The fact two-thirds of cosmetic injectors aren't doctors doesn't even scratch the surface of regulation issues

As a beauty editor who is more than familiar with the world of injectables, even I was a little shocked when I read headlines this week showing two-thirds of cosmetic injectors aren't doctors. I read the headline the day before visiting my go-to injector, Dr Ahmed El-Muntasar, for a Botox top-up.

I asked him if he had seen the stories. He hadn't. But our conversation around the topic was weighty. "You don't need to be a doctor to be a cosmetic injector," he said. "For Botox, you have to be a prescriber—so, for example, a prescribing nurse or a dentist can administer Botox, providing they've had the training. The rules around filler aren't so strict." 

And this wasn't new information to me. I'm very in loop with the current laws and regulation (or lack there of) around cosmetic injections. I have long believed that the UK government's regulation around cosmetic procedures needs to be a whole lot stricter—and I still believe that. But, in my opinion, the findings of this new study don't even scratch the surface of the issues that currently exist in the world of cosmetic injectables. Here's what you should know...

The study itself

The study, which was published in the Journal of Plastic, Reconstructive & Aesthetic Surgery, involved researchers from UCL evaluating 3,000 websites to identify 1,224 independent clinics and 3,667 practitioners who were delivering cosmetic injections. The study concluded that, "Of the professions represented, 32% were doctors, 13% were nurses, 24% were dentists and 8% were dental nurses."

The headline that originally piqued my interest in the study stated that two-thirds of cosmetic injectors aren't doctors. The study clearly shows this. However, it does also show that 45% of them (including nurses, dentists and dental nurses) are trained medical professionals. To assume that doctors should be the only practising medical professionals capable or trusted enough to administer injectables isn't, in my opinion, necessarily correct—the situation is far more nuanced.

The stat that I am more interested in? Who accounts for the remaining 23% of injectors? Well, I can make some educated assumptions.

Flawed Botox regulation

As explained earlier, Botox is a prescription-only drug. Therefore, it must be prescribed to a 'patient' by a certified medical prescriber. In practice, this means a face-to-face consultation must take place between the patient and the medical expert—which makes total sense. The issue with the current UK Botox regulation is that the person prescribing the drug doesn't legally have to be the one injecting it—they just have to be there to prescribe it. However, the responsibility of the treatment legally falls in their hands. Therefore, in theory, the law makers assume no medical professional worth their weight would let a non-medical injector do their work for them.

The worrying part is, this isn't always true. In fact, over the years I have heard of several anecdotal situations which involve non-medical beauticians injecting Botox—and these people could make up at least some of the unaccounted for 23% of injectors. The ways in which they get their hands on it varies, but one stand-out tale included a rare bad-egg prescriber selling their supply to non-medical beauticians for extra cash. 

The worrying thing about this is that the onus of responsible Botox injections ultimately falls on the patient to know the law. But let me tell you this now: if your Botox injector isn't a medical prescriber or you don't have a face-to-face consultation with a prescriber as a part of your treatment—the person you are paying is breaking the law and shouldn't be trusted.

Lack of other regulation

Botox and other lesser-known types of muscle freezing drugs are, as explained, prescription only. What's worrying, is that other injectables such as filler, are not. But they should be. And this is something I feel very passionately about.

When I raised my concerns about this with Dr El Muntasar last week, he agreed. "Filler has the potential to go really wrong, and I see it happen all the time," he told me.

You see, filler (and other cosmetic injections) can, in theory, be administered by anyone who has undertaken training (which doesn't haven't to be medical). And this is really bad news.

Why medically-trained injectors are so important

As a beauty editor, I choose to visit a practising doctor for any cosmetic injections I have. Dr El-Muntasar works three days a week as a GP for the NHS, and this is something I factored in when making my decision to visit him for the first time. 

You see, medical professionals are well trained in how to administer any and every dermal injection safely—and this is a basic skill that is really important. Beyond that, the biggest reason I always recommend visiting a practising medical professional for your cosmetic injections is because they have a lot to lose if anything were to ever go wrong. Not only have they spent many years studying and working in the field, but they also have medical regulators and investigation boards paying close attention to them, ensuring they do everything by the book.

My reason for choosing a doctor, instead of a say a nurse or a dentist, is a little more nuanced. I have, in the past, visited both nurses and dentists for other treatments, all of which have been safe and yielded good results, but I feel safest in the hands of a doctor—somebody who understands the skin, structure and muscle formation of the face and body expertly.

The injectables boom

The UCL-led study estimates that the UK injectables market will reach a value of £11.7 billion by 2026—and this doesn't surprise me. Injectables have become the new skincare, with almost every woman I know either having considered or received cosmetic injectables. Our desire to look young and youthful as a nation doesn't appear to be diminishing.

With more demand for injectables, the more need there is for injectors to administer them. In an unregulated market, it leaves me questioning what training, licenses and qualifications these injectors will have.

What can the government do?

Last year, the government promised to look into a licensing scheme for Botox and filler injectors. So far, this hasn't come into fruition.

With the rise in demand of injectables combined with a blatant lack of regulation, we're seeing a number of issues arise. Not only are we seeing botched treatments go unpunished, but the healthcare industry is also being left open to corruption and an exodus of its highly skilled workforce to a more lucrative aesthetics industry.

It's time for urgent change. The aesthetics industry needs to stop expecting customers to know what's good for them and improve its transparency—and it's time for the government to make sure it happens.