Under review

The outcome of the Government review into both surgical and non-surgical procedures could dramatically change the scope of practice for beauty therapists. With many cosmetic doctors arguing that therapists should be banned from administering injectables, some now fear that the law could change without the beauty industry being given a fair chance to defend its position or to contribute to the formation of new training and legislation.

On August 15, the Department of Health announced a review, led by Sir Bruce Keogh, medical director of the NHS, which will scrutinise the cosmetic surgery and non-surgical aesthetics industries to determine who should be carrying out which procedures and where tighter rules are needed in training and aftercare.
Keogh has invited feedback from the public and has put together a panel of experts to advise him in his decision as to what changes need to be made. The panel includes: Andrew Vallance-Owen, former medical director of BUPA, Catherine Kydd, campaigner on PIP implants, and Trish Halpin, editor of Marie Claire magazine among others.
 
However, this panel has no representatives from beauty therapy or nursing. The decision not to invite feedback from two of the professions that dominate the market for such treatments has been met with anger by many of the people carrying out these services.
 
Molly Hanson-Steel, chairman of the Cosmetic Treatments and Injectables Association (CTIA), a group set up to create and raise awareness of safe practice standards within the injectables industry, says: “Yet again the ‘expert panel’, seem to dismiss that their attitudes and actions have a direct impact upon the professionals who actually carry out these treatments. Where are the beauty experts within this panel? Does it not affect our industry more than any other?”
 
Kizzy Galvin, who owns Harmony Health and Beauty Salon in Warwickshire adds: “We need to embrace progression but just monitor things better. A lot of people are at risk of losing their livelihoods. This situation hasn’t happened over night yet it appears it may be ending that way. There definitely should be someone on the board representing the beauty sector from this angle.”
 
The review will assess:
• The regulation and safety of products used in cosmetic interventions
• How to best ensure that the people who carry out the procedures have the necessary skills and qualifications
• How to ensure that organisations have systems in place to look after their patients both during their treatment and afterwards
• How to ensure that people considering cosmetic surgery and procedures are given the information, advice and time for reflection to make an informed choice
• What improvements are needed in dealing with complaints so they are listened to and acted upon.
 
The background
The review was launched in the wake of the PIPs scandal in which certain breast implants were found to contain unauthorised silicone originally intended for mattress filler.
 
Shortly after this, an undercover investigation by the BBC found that Harley Aesthetics, one of the UK’s largest purchasers of botox, was flouting laws on remote prescribing by allowing nurses to inject patients with the drug without prescription if they were unable to reach the doctor by phone. This caused the General Medical Council to outlaw remote prescribing of botox meaning doctors must see patients face-to-face before prescribing the drug, which can then be administered by a non-medical professional.
 
Both surgical and non-surgical procedures are now under review and many fear that the decision could prevent beauty therapists carrying out injectables and possibly other advanced aesthetics treatments without good reason.
Beauty and spa business consultant Dr Glenis Wade says, “I found it curious how Keogh on the news did much finger pointing at hairdressers and what he called ‘beauticians’. He said little about unscrupulous plastic surgeons or the implant manufacturers that started the row.”
 
Eileen Strong of FACE clinic in Cardiff, who has done ongoing training for 23 years, argues that the advisory panel is not in a position to fully understand the different levels of training in the beauty industry and is in danger of side-lining experienced and competent professionals. “There are different levels of therapist that have trained to a special NVQ Level 3 and also electrolysis and thread vein practitioners. We are not beautcians as they are suggesting. Nurses complete three years and beauty therapists do too,” she says.
 
Welcome change
 
While most beauty professionals welcome tighter restrictions, they argue it would be wrong if these oust the beauty industry, which was not involved in the original scandal, and suggest instead that the beauty and medical professions should work together to find an inclusive solution to training and legislating these procedures. “Yes, we need regulation and yes, we need to see ‘back street botox’ stamped out,” says Hanson-Steel. “However, the CTIA wants to see regulations for the utmost safety of the consumer but also to provide choice for the client as priority, and not a system that resembles a cartel restricting one profession over another.”
 
New industry body the Association of Aesthetics Injectables & Cosmetic Lasers (AAIC) is working to create a qualification that would be open to all practitioners whether they have a medical or non-medical background.
 
Babtac past chairman Angela Bartlett has consulted with AAIC director Chris Wade  on the development of the qualification and adds: “We would also like to see a botulinum toxin audit trail, annual inspection of practitioners by an independent inspectorate, and preferred supply chain of dermal fillers: there are only nine approved in the US but over 100 available in the UK.
 
“I hope Sir Bruce Keogh’s review will be transparent and balanced and that qualified non-medical injectable practitioners will not have their right to work penalised.”
 
Profit potential
 
Some go so far as to suggest that doctors are putting pressure on the Government to rule against non-doctors carrying out these treatments so that they can monopolise the market and the considerable financial benefits it offers.
Madina Palmos, who was a qualified medical doctor in Russia but works in the UK as an aesthetic practitioner, says: “Giving a body tattoo or permanent make-up is almost as risky as injectables. Why then is the medical industry not interested in closing all the tattoo shops in Camden? My guess is it is because they are not wanting to corner that market for themselves.”
 
The safety angle
 
Doctors have argued that it is unsafe for therapists to carry out invasive treatments because they are not medically trained to deal with any adverse reactions, such as anaphylactic shock, arising from treatment.
 
However, the CTIA emphasises that the aesthetic therapists it trains and audits have anaphylactic training and are covered by professional malpractice insurance. “We comply with all laws and regulations regarding prescription-only medicine and work closely alongside doctors to ensure that we keep lawful and compliant,” adds Hanson-Steel.
 
Many aesthetic practitioners have argued that if they are found to be in any way lacking, they should be given the opportunity to train and pass qualifications in the necessary areas rather than being forbidden from carrying out treatments without a full medical degree.
 
Nicola Crellin-Bansal, manager of HB Med salon in Bolton, says: “I would be very happy to be inspected and to attend any training course the Goverment recommends. I am not medical and do not protest to be so. However, medical practioners are not therapists. We adopt a holistic approach and my clients come to me as I care.”
 
While doctors argue that therapists are not medically trained, beauty professionals have pointed out that many of the doctors carrying out lucrative services such as botox are not experienced in giving skincare and ageing advice. Bartlett says: “Biased support is being given to medical practitioners who may not have all the necessary aesthetic training such as in-depth training on skin structure, muscles of the face, and the ability to assist patients with concerns about skin ageing.”
 
Also, doctors are often not equipped to offer clients a full range of beauty services, meaning that if a client requests botox from a doctor, they will not have all the non-invasive alternatives explained to them to make sure they make an informed decision, or have accesss to an alternative if they are not suitable for botox.
 
Personal touch
 
Some salon owners have also suggested that, while they are not medics, beauty therapists are better positioned to offer a level of personalised service and customer care than doctors, who are unlikely to see their patients as frequently and often have a separate day job.
 
Kirsty Hopper of MD Therapy says she has had 100% client satisfaction from injectable treatments she performed and puts that down to the customer service. “That’s what we do in this industry. I have had medics working in my clinic doing injections who have left to drive home before the client has even left the treatment room,” she adds. “They often can’t remember the client’s name and face because they visit so many places. If the medic then leaves and won’t be back for four weeks we are left with client aftercare anyway.”
 
Hopper says that having used visiting medics in her clinic and been unhappy with the service, she felt the only way to get a reliable level of service was to train herself. The outcome of the review is expected to be announced in March 2013. PB
 
Direct action
 
While beauty professionals may be missing from the advisory committee, they are still able to share their opinions on any regulatory changes via the Department of Health website at www.dh.gov.uk/health/cosmetic-form or via email to cosmeticinterventionsreview@dh.gsi.gov.uk
 
Meanwhile beauty association Babtac has announced the intention to present an extensive contribution to Sir Bruce Keogh’s review on behalf of the beauty industry. Any therapist wishing to comment or become involved can email the association at info@babtac.com