"What Did She Expect?"—The Sexism and Classism Behind The UK’s Aesthetics Safety Crisis

I’m sure you are aware of the kinds of comments that are made when aesthetic treatments go wrong. Why would you let somebody mess with your face like that? Clearly she went to see somebody dodgy. The feeling—sometimes implied, sometimes explicitly expressed—is that the person affected ‘should have known better’.

This is, obviously, incredibly judgmental. But more than that, it ignores the beauty standards that drive people to seek treatment, as well as the huge gaps in our current system that leave people exposed to harm. And it’s women who are most affected.

By global standards, the current rules are lax and their loopholes notorious. For example, technically, anybody can inject filler. No formal qualifications or insurance are legally required, nor the medical training needed to manage the situation if and when things go wrong—and injecting filler in even slightly the wrong place can be catastrophic. In 2024, a woman died after receiving a liquid BBL—a highly dangerous procedure whereby filler is injected into the buttocks.

Then there are the counterfeit, unlicensed and illegal products that are rife in the UK. Last summer, 41 cases of botulism were reported in the space of almost two months, linked to the use of an unlicensed fake product.

And yet somehow, we are in a place where navigating the complexities of our aesthetics industry is entirely on the consumer. If you end up being treated by somebody inexperienced, well, that’s your fault for not checking a list of things you may not have even known about—the implication being that you are somehow responsible for things going wrong.

When you look at who is most likely to experience these complications, and who is most judged when they do occur, there is an undercurrent of misogyny and classism. Aesthetic treatment complications are therefore incredibly political.

The Presumption of Safety

Many consumers assume safety is universal when booking aesthetic treatments. “I think it's a genuinely reasonable gap in understanding rather than any failure on patients' part,” says Dr Caroline Warden, GP and Aesthetic Doctor and founder of the Dr Caroline Warden Skin & Aesthetic Clinic. “Most people assume that if someone is advertising and charging for a treatment, they must be operating within some regulated framework.”

But sometimes they aren’t. What seems like an industry that must have watertight rules in place around who can pick up a syringe could not be further from reality. While botulinum toxin (often the brand name Botox) is a prescription-only medicine, dermal fillers and other aesthetic devices, like lasers, aren’t restricted to any particular qualification.

This somewhat undermines the “should have known better” argument. Known what, exactly? That someone legally offering treatments that break the skin, including injections, may have no medical qualifications? That a legitimate-looking business may not be equipped to manage an emergency?

“Patients tell me they feel ashamed, ‘stupid’ and confused as to how there are no regulations to govern who is allowed to inject,” says Dr Steven Land, Aesthetics Doctor and Director of Novellus Aesthetics, adding that this is exacerbated when they learn how unusual this lack of rules is compared to the rest of the world.

Dr Warden echoes this. “Patients frequently arrive apologetic, almost as though the complication reflects a mistake on their part rather than a shortfall in the care they received,” she says.

Of course, complications can happen even in experienced hands. “No aesthetic treatment is completely without risk,” says Dr Cindy Teo, GP and Aesthetic Doctor and founder of Dr Cindy Aesthetics. “The important difference is how we minimise those risks, and whether a practitioner can recognise a complication early and act quickly before it becomes more serious.”

The crucial difference is that regulated professionals are overseen by various bodies, through which consumers can complain when things go wrong, and are bound to strict codes of conduct. Medics have a duty of care and can lose their licenses in the event of serious misconduct. The system is far murkier when it comes to unqualified and unregulated practitioners.

The issue, then, isn’t that cheap treatments are dangerous. The issue is whether appropriate safeguards exist before, during and after treatment. Too often, the answer is no.

The Class Divide in Aesthetic Treatment Safety

The desire (or pressure) to be “beautiful” isn’t new, but we live in a time of social media filters and AI capable of generating entirely new versions of what we could look like. Beauty standards are served up on our phones almost constantly, so it’s hardly surprising that so many women end up wanting treatments. But the playing field isn’t level.

Much has been written about the gap between those who can and cannot afford beauty and aesthetic treatments, and how those who can benefit from them. But when those from lower-income backgrounds do seek treatment, there is still a disparity. “Cost can affect access to safer treatment, as those on lower incomes may have fewer affordable options and be left more exposed to risk in a poorly regulated market,” says Caroline Corby, Chair of the Professional Standards Authority for Health and Social Care (PSA).

Research published earlier this year by UCL also suggests that higher concentrations of non-medical practitioners offering Botox, in settings like salons and spas, are more likely in deprived areas. It is silly to pretend there isn’t a kind of safety gap at play, driven by who can afford access to treatments in the safest settings.

This is where simply warning consumers against anything “suspiciously cheap”, though important, can feel inadequate. Of course, people should be warned of red flags. But when the safest treatment is financially inaccessible to many, price often makes the decision—which is why stricter regulations are critical to consumer protection.

There are horror stories of procedures being carried out in places like public toilets or garages. The knee-jerk instinct to ask why somebody would agree to that is understandable. But it shouldn’t stop there. Why was that treatment available in the first place? And what combination of beauty pressures, financial constraints, regulatory failures and a desperate desire to access treatment made it an attractive enough proposition to accept? This is clearly about more than enjoying a beauty self-care moment.

Regardless of the circumstances, everyone should be entitled to help and support when complications arise.

When the System Blames the Patient

Nevertheless, we know that the judgment that can come with complications is very real. However, as Corby says, “People should have clear information about risks, but the focus should be on better safeguards and standards, not placing responsibility on the consumer when things go wrong.”

Ashton Collins, director of Save Face, says that judgement can even extend to the institutions supposed to protect people. “We've had situations where women have been told when they've arrived at hospital, you are the illest person in this hospital, and unless you have an operation in the next hour, you will die. That's been caused by somebody who has been completely negligent and is technically, legally assault,” she says.

Yet when cases are reported, Collins says women can be treated as though they’ve made “stupid choices driven by vanity. Basically, ‘what did you expect’ is the vibe.”

Can you imagine this playing out in other industries? A person is left with a life-threatening injury after a commercial service and they are met with judgement and blame?

Accountability, meanwhile, can be remarkably difficult. Collins describes “ghost practitioners” who operate through social media, sometimes without patients even knowing their full name or address. “When things go wrong, she blocks you,” Collins says. “That cycle will go on; she'll close that page down and set up somewhere else.”

The NHS and the costs of treating these complications are frequently brought into the debate, too, given that these are elective treatments. But if public money is repeatedly being spent treating preventable injuries, why is so much outrage directed at the patient, not the systems that allow unsafe practice to flourish? Why aren’t there better systems in place to prevent as many of these injuries as possible?

Has Prejudice Helped Hold Up Regulation?

We know women are often blamed when treatment goes wrong. So have misogyny, classism, and those attitudes around beauty have contributed to the lack of urgency in protecting them from complications? I don’t think it’s a wild assumption.

“In the past, I have wondered whether the slow regulatory response could be partly attributed to a feeling that when things go wrong, women ‘bring this on themselves’, perhaps through a perception that undergoing these procedures is driven by vanity,” says Corby. “It shouldn’t matter what the procedure is; if it carries a high risk, there should be adequate protections around it to keep people safe and well.”

Regulation is coming (though not without criticism), but progress has been slow. A proposed licensing scheme for England, which categorises treatments via a traffic light system, is still under discussion, while Scotland has announced its licensing scheme, set to come into effect in 2027. No such proposals have been made for Wales or Northern Ireland.

‘What did you expect?’ is therefore unfair and entirely the wrong question when complications arise. This is an industry where, currently, qualifications aren’t mandatory, standards vary wildly, accountability is hard to enforce and consumer protection is an afterthought. But when the stakes are so high, everyone should have the right to expect that their treatment is regulated accordingly.

How to Stay Safe Until Regulations Are Strengthened

• Check registration via the General Medical Council for doctors, General Dental Council for dentists, and the Nurses and Midwifery Council for nurses and nurse prescribers
• Read about PSA’s Look Before You Book Campaign—and look for the accreditation badge before booking
• Use the Save Face Register and resources
• Read BCAM’s Vet It Before You Get It Campaign—including the Pre-Consultation Safety Questionnaire