According to an analysis of the UK's cosmetic injectables industry by UCL researchers, 68% of cosmetic practitioners who are administering injections such as Botox are not qualified medical doctors.

The study, published in the Journal of Plastic, Reconstructive & Aesthetic Surgery, is the first survey of who is providing cosmetic injectable services, such as Botulinum Toxin (Botox) and Dermal Fillers, in the UK. Currently, little is known about the background qualifications, training and experience levels of those who are administering treatments.

To fill this knowledge gap, researchers from UCL evaluated 3,000 websites to identify 1,224 independent clinics and 3,667 practitioners who were delivering cosmetic injections such as Botox.

Of the professions represented, 32% were doctors, 13% were nurses, 24% were dentists and 8% were dental nurses. Of the 1,163 doctors identified, 41% were on the specialist register and 19% were on the GP register. Among the 27 specialties represented on the specialist register, Plastic Surgery was the largest group (37%) followed by Dermatology (18%).

The UK injectables market is predicted to reach a value of £11.7 billion by 2026, but to date is effectively unregulated. The UK government is preparing to update policy around injectables, with a public consultation on the industry due to begin in August 2023. Recommendations are expected to inform amendments to the Medical Act in 2024.

There are well-documented, yet to date unaddressed challenges in the UK cosmetic injectables market. Without knowledge of the professional backgrounds of practitioners, we cannot adequately regulate the industry. Our research highlights that the majority of practitioners are not doctors and include other healthcare professionals, as well as non-healthcare professionals such as beauticians.

The range of backgrounds opens a broader question relating to competence and consent. One of the key challenges facing the government's licensing scheme is to ensure that practitioners granted a license possess the skills and experience required to safely administer their treatment to minimize risks to patients.

It is important for patients to be able to feel comfortable and confident that the person administering their treatment is competent in the procedure as a fundamental foundation of informed consent. This research provides a unique insight into the sector to help inform regulators and patients, and work towards a safer and more transparent cosmetic injectables industry in the UK."

Dr David Zargaran, Study Author, UCL Plastic Surgery

As well as the professional background of those providing cosmetic injections, until recently there has been little research on the incidence of complications and the impact that these have upon patients. A second study from the same authors, published on 3 July 2023, found that 69% of respondents to the study had experienced long-lasting adverse effects, such as pain, anxiety and headaches.

Professor Julie Davies (UCL School Global Business School for Health), a co-author of the study, commented: "The UK cosmetic injectables industry has expanded rapidly in recent years. This has happened largely without scrutiny or oversight. Our findings should be a wake-up call for legislators to implement effective regulation and professional standards to safeguard patients from complications. Although the risks associated with injections are often mild and temporary, the physical complications can be permanent and debilitating. There are also serious psychological, emotional, and financial consequences for patients when procedures go wrong."

The work was supported by a research grant from QUAD A.