Cosmetic injection patients receive ‘alarming’ differences in quality

Patients are not always offered advice or given consent forms before undergoing the anti-wrinkle treatment, according to the largest study of its kind, which revealed "serious gaps" in the system.

More than 900 adults who had undergone botulinum toxin treatment took part in the research led by academics from Anglia Ruskin University (ARU) in Cambridge.

An estimated 900,000 cosmetic anti-wrinkle procedures are performed annually in the UK.

But it remains one of the few high-income nations where non-healthcare professionals can legally administer botulinum toxin with minimal oversight.

Of the 919 participants, 91% were female, the majority (54%) had received more than five anti-wrinkle injections, and they were most commonly delivered in beauty clinics (46%).

More than four out of five participants (81%) said their motivation for treatment was anti-aging reasons, according to the findings published by Aesthetic Surgery Journal Open Forum.

But less than half (42%) said that a prescriber was present during their consultation, despite existing requirements for botulinum toxin to be dispensed by a qualified prescriber.

One in 11 (9%) said they were not provided with a written consent form before their procedure, while 18% were not informed of possible complications.

Only a quarter of the participants (26%) said they received any form of post-treatment support, while just 28% recalled receiving advice on how to manage potential side effects.

Although most participants reported a high level of satisfaction, with 90% expressing positive views about their treatment, short-term complications included bruising or swelling (26%), headaches (25%), and injection site pain (10%).

Long-term complications were relatively rare, with botulinum toxin resistance (3%) the most common.

Formal complaints following treatment were filed by only 5% of the participants, but at the same time, only 35% admitted they were familiar with current regulations and 74% said they were unaware of the UK's "Yellow Card" reporting system.

Through Yellow Card, the Medicines and Healthcare products Regulatory Agency (MHRA) collects information reported by the public about suspected safety concerns.

The Government recently announced proposals to introduce tighter restrictions around cosmetic injections, and the plans are now subject to public consultation and parliamentary scrutiny.

An overwhelming 89% of the study participants said they were in favor of stricter oversight.

Study co-lead author Professor Lee Smith, of ARU, said: “The use of botulinum toxin for cosmetic purposes in the UK is a healthcare paradox – it’s a medically regulated drug but it’s widely used in an unregulated aesthetic marketplace.

“Our survey found that the public doesn’t know how to report issues they experience, highlighted by the lack of awareness of the Yellow Card scheme.

"At the same time, non-healthcare professionals, who represent a large proportion of those carrying out injections, lack formal reporting obligations as they are not members of professional bodies, indicating there could be a significant under-reporting of complications."

Co-lead author Dr. Roshan Ravindra, an aesthetic doctor at KLNIK, said: “Our survey, the largest of its kind in the UK, shows that when administered correctly, botulinum toxin is generally well-tolerated and can be effective.

"However, our survey reveals serious gaps in informed consent and aftercare.

"Nearly one in 10 people didn’t sign a consent form and almost one in five weren’t told how to manage complications.

“As the Government moves towards statutory licensing, it’s vital the scheme includes minimum educational standards, ethical codes and robust enforcement mechanisms.

"Technical skill alone isn’t enough.

"Practitioners must be trained in communication, patient-centered care and the ability to screen patients, so those with conditions such as body dysmorphic disorder are instead provided with help rather than treatment.”

Smith added, “The new regulations proposed by the Government, where local authorities will oversee standards and licenses, cannot come soon enough.

"In the meantime, the public will continue to be able to receive cosmetic injections in unregulated settings with variable standards, and the NHS will continue to pick up the pieces when things go wrong.”