Staying in control

In any oth­er area of med­i­cine you would expect gov­ern­ment reg­u­la­tion to be in place to ensure safe­ty and stan­dards were being met. Yet, when it comes to cos­met­ic pro­ce­dures, the reg­u­la­to­ry are­na has become a mine­field, putting con­sumers at risk from unscrupu­lous prac­ti­tion­ers try­ing to cash in on the lucra­tive anti-age­ing mar­ket.

While the cos­met­ic surgery sec­tor is reg­u­lat­ed by the Care Qual­i­ty Com­mis­sion (CQC) and oper­at­ing facil­i­ties are inspect­ed to make sure they meet stan­dards, the pub­lic can still fall foul of rogue prac­ti­tion­ers labelling them­selves as cos­met­ic sur­geons when they are not actu­al­ly qual­i­fied to do so.

Harley Street has become syn­ony­mous with cos­met­ic surgery, but it is impor­tant to remem­ber that Harley Street is an address not a qual­i­fi­ca­tion, so the only way to safe­guard your­self is to always check that your sur­geon is on the spe­cial­ist reg­is­ter with the Gen­er­al Med­ical Coun­cil (GMC).

For peo­ple seek­ing less inva­sive forms of cos­met­ic enhance­ment, how­ev­er, it is not so cut and dry. The non-sur­gi­cal sec­tor is one of the biggest growth areas, par­tic­u­lar­ly when it comes to cos­met­ic injecta­bles, such as bot­u­linum tox­in (Botox®) and der­mal fillers, but the lack of reg­u­la­tion sur­round­ing it has made it dif­fi­cult for con­sumers try­ing to find a safe and eth­i­cal prac­ti­tion­er.

Since the gov­ern­ment made the some­what con­tro­ver­sial deci­sion not to impose statu­to­ry reg­u­la­tion on this boom­ing mar­ket, every­one from vets to beau­ty ther­a­pists and podi­a­trists have been try­ing to take a bite of the cos­met­ic injectable pie. But with demand ris­ing every year, the need for some form of con­trol was huge­ly appar­ent.

After six years of dis­cus­sion between the indus­try and the Depart­ment of Health, it seemed as if there was final­ly a light appear­ing at the end of the tun­nel when, in Sep­tem­ber 2010, the Inde­pen­dent Health­care Advi­so­ry Ser­vices (IHAS) launched its Reg­is­ter of Injectable Cos­met­ic Providers, known as Treat­ments You Can Trust (TYCT). The aim of the scheme is to pro­vide indi­rect reg­u­la­tion through the Health and Safe­ty at Work Act, Med­i­cines Act and pro­fes­sion­al fit­ness-to-prac­tice con­trols (name­ly the GDC, GMC and NMC), and to encour­age mem­bers of the pub­lic to choose providers that have been award­ed its Qual­i­ty Assur­ance Mark.

TV’s Dr Hilary Jones, who is a mem­ber of the TYCT Gov­er­nance Group, which has been set up to estab­lish the inde­pen­dence of the reg­is­ter, says: “Any­thing we can do to make it eas­i­er for con­sumers to find an appro­pri­ate provider in a safe envi­ron­ment is a major step for­ward.”

Unlike lip­stick and mas­cara, these treat­ments are seri­ous med­ical pro­ce­dures with seri­ous risks attached

The scheme is now grow­ing in strength but with many clin­ics being slow to sign up for the vol­un­tary reg­is­ter, indus­try bod­ies, such as the British Asso­ci­a­tion of Cos­met­ic Doc­tors (BACD), have been doing their own part to pro­mote the safe and eth­i­cal prac­tice of cos­met­ic med­i­cine. Chair­woman Dr Saman­tha Gam­mell says: “We vet all of our mem­bers and also have a star-rat­ing sys­tem on our web­site so patients can see whether the doc­tor has met our more advanced cri­te­ria.”

One area that the IHAS is crack­ing down on is the issue sur­round­ing the use of cos­met­ic injecta­bles by beau­ty ther­a­pists.

“Beau­ty ther­a­pists are not allowed to car­ry out bot­u­linum tox­in treat­ments in the UK full stop,” says Sal­ly Taber, direc­tor of the IHAS. “They are not med­ical­ly trained and there­fore can­not pre­scribe or admin­is­ter the treat­ment legal­ly, as it is a pre­scrip­tion only med­i­cine.”

But it is in the area of der­mal fillers that a loop hole or grey area exists and it is this that caus­es the IHAS, and the indus­try at large, the most con­cern. Fillers are clas­si­fied as med­ical devices rather than med­i­cines and there­fore it is not actu­al­ly ille­gal for a non-medic to admin­is­ter them, how­ev­er fillers can poten­tial­ly cause last­ing dam­age. “It’s extreme­ly con­cern­ing that the law cur­rent­ly allows beau­ty ther­a­pists to car­ry out injectable cos­met­ic treat­ments. TYCT will cat­e­gor­i­cal­ly not accept these indi­vid­u­als on to the reg­is­ter,” adds Ms Taber.

Dr Gam­mell com­ments: “Injectable treat­ments are increas­ing­ly becom­ing part of our dai­ly beau­ty vocab­u­lary but, unlike lip­stick and mas­cara, these treat­ments are seri­ous med­ical pro­ce­dures with seri­ous risks attached. It may be cos­met­ic but it is still med­i­cine.”

While peo­ple are often ful­ly aware of the risks of cos­met­ic injecta­bles, many under­es­ti­mate the dan­ger of lasers. A burn from a laser can be extreme­ly seri­ous, which makes it even more shock­ing that, in Octo­ber 2010, the gov­ern­ment decid­ed to dereg­u­late cos­met­ic lasers and intense pulsed lights (IPL) for cos­met­ic uses.

This means that although the CQC con­tin­ues to reg­u­late all health­care pro­fes­sion­als using lasers and IPLs to treat “dis­ease, dis­or­ders or injury”, the beau­ty sec­tor now falls out­side of its remit, leav­ing non-med­ical­ly trained prac­ti­tion­ers to treat clients with­out being account­able.

Dr Philip Dob­son, med­ical direc­tor at LCS Health­care, says: “The reg­u­la­tions have been framed so as to reg­u­late the med­ical sec­tor to the high­est pro­fes­sion­al stan­dards for car­ry­ing out pro­ce­dures, where­as, iden­ti­cal treat­ments per­formed by beau­ty ther­a­pists, includ­ing advanced skin abla­tion, could be done per­fect­ly legal­ly on their kitchen table, with­out any statu­to­ry reg­u­la­tion or even med­ical super­vi­sion.”

With feel­ings in the indus­try about de-reg­u­la­tion still run­ning high a year after the changes were imposed, the IHAS has been work­ing along­side indus­try bod­ies to set up a sim­i­lar qual­i­ty mark for cos­met­ic lasers and IPLs, which could come into place ear­ly in 2012.

But all this is not meant to scare­mon­ger the beau­ty seek­ing pub­lic. In the right hands, cos­met­ic pro­ce­dures are incred­i­bly safe, as long as you remem­ber that the right hands should be med­ical — and they should be account­able.

SAFEGUARDS

• Look for cos­met­ic injectable providers with the TYCT Qual­i­ty Assur­ance Mark.
• Make sure your sur­geon is on the Spe­cial­ist Reg­is­ter with the GMC or that your den­tist, doc­tor or nurse is reg­is­tered with their rel­e­vant pro­fes­sion­al body (GDC , GMC , NMC).
• Use the “find a surgeon/doctor” loca­tors on the BAAPS or BACD web­sites.
• Don’t be afraid to ques­tion your prac­ti­tion­er about their expe­ri­ence and qual­i­fi­ca­tions.
• Make sure you have a thor­ough con­sul­ta­tion.
• Do not go to a beau­ty ther­a­pist or non-medic for cos­met­ic injecta­bles.

In any other area of medicine you would expect government regulation to be in place to ensure safety and standards were being met. Yet, when it comes to cosmetic procedures, the regulatory arena has become a minefield, putting consumers at risk from unscrupulous practitioners trying to cash in on the lucrative anti-ageing market.

SAFEGUARDS