The Mad, Mad World of Medical Aesthetics

Posted on the 22 April 2010 at 12:03

It has been reported  that a company in Doncaster is once again offering botulinum toxin training to Beauty Therapists. The training courses are advertised on the company website as being available to any beauty therapist of NVQ level 3 or equivalent.


The fact that this is allowed to happen demonstrates the ridiculous lack of legislation in this country regarding medical aesthetics. In the majority of European countries, botulinum toxin is only allowed to be administered by Doctors. Lasers are, in most European countries, only allowed to be used by Doctors, dermal fillers are, in most European countries, only allowed to be administered by Doctors. In the UK it seems that we are happy to allow anybody to administer these procedures without any protection from the government or governing bodies!


Mr McGrath may comment: “I think the medical fraternity out there do not like it because [beauty therapists] are stealing the profits of course, it is a very greedy industry", but that is a ridiculous statement to make. The majority of people involved in the Aesthetic Industry are shocked that this can be allowed. I spoke to a leading member of BABTAC today who commented that it is important to look at the starting point of these therapists. They may have an NVQ level 3 but to get on the course they only need 3 grade C level GCSE’s! Do you really want someone with 3 GCSE’s injecting your face with a neuro toxin or a dermal filler or peeling your face with a CO2 laser?


The industry has to act now. The self regulation scheme is a start but it is only that, a start. It needs to be properly backed by law and made public knowledge. The proposed withdrawal of the Care Quality Commission (CQC) for the regulation of Lasers and IPL’s  is another example of the ridiculous nature of our industry. Again your 3 GCSE qualified person can fire a laser, IPL and even CO2 laser at you when in the majority of Europe you will have had to have done 6-8 years at medical school to do this. The same BABTAC person told me they are horrified with the proposal as they provide insurance to therapists for Lasers and IPL and at least the CQC ensured some standards and training!


This all started with remote prescribing, yes it is legal but that doesn’t make it right and certainly it isn’t best practice. Somewhere there is a Doctor who is prepared to write a prescription for these therapists to enable them to get the product. The companies will supply as they have a prescription; it is not their job to police the industry, though they should try to protect their products image more. So who’s job is it? The MHRA technically should be dealing with this and it would be nice to see the various associations out there, doing more to put pressure on them to act and act quickly, though some may have to get their own membership in order first!


This is not about protectionism, botulinum toxin is a prescription only medicine (POM) and as such should only be provided after a full consultation with a practitioner with prescribing powers. As it is an aesthetic procedure, the consultation MUST be face to face, or how can they decide if it is suitable for you? Dermal fillers are not POM in the UK and indeed Europe, however in most of Europe it can only be administered by a medically trained professional. Now some dermal fillers contain the local anaesthetic Lidocaine, a POM with a known record of patient sensitivity. How, when water administered by injection is a POM can this only be classed as a medical device? The EU tells us we have to have straight bananas, so why can’t we adopt the more sensible of European laws?


Did you know that to inject or carry out a medical procedure on a dog or any other animal you have to be qualified as a vet and yet to inject a person you just need a hand!


Welcome to the mad, mad world of Medical Aesthetics!


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Blog Comment(s) [7]

The industry has been trying to right this for years.... it's the government that needs to listen and make the necessary changes. It's a sad state of affairs when animals have more protection than humans....

Dr Ravi Jain |

Why bother with self regulation?

I notice that has, once again, commented on the issue of training NVQ level 3 Beauty Therapists in the provision of Botulinum Toxin ( Training for Beauty Therapists Raises Safety Concerns ). This is at the same time as self regulation for aesthetic clinics is now a reality and the CQC are withdrawing from the registration of lasers.

It seems to me that our “Aesthetic Industry” is being driven into the ground by various schemes to see how much money can be extracted from the industry. We really are being turned into a “cash cow”!

Let’s start with Botulinum toxin. I cannot remember the last time we were able to increase our retail price for this treatment despite the fact that our costs continue to rise. In actual fact the price keeps being driven down by mobile nurses who have no “rent, rates, light & heat” to pay and who just “turn up” in the back of local hairdressers’ salons and treat all and sundry. We all know that the majority of them are getting their prescriptions signed off by a doctor “somewhere” and we all know that the doctor never sees the patient but nothing is done to prevent this by any of the governing bodies! Oh, they all say that it’s illegal and they are “acting when they get a complaint” but can anyone tell me of a single action? The new self regulation body IHAS has failed to address this issue with anything more than a token nod. Why would I sign my clinics up to yet another organisation that is going to charge me for the privilege but not actually help me with my business? For all the public know or care I could create my own “kite mark” for my clinics and it would be just as impressive as the one from IHAS and it wouldn’t cost me several hundred pounds a year to have.

It is time our industry truly got together to take action to preserve our business. Right now all we have are hundreds of clinics all trying to get by as best they can whilst all sorts of people and organisations pick our pockets for our profits. This has to end! We need an Association that will truly represent the entire industry not just their own clinics or members. Time to put away business rivalry and look to business preservation! We need enough power to confront the suppliers that say “we have to supply them, they have a legal prescription”. What rubbish! All the suppliers are fully aware of the Doctors in far flung regions buying way more product than they can possibly use signing prescriptions for nurses they probably haven’t met for supply to patients they have never seen. Act now! Defend your ethical customers! It won’t affect your bottom line to say no but it will support your loyal, ethical customers. Until the IHAS comes up with a plan to stop illegal prescribing, mobile nurses and beautician injectors I see no reason to spend even 1p to join!.
Robert Houtman
National Slimming & Cosmetic Clinics

Robert Houtman

As a nurse in the industry for over 4 years, I've worked really hard to develop my skills, be appropriately qualified; (I am an independent nurse prescriber) and maintain professionalism at all times. I have my own full time clinic from where my clients know they have full time access to me should they need to. This is the only way forward in this business to succeed and maintain client and healthcare professional safety. Whilst not perfect, the IHAS self regulation scheme is a start. It's not just practitioners that have to be aware, surely the client has some responsibility too?

Cathy Walker

I agree that there needs to be more regulation in our industry to protect patients from rogue providers and that is why the IHAS, and other organisations, have been lobbying Government to take action.

The Government has decided that self regulation is the most appropriate form of regulation for cosmetic injectable treatments and, whether you believe this is sufficient or not, it is many times better than the current unregulated environment.

So, since this is what's on offer, we have to make it work. That's why the major clinics have backed this new scheme and are determined to make it a success. It depends on two things. First, encouraging appropriately qualified providers (drawn from doctors, dentists and registered adult nurses) to join a national register and secondly for patients to be encouraged, through a long term programme of profile raising, to choose only those providers that are registered.

The scheme will be officially launched in April with support from the Department of Health and the Chief Medical Officer for England together with the backing of the GMC, GDC and NMC.

Everyone that provides these injectable treatments should join the register through the public website that we will launch in April. This will help to ensure that patients make an informed choice when selecting a provider and hopefully the number of rogue providers will fall.

We can't sit back and do nothing the shared regulation scheme provides a quick and simple way of providing patient protection.

Sally Taber
Independent Healthcare Advisory Services

Sally Taber |

I am a highly skilled nurse practitioner who has been in the business for the last 6 years. I work with a Doctor in a busy clinic in Perth and all our clients are consulted face to face by the Doctor.We do things right. I agree that allowing beauty therapists to be allowed to inject botox is a slippery slope, although I am sure many beauty therapists have a good aesthetic eye.
I am getting a bit fed up with the same old story that Doctors are being coersed into prescribing botox in order that nurses can make the money. Let's not be naive here. No one does anything for free.
Yes, everyone wants a piece of the pie. Only the other day I met a radiologist who decided that he would train to give botox purely and simply because of the profit that could be made.
Just because you can, doesn't mean you should. Leave the injecting for the skilled practitioners who are doing it for the right reasons.

Ysobel Peters

Hi everyone,

We may be able to help. SAI has been set up by medical professionals with experience in healthcare accreditation.

Our aim is to ensure that patients are as safe as possible when attending a spa, medispa or cosmetic clinic. Our standards are high and designed to minimise risk by assessing the facility and its management and practitioners.

Standards are evidence based and regularly updated.

We feel strongly that patients should know which clinics take quality seriously and be able to make informed choices.

Let us know if you want any more information.

Andrew Peet

Andrew Peet

There still seems to be a lot of confusion (or maybe ignorance) over the guidelines regarding remote prescribing. As a nurse just starting out in the industry, I would not want to undermine my profession or risk my registration and the safety of my clients by jumping onto the back street botox bandwaggon. I have seen it being offered in some precarious places and I know some nurses who administer it have obtained their prescriptions from 'a Doc in Harley Street.' I have spoken to the NMC but I am quite annoyed that they are not doing much to enforce the guidelines. A quick search on the internet will reveal a number of companies offering remote prescription services for nurses who sign up to their botox training course. How can they still do this? I agree that there needs to be more protection and information for patients definately, but also protection for the practitioners. What will it take to tighten up the regulations? Something goes wrong and a patient is harmed, a nurse will lose their registration and their livlihood the prescriber maybe gets a slap on the wrist?

L Scott