.The 'overconfident ignorance' often witnessed is also perturbing .

Dr Paul Temple

Also amazed that beauty therapists are included, I wonder what kind of training is going to be thought appropriate for all of us? Will Sir Keogh's review be completely ignored like the Leveson enquiry was initially. I wonder what the fallout from Sir Keogh closing the Leeds Children heart surgery unit will be and if this will affect his credibility and this review? There is also a bill going through parliament, which will then go through house of lords recommending a statutory inspectorate "offcos" for providers of cosmetic surgery and procedures.

Diane Jeffery