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Protecting against rogue practitioners

While steps are being taken to improve consumer safety, little seems to have changed since the government-backed Keogh Review called for more stringent regulation and improved training within the cosmetic intervention sector.

NHS medical director Professor Sir Bruce Keogh said there should be proper redress for patients if things go wrong and recommended that non-surgical treatments, such as dermal fillers, be made prescription only. All those carrying out any cosmetic intervention, such as injectable fillers and anti-wrinkle injections, should be properly qualified to do so, he said.

In addition, the General Medical Council (GMC) wants patients to be given a two-week cooling-off period before deciding to undergo a cosmetic procedure. But it is important to note that the forthcoming GMC guidelines will apply only to doctors and will not affect beauticians or other non-medically qualified personnel who administer Botox and fillers.

The Keogh Review’s recommendation that injectable fillers be classified as medicines and become prescription only has not been enforced, and anti-wrinkle injections, which are currently prescription only, are still being administered by unqualified personnel.

“The review said beauty therapists may train and work under supervision,” says Sharon Bennett, chairwoman of the British Association of Cosmetic Nurses. “However, the government has not put into place anything to regulate this.

“Beauty therapists are getting their products either off the internet or from doctors, nurses and dentists who don’t then take responsibility for the work undertaken, so patients are left exposed and vulnerable whichever option is taken.”

While there is great merit in promoting and advocating patient safety as a core value, there is still a chance that poorly trained and unscrupulous individuals are using this term to lure the public

Fortunately, there is a plethora of resources online that consumers can access when considering a cosmetic intervention. The British Association of Plastic Reconstructive and Aesthetic Surgeons devised a Think Over Before You Make Over campaign to address the worrying lack of consumer awareness about how to choose safe and appropriate cosmetic surgery. This resource, among others, allows consumers to access the reliable, trustworthy and sensible information they need to make informed choices.

It is not always easy for the public to access reliable online information, as aesthetic expert Dr Sophie Shotter says: “I think the general public don’t really have a clue about where to start looking for someone good to see. Not everyone is lucky enough to know someone to give them a word-of-mouth recommendation, hence so many people start their research online.”

Conflicting advice is increasingly common. For example, is it obvious to a lay person what “accredited” means and the implications of the term? Is there the danger of a “bandwagon” effect and the word “safety” becoming commercialised and used as yet another marketing ploy?

According to cosmetic surgeon Paul Banwell: “While there is great merit in promoting and advocating patient safety as a core value, there is still a chance that poorly trained and unscrupulous individuals are using this term to lure the public.”

Those looking to undergo a cosmetic surgery procedure need to find a good, well-qualified and reputable surgeon with whom they are comfortable.

The British Association of Aesthetic Plastic Surgeons (BAAPS) recommends individuals liaise with their GP who will be able to refer them to a registered plastic surgeon and correspond with him or her regarding any medical problems that may affect surgery. Both surgeon and GP can then continue to liaise if appropriate during the recovery period.

Those who are considering surgery should take enough time to ensure they are wholly comfortable with their decision, the surgeon and the clinic or hospital in which the procedure will be carried out. The public must not be swayed by pushy marketing tactics or free consultations, and must also beware booking fees and non-refundable deposits. BAAPS can verify if a surgeon has the proper credentials.

Similarly, those considering a non-surgical treatment must check the practitioner’s qualifications, and find someone who is safe and well qualified. Nurses must be registered with the Nursing and Midwifery Council, doctors with the GMC and dentists with the General Dental Council. Practitioners must be trained to deal with allergic and other adverse reactions, and the clinical environment in which treatment is carried out must be clean and safe.

“A good practitioner will fully explain the risks, what is involved, what result to expect and will not pressurise a client into agreeing to treatment,” says Mandy Luckman, clinical negligence lawyer at Irwin Mitchell.

The industry is still largely supportive of proactive change and frustrated where there is lack of it.

Consultant plastic, reconstructive and aesthetic surgeon Fulvio Urso Baiarda says: “Arguably, a robust and uncompromising response to the PIP scandal was needed in order to protect the public. But consumers are still in danger from charlatans despite the recommendations made in the Keogh Review. It is totally unacceptable that consumers are still subjected to appalling practices by some questionable activities and individuals.”

Fellow consultant cosmetic surgeon Mr Banwell concludes: “There must be further measures to censure rogue practitioners and perhaps full regulation of the industry would be an effective way to rein in individuals who have scant regard for patients’ wellbeing.

“There are still far too many practitioners who carry out cosmetic interventions inappropriately, recklessly endangering the health of their patients.

“While significant developments have been made, the cosmetic interventions industry is a very long way from being safe for its consumers, so long as such activities continue.”


PIP implant scandal

Women around the world were in fear when in 2011 it emerged that PIP breast implants had been manufactured with industrial-grade silicone that was prone to rupture.

The implants were manufactured by French company Poly Implant Prostheses, the founder of which was jailed for four years in 2013, guilty of aggravated fraud.

French health data revealed that the rupture rate of the implants could be as high as 25 per cent.

The implants were implicated in several deaths due to toxicity and were also linked to a number of cases of breast cancer, although a direct cause has not been proven.

There are as many as 50,000 women in the UK with PIP implants, but shoddy record-keeping by some cosmetic surgery providers has resulted in women not knowing which implants they have.

The NHS and some cosmetic surgery clinics have pledged to remove PIP implants free of charge, but as yet the vast majority of women have not undergone removal surgery.

Thousands of British women are currently fighting for compensation after being given the faulty implants.

The scandal resulted in a government recommendation for a register logging every breast implant operation carried out in England, but concerns remain that not enough safeguards are in place to prevent a similar situation occurring again.

Cosmetic surgeon Ricardo Frati concludes: “I’m concerned that not enough has been learnt following PIP. Professional organisations have been keen to see a mandatory implant register established, but this hasn’t happened.”