Botox: What it is and why two-thirds of people delivering cosmetic surgery are not doctors

The study is the first survey of who is providing cosmetic injectable services, including botulinum toxin (botox) and dermal fillers, in the country.

Experts suggest that without knowing the professional backgrounds of practitioners, the industry cannot be properly regulated.

Most commonly injected into people's faces, botox injections use a toxin to prevent certain muscles from moving, helping to smooth out rough lines and wrinkles.

To find out about background qualifications, training and experience levels of those who were administering treatments, researchers from UCL looked at 3,000 websites. They identified 1,224 independent clinics and 3,667 practitioners who were delivering cosmetic injections.

Of the professions represented, 32 per cent were doctors, 13 per cent were nurses, 24 per cent were dentists and 8 per cent were dental nurses.

According to the findings, of the 1,163 doctors identified, 41 per cent were on the specialist register and 19 per cent were on the GP register.

The study, published in the Journal of Plastic, Reconstructive and Aesthetic Surgery, found that amongst the 27 specialities represented on the specialist register, plastic surgery was the largest group (37 per cent) followed by dermatology (18 per cent).

Dr David Zargaran, UCL Plastic Surgery, an author of the study, said: “There are well-documented, yet to-date unaddressed challenges in the UK cosmetic injectables market.

“Without knowledge of the professional backgrounds of practitioners, we cannot adequately regulate the industry.

“Our research highlights that the majority of practitioners are not doctors and include other healthcare professionals, as well as non-healthcare professionals such as beauticians.

“The range of backgrounds opens a broader question relating to competence and consent.

“One of the key challenges facing the Government’s licensing scheme is to ensure that practitioners granted a licence possess the skills and experience required to safely administer their treatment to minimise risks to patients.

“It is important for patients to be able to feel comfortable and confident that the person administering their treatment is competent in the procedure as a fundamental foundation of informed consent.

“This research provides a unique insight into the sector to help inform regulators and patients, and work towards a safer and more transparent cosmetic injectables industry in the UK.”

According to the study, the UK injectables market is predicted to reach a value of £11.7bn by 2026, but to date is effectively unregulated.

The UK government is preparing to update policy around injectables, and a public consultation on the industry is due to begin in August 2023. Recommendations are expected to inform amendments to the Medical Act in 2024.

Professor Julie Davies, UCL Global Business School for Health, a co-author of the study, said: “The UK cosmetic injectables industry has expanded rapidly in recent years. This has happened largely without scrutiny or oversight.

“Our findings should be a wake-up call for legislators to implement effective regulation and professional standards to safeguard patients from complications.

"Although the risks associated with injections are often mild and temporary, the physical complications can be permanent and debilitating.

“There are also serious psychological, emotional, and financial consequences for patients when procedures go wrong.”