Vets could administer Botox, says NHS chief

Concerns have been raised around the industry, which provides treatments ranging from breast augmentation to facelifts and chemical peels, about the qualifications of practitioners, aggressive marketing techniques, and whether or not the psychological welfare of patients is adequate.

Professor Sir Bruce Keogh, NHS medical director, will lead the review and has said he plans to stamp out the “grubby practices” in parts of the industry.

An issue will be around practices such as botulinum toxin injections (such as botox) and chemical peels which can be performed by non-healthcare professionals – commonly beauticians.

How, and if, these practices can be further regulated will be something for the review to consider – with Professor Keogh even suggesting that vets, because of their training in anatomy and physiology, could administer Botox (see Cathy Newman interview, below).

A Department of Health Spokesperson told the programme: “We know that many people who are not properly qualified are giving botox injections. The point of the review is to look at how we make sure that anyone who gives botox injections has the necessary skills and qualifications.”

The review will look at cosmetic surgery where “the intervention is not clinically indicated to safeguard or improve the physical and mental health of the patient”.

Cathy Newman interviews Sir Bruce Keogh

Cathy Newman: When you’ve got podiatrists and even vets looking to offer Botox, there must be legions of people who you would consider not fit to carry out these kinds of procedures?

Sir Bruce Keogh: I think there are people out there. I wouldn’t want to suggest that podiatrists or vets can’t, but certainly some people out there…

CN: You’d be happy for a vet to give you Botox?

Sir Bruce Keogh: I think the answer to that is probably no

CN: Would you be happy for a vet to give anyone Botox?

Sir Bruce Keogh: Well you know vets go through a massive training programme in anatomy and physiology which is not that dissimilar in many respects from the standard of training that doctors have…

CN: So if its OK for a horse, it’s OK for a human?

Sir Bruce Keogh: That’s not the area that I’m trying to get into.

Inside the industry

The cosmetic surgery industry was valued by market research company Mintel at £2.3bn in 2010. In that year the British Association of Aesthetic Plastic Surgeons (BAAPS) said that its members, who account for around a third of the industry, had carried out 38,274 cosmetic surgery procedures.

One year later and that figure was 43,069 – an increase of 12.5 per cent.

Around 90 per cent of treatments carried out by the industry are non-surgical (such as dermal fillers, chemical peels, botox injections and laser hair removal), Mintel estimates. These account for 74 per cent of the market value of the sector.

Many of the procedures under the cosmetic surgery umbrella can be carried out by “non-healthcare professionals”, in many cases beauticians, and the review will look at whether there should be better ways of monitoring their performance.

@channel4news it absolutely needs to change and the first step is recognising those in the know and also regulating training for everyone

— J Aesthetic Nursing (@JAestheticNurse) August 15, 2012

And a recent survey said many people are more concerned about the cost of treatment than the qualifications of those administering it.

The Department of Health survey found that two-thirds of the 1,762 people questioned considered cost as a factor when deciding whether or not to have cosmetic surgery while only half took the qualifications of their practitioner into consideration.

Want to give your views or share your experience? Follow the link to do so on the Department of Health website.

What the review will look at

Professor Keogh (right) was keen to emphasise today that many parts of the industry are professional and ethically run – but said that there are “grubby practices” that need to be dealt with.

“The recent problems with PiP breast implants have shone a light on the cosmetic surgery industry,” he said. “Many questions have been raised, particularly around the regulation of clinics, whether all practitioners are adequately qualified, how well people are advised when money is changing hands, aggressive marketing techniques, and what protection is available when things go wrong.

“I am concerned that too many people do not realise how serious cosmetic surgery is and do not consider the life long implications it can have.

“That’s why I have put together this review committee to advise me in making recommendations to government on how we can better protect people who choose to have surgery or cosmetic interventions.”

The review will focus on the following issues:

• regulation and safety of products used in cosmetic interventions

• how best to ensure that the people who carry out procedures have the necessary skills and qualifications

• how to ensure that organisations have the systems in place to look after their patients both during their treatment and afterwards

• how to ensure that people considering cosmetic surgery and procedures are given the information, advice and time for reflection to make an informed choice

• what improvements are needed in dealing with complaints so they are listened to and acted upon.

Drawing a lnie

The review has been welcomed by BAAPS. Fazel Fatah, BAAPS president, said: “We would like the review to take this opportunity to draw a clear line between cosmetic treatments that are seen as a commodity and cosmetic surgery that is serious medical treatment which must be provided by fully trained and qualified surgeons.

“We also welcome the establishment of a compulsory independent national register for breast implants and other implantable materials including those that are given through injections.

“We would very much like the review to look at the issue of advertising of cosmetic surgery that is widely used to prey on the vulnerability of patients who seek cosmetic surgery for psychological reasons. If an outright ban is not achievable, then a new strict code of advertising is badly needed to protect patients.”

James Frame, professor of aesthetic plastic surgery at Anglia Ruskin University, said: “Everybody has been asking for something like this for the past 30 years. There has to be a fundamental sea change in the marketing of cosmetic surgery and non-surgical aesthetics in our country.”

Examples of treatments

Breast Implants: Breast augmentation, the insertion of an implant via a cut, can only be carried out by a qualified doctor, though this doctor does not necessarily have to be a surgeon to carry out the surgery outside the NHS. The only legal requirement is that doctors be fully registered.

Dermal Fillers: The process, which involves a series of small injections, can be carried out by non-healthcare professionals. Side effects vary from recurring cold sores to skin necrosis.

Botulinum toxin injection: Botulinum toxin is a purified protein that blocks signals from the brain to the nerve endings. Risks of use include drooping of the eyelid, swelling of the face and blurred vision.

Chemical Peel: Chemical peels, whicha re used to remove layers of skin from the face, are not considered to be a medicine or medical device – and therefore can be administered by a non-healthcare professional.Side effects can include scarring, infection and skin colour changes.

PIP scandal

The review follows the PIP scandal in which French firm Ploy Implant Prothese (PIP) was found to have manufactured breast implants with non-medical grade silicon. The silicon in the implants was intended to be used in mattresses.

Around 47,000 British were women were thought to have the implants, and many more worldwide.

The NHS Medical Directors expert group, also led by Professor Keogh, found that the implants had a 15 per cent to 30 per cent chance of rupturing over a 10-year period, compared to a 10 per cent to 14 per cent in other implant brands.

Though the materials inside breast implants are not said to be toxic or carcinogenic, they can cause tenderness and swelling.

Data from the Department of Health says that 750 women in the UK are to have the PIP implants removed, 490 of whom received the implants at private clinics.