While unfortunate that this is the topic of one our first posts for our blog, we feel it important to transparently and frankly address the topic of safety in Aesthetics. As a clinic led by highly experienced, Registered Nurses, we pride ourselves on providing a service that is both clinically effective but also, most importantly, safe for you, our clients and service users. So, concerns over safety in our industry and health care sector are of great importance to us!
Background to this blog
Many of you with an interest in, or at least, an awareness of Aesthetics will no doubt have seen, in early October 2024 it was reported on national news, that tragically, a young mother of 5 died following a "BBL" (Brazilian Bum Lift) procedure. This particular procedure we understand involved using dermal filler (very large volumes - well over 100mL) to increase the size of the buttocks. This is an extremely risky procedure as the buttocks have many large blood vessels and injection of filler into these vessels can cause serious clots which can fatally travel to the lungs. While we do not know the full clinical details of this young woman's death, we suspect this is what has happened given the information we do know (that she died very soon after the procedure).
Those invovled were arrested and there is a criminal investigation ongoing at the time of writing this blog. We know the alleged Practitioner involved is a 'non-medic' or someone who has no medical/clinical background and no Professional Registration. This Practitioner, and many like them have simply undertaken a course which likely took a day or two to complete and then started to practice on real people with no further requirement of supervision or confirmation of competance. By contrast, in California where high levels of safety regulations are in place, only experianced Doctors with suitably high levels of specialist training are allowed to perform such a procedure and it must only be undertaken under Ultrasound guidance to ensure blood vessels are avoided. The gulf of difference in the levels of knowledge, safety, clinical governance, skill and expetise of two such different approaches cannot be understated.
At the same time as this tragic and dramatic event, in line with the growth of the Aesthetics sector, there is a considerable increase in the number of people people seeking assistance for complications associated with Aesthetic treatments such as vascular occulsions (VO) in dermal filler use. This is where a blood vessel gets blocked by the filler. If not resolved this will lead to an area of skin and tissues becoming necrotic (dying) leaving a wound or worse. For example VOs in the temple areas could stop blood supply to an eye causing blindness! Such complications require rapid recognition, diagnosis and urgent dissolving of the filler to prevent those serious injuries happening. Practitioners must be well trained, have astute clinical assessment skills, and be able to calmly and effectively manage the complication, taking the right action in a timely manner and escalating safely as needed.
Even the best Practitioners will very occasionally encounter a complication such as a VO, albeit it happens much less frequently for skilled Practitioners with good anatomical knowledge. So, every Practitioner should be as equally expert at managing complications as they are at delivering the treatment! Stories where providers are unable to dissolve independently or manage their complications abound on social media or even on the news such as this recent story here where the Practitioner completely and dangerously mis-managed a complication.
It is not just our own ancetdotal experiance, but it is consistently highlighted by groups such as Save Face that the quality of treatments from some clinics and Practitioners is so poor that it falls below any reasonably acceptable standard due to poor quality products, inappropriate clinical settings and or poor practitioner skill with poorly delivered treatments leading to more concerns for clients!
The Concern
This brings us to our critical point: In the UK, there is virtually no regulation of the Aesthetics industry. Any lay person can go and undertake courses to inject botox or use dermal fillers and start practicing the following day! Furthermore, availability of fake medicines on the black market such as Wegovy, Ozempic and Mounjaro are poorly policed allowing unscrupulous people to sell cheap imitation medicines which are very dangerous.
There is no legal restriction on who can provide what are specialist and often advanced medical interventions. Many Aesthetics treatments require detailed and intimate anatomy knowledge and a framework of knowledge and thinking to understand the risks at every level of tissues and indeed wider organ function around the treatment being administered.
There is no legal requirement for someone to have indemnity insurance. If something goes wrong with a Practitioner without insurance, it will be unlikely that you will be able to claim sufficent monies to cover the cost of your injuries and the impact these have on your life.
There is no legal requirement for clinics to be registered as a safe place of business and health care. Hospitals, care homes, dentists and in some areas (such as Wales), clinics that provide class 3b and 4 laser treatments or prescribe medicines like Wegovy and Mounjaro, all have to register with organsiations such as Health Inspectorate Wales (HIW) and the Care Quality Commission (CQC) in England. Registered providers such as TT Medical Clinic (HIW Registered) are held to a standard of processes, clinical governance and various other standards to provide a high degree of confidence that the provider is delivering excellent quality and safe care. They can be inspected by these regulatory bodies at any time to ensure they are following these standards. For all other clinics providing an array of medical treatments, there is no regulatory requirement to show that a clinic is excellent or poor.
There is considerable variation in clinical training available. It varies from excellent to extremely poor, with again, no nationally agreed standards on what qualifications a Practitioner must have to start training others! Furthermore, a newly qualified Practitioner could within a very short space of time start training others when they themself are still a novice.
There is no set framework for how Practitioners demonstrate their skills and abilities after leaving their training courses. Among registered health professionals, there are rigorous processes for ensuring that Doctors (GMC), Nurses (NMC) etc. demonstrate their ongoing continuous professional development and evidence their clinical abilities. For non-registrants, there are no such required checks or reviews to tell if a Practitioner is good or poor. Furthermore, with registered professionals, if you feel they have behaved badly or performed below an acceptable standard, you have the ability to report them to their governing bodies where there will be an investigation and follow up on your concerns where, if problems are found, the body have the ability to limit that professional's practice to protect the public . For someone without a professional registration, your only option to seek recourse from them would be to take them to court.
Can you imagine going to any NHS provider and being seen by an unsupervised Nurse, Doctor or Dentist who has had only 1 day of training who will then treat you with medicines and treatments that they will inject into you? I imagine, like me, you would be concerned and most likely decline treatment from them if you knew?
Consider; when people posing as Professionals do successfully infiltrate the NHS (as in this article) or pose as professionals (such as Paramedics like this story) and are subsequently caught, this is a crime of significance and is usually front page news and the legal repercussions for that person are significant (often custodial sentences).
Yet, in contrast to this almost sacred protection afforded to our public's health and wellbeing from imposters, there is an entire £4bn healthcare sector where upto 30% of the Practitioners delivering (often quite advanced) medical care are not registered professionals and this is completely legal!
We, like many other Professionals working the aesthetics industry have consistently called upon sucessive governments to regulate this sector. The UK is one of very few countries in the world to lack any regulations for non-surgical aethetics!
Unfortunately, this leaves patients/clients/consumers who may have very little insights to the sector to navigate the plethora of providers themselves. It is our hope that any reader of this blog may gain valuable insights in what to look for in a high quality, safe Aesthetic Practitioner. Our advice to our prospective clients is always "if you don't choose us, please make sure who you choose someone is good and safe"!
So what is the unsafe care you are talking about?
While some news stories demonstrate the very extreme end of outragously dangerous practice, such as this story from ITV recently, most bad practice is more subtle to the untrained eye. Never was the phase "if it looks too good to be true, it probably is" more true than in Aesthetics! We live in a society where people want quick results; we have streamed television on demand, amazon prime next day deliverly, deliveroo fast food delivered to your door. We are a fast moving society who want to satify our desires fast. We are often willing to sacrifice quality for fast and cheap but when we are talking about your body, your appearance and your life - why would you risk poor quality? Equally, the internet's ability to find and compare mutliple providers quickly combined with a societal tendancy to seek the best price over the highest quality means some providers will try and tempt clients with extremely cheap deals without explaining why they are cheap. Lets look at 3 typical examples of deals that should concern, not excite you:
Botox deals:
Botox is a prescription only medicine (POM), so if a provider is not able to prescribe, they have to pay a prescriber (a Doctor or independent prescriber) for the botox prescription for their client. This typically costs £25 to £40. A vial of 50iu of botox (generally enough for women with normal strength muscles to have 3 areas of treatment on their upper face) costs, generally, well over £60. A provider will naturally want to make some degree of profit for their time and expertise as well (they are after all running a business and trying to earn a living).
However, we need to consider the costs of running a clinic; rent, utlitilites etc. and also consider consumable costs like gloves, needles, syrgines, skin cleansing products. Good quality care is also meticulously documented by good Practitioners. How are they documenting your care? Are they even documenting their care for you? Did you sign a consent form? Do they use a proper software system to do this all neatly and reliably, which of course - costs money?
Lets assume they pay themselves a very modest hourly rate of £15 and they should allow at least an hour to undertake a full consultation of your concerns, needs, suitaibility for the treatment and approrpiate signing of consent forms. Would you trust a doctor or nurse working for such a low rate? What is wrong with their care if they are willing to sell their work for such a low amount? Top injectors command 100s of pounds an hour. Anything less than £150 for botox should raise questions in your mind to the quality of the provider as even "model days" cost more than this to cover costs if done to a good standard.
What might be happening here to allow some providers to offer such low costs?
Imitation botox: Some unscrupulous providers may be using botox from unlicensed sellers. These can be bought without a prescription (as they are counterfeit). TT Medical Clinic are contacted on a weekly basis through social media by unlicenced sellers offering various toxins for sale without prescription at suspiciously low prices (we emphasise we only use licenced pharmacies)! It may not be botox or only contain very small amounts of botox.
Under dosing: If a provider is offering 'baby botox' for a low cost, it is possible they may be using the same vial of botox that was prescribed and sought properly for one client among several people. This again is entirely unsafe, unprofessional and illegal.
Secondary prescribing: We are aware of some non-prescribers seeking large orders of botox from their prescribers for a single person (such as themself) and then using that botox prescribed for them for other people. Ethical prescribers would question Practitioners ordering large volumes of botox and should be seeing the clients they are prescribing for face to face! Equally, would you trust the clinical judgement of a non-medic to decide if a medicine is safe for you to have?
Also consider quality:
High quality, super fine needles cause less pain and are much less likely to cause bruising. They are, of course, more expensive!
Practitioner quality: As above, highly trained and experienced Professionals will have years of experiance, have considerable training, masterclasses and supervised practice amounting to hundreds if not thousands of hours of practice and thousands of pounds of personal investment. Their knowledge, skills, artistry and ability to care for you as a whole person are sought after and rare. Someone with this high level of skillset does not work for low levels of wage. So if a provider is offering a treatment very cheaply, ask why?
Inapprorpiate practice settings and use: Have you heard of botox parties? Alcohol is a contraindication to botox within 24 hours of injection of botox. It causes an increased risk of bruising, bleeding, ptosis (dropped eyelid) or could simply stop the botox from working as effectively. So why would any competent Practitioner invite a group of people to drink Prosecco and have botox?!
Also consider the risks of having multiple patients all mixed up in the same place at the same time. How do you know whos who? Were they all approrpaitely counselled and informed of the risks when a group of people in a party atmosphere are so easily distracted. What is the quality of clinical review, risk assessment and what the client wants from the treatment. Is a home environment really the best place to undertake a precision, clinical intervention? We think not and beileve any Practitioner offering such care is reckless. Is this the sort of person you want to allow to put toxin in your face?
Dermal Filler deals:
Filler, unlike botox does not require a prescription, but do not be fooled, while filler is a fantastic and safe treatment in the right hands, there are considerable risks associated with using dermal fillers as described above and most Registered Professionals treat filler with the utmost of respect, fully aware of what they need to do to use it safely. Beware anyone who is blasé in using filler.
Not all fillers are created equally. At TT Medical Clinic, we use premium fillers from companies such as Vivacy, Texoane and occasionally some other high quality fillers depending on the individual needs of our clients. Premium fillers will cost in excess of £150 per 1mL, but offer far superior safety, consistency, feel and appearance of the product and the effectiveness and ease of which the product can be injected, sculpted and handled by the Practitioner to get the desired appearance.
Consider these the Rolls Royce and Ferrari level products. There are some good quality fillers for less than than these which still give fantastic results (think your BMW, Mercedes level) but again, factor in other costs. The cost of that skilled Practitioner, the cost of high quality needles or cannulas to get the best and most accurate placement of filler, the clinic costs. Now consider your lip filler deal for £60 and ask what quality of filler and care you are getting for that price?!
Weight loss injections
And finally for this particular blog, weight loss injections. In recent years Ozempic, Wegovy and Mounjaro have gone from being the knowledge of professionals and diabetic patients to a mainstream public awareness. These drugs supress appetite allowing people who have struggled with obesity to finally reduce calorie intake without battling hunger that makes it so difficult with fantastic results for their health and appearance. But with them has come a slew of poor practice and dangerous imitation medicines.
Did you know, Ozempic is not licensed for weight loss?! It is licensed for diabetes. Its sister product, Wegovy is in fact the EXACT SAME DRUG, made in the same factory by the same pharmaceutical company. Wegovy is licensed for weight loss. This protects supply lines of Ozempic which is needed for diabetic patients. If someone has sold you Ozempic for weight loss, they have done so off licence and they are likely not insured if something happens to you. It is also unnecessary as Wegovy is readily available raising the question of why they chose Ozempic over Wegovy (ethically questionable) and is their supplier is not a reputable source?
Ozempic, Wegovy and Mounjaro all come as pens! This is the only way they are sold by their respective manufacturers. It is not possible to get these real drugs in a vial in the UK. If you have bought a medicine marked as Mounajro or Wegovy or Ozempic off the internet and it has come in a vial, it is a fake and at best may do nothing, or at worst harm or kill you. The BBC recently ran this article highlighting the dangers of counterfeit medicines.
Some people claim that they have lost weight on these imitation vials and studies of these drugs have shown them to contain insulin and or amphetamines, which will indeed help you lose weight but in an incredibly dangerous way which could cause severe harm or death if you are unlucky.
So what does safe look like?
To describe to entirety of what goes into ensuring safe, well delivered, evidenced based practice could fill a whole book! But we can discuss several key points:
Training:
Trained medical professionals or 'medics' which includes Doctors, Dentists and Nurses. These Professionals work to a much higher standard than any non-medical person. They will have studied in University for years and have a substantial knowlege of anatomy and physiology before they even consider specialising in a certain field.
By being professionally trained in Universities, they have developed a framework of thinking through years of study, linking anatomy and physiology to the presenting problem and pathology of a problem. Essentially as a service we firmly believe that more advanced Aesthetics, particularly anything that involves prescribing medicines or injecting treatments should solely be the domain of Registered Professionals. That is not to say that all non-medicas are bad Practitioners and that all Registered Professionals should be trusted without question. But you, as the consumer and client have far more assurances and safe guards for you by going to a Registered Professional.
Look for a Registered Professional's experiance. Are they newly qualified, are they new to Aesthetics, do they have a good portfolio of reviews, before and after pictures and social media. Is there evidence of them going for ongoing training and development? Do their results look natural and high quality? Beware anyone filtering patient photos in any way! Did you know you can search the GMC, GDC, NMC and HCPC registers to check if Professionals are registered and if they have any restrictions ont ehir practice. Simply go to the websites to check if they are there!
Regulating bodies:
Clinics registered with the Care Quality Commision (CQC) in England and Health Inspectorate wales (HIW) will have passed a stringent series of quality control checks to ensure they are practicing to a high standard. At present these bodies only regulate clinics who offer Laser services or medical services where prescribing and other medical activities take place.
However, clinics can voluntarily register with organisations like Save Face (for a fee) to show that they are practicing to a high standard as confirmed by such an independent organsiation.
These types of registrations and memberships can provide you as the patient that the clinic and Practitioner is of a good standard and are worth considering when looking for a clinic for your Aesthetic treatment.
Insurance:
As above, even the very best Practitioners will occasionally encounter a complication. The nature of complications occuring is that they occur sooner or later. You cannot always predict who they happen too. High quality Practitioners will be well trained to manage complications and the chances of suffering any lasting harm are remote as they will be able to intervene before any serious injury occurs (such as a VO). Check if a clinic or Practitioner carries appropriate indeminty and public liabiltiy insurance. If they don't and you suffer a complication and for example need to take time off work. You may struggle to get compensation from the clinic. A clinic with insurance are conscientious enough to make sure that their clients are safe and looked after nomatter what happens.
Practicing safe, established care:
Clinics who operate by delivering, safe, established care are doing just that! If you see a treatment being delivered that looks like a fad such as so called butterfly lips for example (where strips of paper stitches are used to supposedly shape the lips after lip filler). This demonstrates the Practitioner has no understanding of how the filler is working under the tissues, there is usually over filling of the lips which goes agaisnt best practice and ultimately this is a weak show to make the lips look very shapely immediately after treatment with no clinical or outcome benefits whatsoever. In fact, over filled lips are likely to result in filler which migrates (moves) out of place and beyond the lip border, in time resulting in a swollen, shapeless look.
If a Practitioner is willing to tell you "No", this is usually a very good sign that they are practicing safely and well. If a client is asking for an amount of filler of treatment which is not going to end up looking good or cause problems, they are looking after you, not being difficult. Take time to listen to what they are trying to tell you when they say no!
Equally, we always beleive it is for the client to tell us what they are concerned about. We will never be drawn by a client to answer the question "what do you think I need done"? A client must at least be able to have a conversation and explore what it is they are not satifised with and we will help them address the concern. We may explain that the cause of a concern is related to another area (i.e. the appearance of 'jowls' maybe becuase of a lack of support in the tissues in the cheeks), but we won't identify any flaws for you as you may not have been concerned about that area and or we will have given you a new concern! Any Practitioner who seeks to identify your flaws for you is being unethical hoping you will spend more money addressing multiple problems beyond your initial concern.
Do they have their certificates? At TT medical Clinic all of our certificates from our University studies to our various treatment skills are all in a file in the clinic ready to be shown at a moments notice!
Professional Premises - Professional attitude:
It doesn't nessecerily have to be a huge, flash, large scale clinic building. But Practitioners who have dedicated clinical areas which are clean, neat ad organised, professional and have appropriate features like hand washing facilities and sharps boxes are all signs of a good practitioner and clinic. As mentioned above, Practitioners willing to try and take a clinic setting into the unpredictable nature of other people's homes for what is elective treatment should be treated with scepticism. A proper medical bed or chair with excellent lighting is going to ensure that you can be positioned just right to ensure your treatment is delivered with prescision and care. How would this be done on a couch or bed in a house!
Also consider your Practitioner's dress code. Are they wearing appropriate clinical clothing like scrubs or a tunic or are they casually dressed? Do they wash their hands before examining or treating you, do they use protective items like gloves? Do they have a professional demeanour and attitude? Do not be afraid to leave a clinic if you do not feel the Practitioner is the right fit for you. Find a Practitioner you trust and have faith in based on the evidence of what you learn, see and hear from them.
In Conclusion
If you got this far! Well done for sticking with me. I hope this blog has been helpful in giving you some insights to Aesthetics and how to pick a safe Practitioner and keep yourselves safe and well as well as looking your absolute best. As we say, "if you don't pick us, just make sure you pick someone safe"!
If you have any thoughts or comments on this, we'd love to hear from you and of course you can always contact your MPs to lobby them regarding the regulation of Aesthetics. If you are concerned about a clinic or a Practitioner - if they re a registered Professional, you can get in touch with their regulatory body and if they are not a Registered Professional you can always get in touch with you local authority to raise your concerns over a business operating unsafely.
If you are concerned you have had poor quality care or are having a complication right now your Practitioner cannot put right, please do contact us. We can't guarantee we'll respond out of our operating hours but we'll do our best to help if we can.
Best Wishes everyone
Tom & Tanith
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