Cosmetic Surgery and Regulation in the UK

We live in an age where people are more appearance-conscious than ever. Peer-pressured to look the best we can, sometimes aiming for an appearance only attainable with cosmetic surgery or more minor cosmetic treatments.

In the age of popular apps like Instagram and Snapchat, with all their image filters and enhancements, it is perhaps unsurprising that technology is creating a sense of self that encourages us to hide our quirks and blemishes.

Once upon a time, these procedures were perceived as being sought only by those who were growing old, but in current year there is ever more interest from the young to seek out such perceived enhancements.

Amongst the young, dermal fillers and Botox are a skyrocketing trend these days. They wish not to undo the warning signs of ageing but prevent it from happening altogether.

We’re going to take a look at several aspects of cosmetic surgery, regulation in the UK, and how the law can step in to assist with cosmetic surgery compensation claims for those who have received a substandard service or botched treatments.

Invasive Cosmetic Surgery Procedures

Cosmetic surgery covers a whole range of invasive and non-invasive procedures, aiming to improve a client’s overall aesthetic appearance. More invasive procedures include procedures that break the skin, such as facial, brow and body lifts, as well as other enhancements like breast augmentation.

These procedures often have a more permanent outcomes, are hard to reverse, and are subject to much heavier regulation.

Non-invasive Cosmetic Surgery Procedures

Non-invasive cosmetic procedures encompass such treatments as Botox, dermal fillers, laser treatments, and other procedures which intentionally damage the skin promote the body’s own Hyaluronic Acid.

These procedures are often temporary, possibly lasting 6-12 months, and in some cases – like dermal fillers – can be reversed or have effects that simply subside over time. Many people choose such treatments as they often result in fewer complications, less scarring, and benefit from shorter recovery periods and lower costs.

When it comes to non-invasive cosmetic procedures such as fillers, however, the industry runs completely without regulation.

Any individual who wishes to do so can set up their own business without any training, qualifications or prior experience. This has been a vocalised topic in both the mainstream press and the Houses of Parliament for a long while.

In times of such rigorous health and safety standards, how has this industry escaped regulation? Why is the UK one of the only European countries failing to do so? Local Councils demand licensing for tattoo and piercing studios, but anyone can start a business carrying out fillers.

Injury and possibility of adverse side effects of Botox and fillers are something seen and heard about on a regular basis.

Regulation

The UK lags behind its European neighbours, with many countries enforcing strict requirements for non-surgical procedures.

Spanish authorities require a qualified doctor to administer Botox and fillers, and doctors must take specialist training before they can carry it out. Even nurses and dentists are ineligible to undertake such procedures. France has long since operated under similar legislation.

Scotland is the first part of the UK to introduce proposals for industry regulation, calling for non-medical professionals apply for licensing to carry out such practices, similar to those working in the tattoo and piercing industries.

It is a step in the right direction, though rather a small one overall. 2013 was the last time England undertook a report highlighting the workings of the industry.

This report provided many recommendations to improve the industry and correctly foresaw the sharp rise in demand. It called for fillers to be categorised as medical devices, which would mean that they would only be available on prescription were such legislation imposed.

What are dermal fillers? 

Injectable dermal fillers consist of a gel, usually containing hyaluronic acid. Hyaluronic acid naturally occurs in the human body, and these filler injections are designed to imitate it.

Products such as Perlane, Juvederm, Belotero and Restylane and many others have become freely available over recent years and have already demonstrated enormous popularity. Reports suggest that there are over sixty such fillers obtainable on the UK market.

Dermal fillers are injected to fill in wrinkles, creating the appearance of smoother skin. They can be used in many areas around the body to fill in wrinkles and add volume to soft tissue. They are, however, most commonly used around the face.

Facially, fillers can be used around the eyes, cheeks, mouth, and jawline, as well as lip fillers applied directly into the lip tissue. There is growing use of fillers used to correct asymmetrical noses, preventing more drastic measure involving surgery to do so.

As previously stated, dermal fillers are unregulated in the UK. This means that anyone can buy them online and administer them – a very scary thought, but it is happening up and down the country every day.

Reportedly, many surgeons are now being sought-after to deal with the results of the mistakes or negligence of those unfit to perform such procedures. Many of which are often carried out in completely unsuitable, unsterile environments, like domestic homes and garages.

Many dubious practitioners advertise on popular social media platforms, with no way of finding genuine evidence of things like experience, background or qualifications.

Potential side-effects

Dermal fillers can cause side-effects, ranging from temporary to permanent. The most common of which include

  • Skin rashes, itching, or pimple-like eruptions.
  • Redness, bruising, bleeding, or swelling.
  • Undesirable appearance (asymmetry, lumps, or overcorrection of wrinkles.)
  • Skin damage causing wounds, infection, or scarring.
  • Ability to feel the filler substance beneath the skin.
  • Blindness or other vision impairment.
  • Loss of blood flow to the area, leading to death of skin cells.

Such side effects may be more or less severe, depending on the volume of filler used.

Treatment for side effects that do not cease depends on which formula was administered. If a client is dissatisfied with the treatment, many practitioners will offer to dissolve the filler for them. However, this may result in permanent scarring or tissue damage if not been carried out correctly, or not reversed within a realistic amount of time.

This often happens if the Botox or filler is directly injected into a blood vessel – also referred to as a vascular occlusion – in which blood flow becomes restricted due to the blocking of the blood vessel. The results of this can be irreversible and leave devastating consequences.

What corrective action can you take?

In the unfortunate event of poor treatment, the first action to take – especially for the more serious side effects – is to seek medical advice from your GP or hospital. It is also worth informing the practitioner of the procedure about adverse side effects experienced.

For side effects that are less severe, the practitioner in question may be able to dissolve the filler and fix the problem. Where you are concerned about the competency of the practitioner, you may wish to take advice from someone else.

Always do your research

When it comes to finding a practitioner to carry out the procedure, you might carry out a lot of research and still find you are at a loss of where to turn.

Many of the websites you find are professional and convincing – however, can you really know anything about who is carrying out the procedure? Are they trained? Do they have the experience? Are they insured?

There are probably another hundred questions circulating around in your head about cosmetic procedures, so it is best to answer all those questions thoroughly before making any decision.

Points to consider when taking legal action:

  • Who administered the treatment?

Was it undertaken by a trained and registered nurse or doctor? It’s possible you may not know, but it’s strongly advisable to make a record of it if you do.

  • Does the practitioner have insurance?

More often than not you likely won’t be aware of this, especially if they don’t have it. As this industry is unregulated, there is no legal requirement for insurance.

This is a big issue when it comes to taking action against negligent treatment. If they are uninsured, it very difficult to claim compensation. You may choose to pursue the practitioner directly, though this is difficult and often ends without success.

If you are able to find out whether they have insurance, record it. Alternatively, an instructed Solicitor can find out for you.

  • Document the injury

Documenting the injury is always worth it. Photographs taken and a diary of symptoms and recovery made will assist future medical experts to assess the problems and give relevant and appropriate advice and reports.

Liability/Negligence

Determining liability is when it’s best to seek legal advice. It is the solicitor’s job to listen to your timeline of events and assess whether your case has the prospect of being taken forward.

At this point we gather all the evidence and medical evidence available, followed by a report from an independent medical expert.

The purpose of an expert report is to prove causation of the injury, i.e. it was in fact the practitioner’s negligence that resulted in the injury, and provide a prognosis for recovery and/or advice for what treatment might best fix the damage done.

To recap, if you have experienced any of the below you may wish to consider making a claim for personal injury, or a refund at the very least:

  • Skin rashes, itching, or pimple-like eruptions.
  • Redness, bruising, bleeding, or swelling.
  • Undesirable appearance, such as asymmetry, lumps, or overcorrection of wrinkles.
  • Skin damage that causes a wound, infection, or scarring.
  • Ability to feel the filler substance under the skin.
  • Blindness or other vision problems.
  • Vascular occlusion
  • Death of skin cells due to loss of blood flow to the area.

However, a large part of liability is consent.

Consent and advice

One way to establish liability is by considering what advice was given prior to the procedure taking place, and what consent you gave going forwards. Before any procedure is carried out, never be afraid to read all the information supplied to you and ask questions where any uncertainty exists.

It is the practitioner’s duty to ensure that you understand the risks. If you are uninformed of the risks, the procedure should not be carried out. Whilst the filler industry is unregulated, advice to all practitioners is the same – they must fully obtain your informed consent.

Even if you have been alerted to the risks and something goes wrong, this does not absolve the practitioner from liability. For example, with a vascular occlusion – whilst this is a known risk – it is often the result of practitioner negligence and failing to correctly perform the procedure.

Clear act of negligence

Such cases would include where the practitioner has made an error when performing the procedure – something outside of the expected. For example:

  • Injecting filler or Botox into an area that was not agreed.
  • Negligently performing the procedure.
  • Failing to stop or correct the procedure when it is clear that there is an adverse reaction.
  • Failing to dissolve any filler or being unequipped to dissolve the filler immediately if there is an adverse reaction.
  • Causing an infection.
  • Scarring resulting from the procedure which was unexpected. This applies to all procedures including laser hair removal.
  • Injuring the client during the course of the procedure.
  • Severe bruising.

Breach of contract – Consumer Protection Rights Act 2015

These cases are harder to prove but include those in which the desired result from the procedure has not been met, and the service you have been provided has not been carried out with reasonable skill and care. There are varied remedies, such as a reduced fee, repeat service, or full refund.

If you have lost faith in the competency of the practitioner, of course it is unlikely you will not want to go for a repeat of a service to fix the problem. However, the remedies stated above do not prevent you claiming damages for injury. For example:

  • Lumps in the lips from lip fillers.
  • Drooping or sagging skin/eyes which was not pre-warned.
  • Uneven smile/face/eyes.
  • Discoloration of the skin.

Johnny Thompson

Johnny Thompson is a senior reporter for Generator Research in Los Angeles, reporting on technology, business, finances, and more. He previously worked as a reporter for the Wall Street Journal and got his start at newspapers in New York, Connecticut and Massachusetts.

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