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Knowledge is power and protection

The cosmetic interventions industry has been left to its own devices, unchecked and largely unregulated. With the demand for facelifts, fillers, Botox and breast implants driving exponential growth, however, something had to give – and silicone breast implants were the first to yield.

When safety concerns were raised over fraudulently produced PIP (Poly Implant Prothèse) breast implants in 2011, the Department of Health convened an expert group to investigate the scandal led by NHS medical director Sir Bruce Keogh. Suddenly, the cosmetic industry found itself in the spotlight.

In addition to investigating the fraudulent French-manufactured breast implants, Sir Bruce was commissioned to conduct a wider review of regulations concerning cosmetic interventions. Published in April 2013, the Keogh report made a series of recommendations designed to protect consumers and to ensure that aesthetic procedures are advertised responsibly.

One of the major concerns highlighted by the review was the lack of unbiased information available to the public. Sir Bruce acknowledged: “There is no provision for consumers to learn about cosmetic procedures from knowledgeable experts who are not driven by commercial considerations.”

Professor James Frame, a respected cosmetic surgery professional, agrees: “So-called experts largely comment for personal gain and there are in fact very few ‘experts’ with the detail of knowledge to give comparative data on products, equipment or surgical outcomes. Companies themselves are frequently responsible for misinformation and questionable accuracy when looking for sales and, instead of demonstrating advantages to their products, they tend to denigrate competitors.”

However, medical legal expert Mandy Luckman, from solicitors Irwin Mitchell, contends: “There are some excellent sources of unbiased information available to the general public; however, this will only be accessed if awareness of those sources is significantly improved.”

In a world of public relations, marketers and constant spin, it can be hard for the public to know who to turn to for sound advice. As the Keogh review notes, people are “making purchasing decisions on procedures and products that may have a significant impact on their health and wellbeing. It is essential that people are helped to make informed decisions based on clear, easily accessible and unbiased information and data”.

The cosmetic profession may be dependent upon the media through marketing to sell its products. It is not unreasonable for cosmetic procedures to be promoted in this manner. It is vital, however, that the information disseminated is accurate, providing a balanced view of the benefits and possible side effects of the product or treatment in question.

It is essential that people are helped to make informed decisions based on clear, easily accessible and unbiased information and data

Ron Myers, director of, is only too aware of the balancing act that companies face: “The media love ‘new’,” he observes. “But that doesn’t mean to say it’s an established product and that it’s safe or effective… there are many ‘new’ products or treatments that simply do not do what they claim.”

The Keogh review points out “the safety of some products being used in cosmetic interventions is an area of serious concern and the existing regulations are not sufficient to protect the public”.

Cosmetic injectable fillers are of particular concern, the report says. There are between 140 and 190 dermal filler products available in the UK and no restrictions on who can purchase these.

The British Association of Aesthetic Plastic Surgeons recently warned of unregulated cosmetic fillers becoming a “ticking time bomb”. In a study of cosmetic surgeons in 2009, one in four surgeons reported seeing patients who had received botched jobs at the hands of poorly trained professionals and, more alarmingly, non-medically trained practitioners.

This contrasts starkly with the United States, where all dermal fillers are regulated by the FDA (Food and Drug Administration) and carry restrictions on who can acquire them.

It’s not just cosmetic products that come under fire in the Keogh review. There is also criticism of price-sensitive advertising; in particular, discount deals of the sort offered by voucher companies come in for disparagement.

Pinpointing pricing as an area of concern is one thing, finding a way to regulate it is another. Consultant plastic surgeon Adam Searle says: “This trivialisation and commoditisation of medical procedures is appalling. There are going to be patients who experience significant complications and lifelong damage from pursuing ill-planned and ill-thought-out operations.”

Dr Tracy Mountford, of The Cosmetic Skin Clinic, adds: “I am in total agreement with the Keogh report criticising discounted offers in order to incentivise patients. This is something the public should steer clear of. Patients must be aware that these are medical procedures and the experience of the treating practitioner is key.”

With research indicating that only 3 per cent of people in Britain would be prepared to use a discount deal for cosmetic surgery, the threat may have been overstated. Nevertheless, any measures that can prevent vulnerable individuals from falling victim to unscrupulous vendors must surely be welcomed.

Patient power is now biting back with consumers taking matters into their own hands. Independently formed campaign groups are working to seek answers and justice where trusted medical professionals have failed.

Trisha Devine, of the PIP Implants Scotland Campaign, concludes: “The public deserves to know about the services they are using and we would like to see an independent patient advisory service set up, which service providers, clinics and surgeons are duty bound to.”

It is clear there is still much work to be done in shoring up the cosmetic industry’s reputation. If the industry is proactive in actioning the Keogh review’s recommendations, everyone stands to benefit. Consumers will be better informed, while cosmetic practitioners can look forward to earning the trust and respect of the British public.