Turn the other cheek

This blog was co-authored by Jonathon Enston and Georgia Hughes.

A recent BBC investigation into a self-styled "beauty consultant" publicised potential dangers of unregulated cosmetic procedures in the UK. It was alleged that one practitioner performed liquid Brazilian butt-lift (BBL) procedures on numerous individuals, which caused serious harm, including life-threatening complications such as sepsis and necrosis. The investigation calls for increased regulation within the industry, but it does neglect the wealth of highly skilled practitioners operating across the country.

The Concerns Highlighted by the BBC

The BBC state that their investigation uncovered that several people required emergency hospital treatment after undergoing liquid BBLs. Accounts from over 30 women describe severe complications, including tissue death, sepsis, and disfigurement. One woman reported feeling that she would rather have died than endure the pain she experienced after the procedure. They state that lack of clinical oversight, improper use of medication, and failure to adhere to basic medical safety standards have raised serious legal and ethical concerns with calls for a need in further regulation.

Despite these apparent breaches of medical and pharmaceutical regulations, holding the practitioners accountable has proven challenging as non-surgical cosmetic practitioners are not subject to oversight from regulatory bodies such as the General Medical Council (GMC) which is a concern raised by the BBC.

Regulatory Response and Calls for Reform

Local authorities, including Glasgow City Council, Epping Forest District Council, and Brentwood Council, attempted to tackle the problem by issuing prohibition notices under health and safety laws. The Department of Health and Social Care has acknowledged the outcome of the BBC’s investigation as "shocking" and has stated that it is "urgently looking at options for tougher regulation."

Industry bodies such as Save Face have called for stricter laws requiring that only GMC-registered and licensed surgeons perform liquid BBLs.

Shortcomings of the BBC Investigation

Despite the concerns raised and strong criticisms advanced by the BBC, these are a small number of examples within a huge industry with valued practitioners nationwide. The investigation neglects the wealth of skilled practitioners operating lawfully and expertly within a thriving industry.

Such investigations and reports may have significant detriment to the industry which is unfair on practitioners and consumers alike.

Challenges in Prosecutions

Legal action against unlicensed practitioners is complicated based on the current legal and regulatory framework. In one case life-saving surgery after a liquid BBL was required, and which was reported to Greater Manchester Police. However, jurisdictional issues between different police forces delayed progress. Furthermore, practitioners require consent from their clients to undertake such procedures which adds further complications as to whether any criminal offences are actually committed.

Warnings for Practitioners

As a result of public criticism and legal reform, cosmetic practitioners and aestheticians are subjected to a high level of scrutiny. It is important to be aware of the following matters: 

• Administering antibiotics without a valid prescription is a criminal offence under UK law.
• Injecting increasing doses of local anaesthetic without a qualified prescriber present may lead to danger to clients.
• Operating in non-clinical environments, significantly increasing the risk of infection and may lead to allegations of negligence.
• Posing as a licensed professional is fraudulent.

Proposed Reforms to the Industry

The investigation by the BBC highlights concerns faced with unlicensed non-surgical cosmetic procedures. The focus is on lack of legal accountability which they say suggests enables unqualified and unlicensed individuals to carry out potentially procedures that may cause harm, with little consequences or recourse.

Proposed reforms within the industry include:

• Implementing Mandatory Licensing Requiring all cosmetic practitioners to be registered with a recognised medical body as well as the Care Quality Commission (CQC).
• Strengthening Enforcement Ensuring police and regulatory authorities have clear legal and regulatory framework to take action against those to undertake cosmetic procedures by those who are unlicensed and unregistered cosmetic procedures
• Banning High-Risk Procedures Outside Medical Settings Preventing procedures like liquid BBLs from being carried out in non-clinical environments

Consequences to the Industry with the Proposed Reforms

If the regulatory framework is established in accordance with the current proposals then any practitioner who carries out a liquid BBL whilst being unregistered would commit a criminal offence contrary to Section 10 of the Health and Social Care Act 2008.