'Cosmetic crisis' waiting to happen
By James GallagherHealth and science reporter, BBC News
Injections to plump up the skin are a "crisis waiting to happen" and should be available only on prescription, a UK review of cosmetic procedures has said.
It warned that dermal fillers, covered by only the same level of regulation as toothbrushes, could cause lasting harm.
The independent review added cosmetic surgery had been "trivialised". It also attacked "distasteful" companies for putting profit ahead of care.
The review has recommended a series of measures to better protect patients.
It was commissioned by the Department of Health in England, but the findings will be passed to health ministers throughout the UK.
From fillers to breast implants - the cosmetic procedures industry is booming. It was worth £750m in the UK in 2005, £2.3bn in 2010 and is forecast to reach £3.6bn by 2015.
But there is considerable concern that regulations have failed to keep pace - leaving patients vulnerable.
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Anybody, anywhere, anytime can give a filler to anybody else, and that is bizarre”
Sir Bruce KeoghNHS Medical Director
The biggest growth is in non-surgical procedures such as fillers to tackle wrinkles, Botox and laser hair removal - the area the report describes as "almost entirely unregulated".
The advisory panel said the procedures, which could go horribly wrong, were being treated as casually as having highlights done at a lunchtime hairdresser's appointment and had become commonplace at "beauty parties".
Former beauty clinic manager Sarah Payne recalls how a dermal filler treatment went badly wrong
Sir Bruce Keogh, the NHS medical director for England who led the review, said: "The most striking thing is that anybody, anywhere, anytime can give a filler to anybody else, and that is bizarre."
At a European level, both medical devices such as breast implants and Botox, which is classed as a medicine, are regulated.
Fillers are deemed to have no medical purpose so are regulated in the same way as toothbrushes and ball-point pens. There are 190 different fillers available in Europe compared with just 14 in the US.
Bad practice
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Analysis
James GallagherHealth and science reporter, BBC News
When you go for cosmetic surgery, you expect the same standard of care as for any other operation. The review makes it clear that this is not the case.
There have been widespread calls for reform since a health scare caused by faulty breast implants, made by the French firm Poly Implant Prothese (PIP).
Data on which women had been given PIP implants, let alone what had happened to them, was not kept. It was described as a "data-free zone".
And the problems are wider. Botox should be available only on prescription, but is far more readily available.
Calf and buttock implants are barely regulated at all. The same goes for dermal fillers.
Sir Bruce Keogh says: "I don't think we can wait, keeping our citizens at risk."
Sir Bruce also said cosmetic surgery deals, such as buy-one-get-one-free offers and handing out free breast surgery as prizes in raffles, were a "particularly distasteful" way of incentivising people to go under the knife.
There were also questions of safety. The review said there were no checks on surgeons' qualifications in some parts of the private sector, an issue made worse by more than half of cosmetic surgery being performed by "fly in, fly out" doctors - surgeons based abroad who fly into the UK to perform operations and then fly back out again.
The review recommends:
- Legislation to classify fillers as prescription only
- Formal qualifications for anyone who injects fillers or Botox
- Register of everyone who performs surgical or non-surgical cosmetic interventions
- Ban on special financial offers for surgery
- Formal certificate of competence for cosmetic surgeons
- A breast implant register to monitor patients
- Patients' procedures must be approved by a surgeon not a salesperson
- Compulsory insurance in case things go wrong
- A pooled fund to help patients when companies go bust - similar to the travel industry
Dan Poulter, Health Minister for England, said he agreed "entirely" with the principles of the recommendations and there would be a full response in the summer.
"There is a significant risk of people falling into the hands of cowboy firms or individuals whose only aim is to make a quick profit. These people simply don't care about the welfare of the people they are taking money from.
"It is clear that it is time for the government to step in to ensure the public are properly protected."
Common sense
The review was started after a global health scare caused by breast implants made by the French firm Poly Implant Prothese (PIP).
A breast implant made by Poly Implant Prothese
The implants were filled with industrial grade silicone and had double the rupture rate of other implants.
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Profits before patients, that's what happens. Surgery is sold like double glazing and it's totally wrong”
Michael SaulTJL solicitors
Catherine Kydd, 40, from Dartford in Kent, had ruptured PIP breast implants.
She said: "Why is it acceptable that I have to live with industrial silicone in my lymph nodes for the rest of my life due to this industry that is not properly regulated?"
Her story is far from unusual. Michael Saul, from TJL solicitors, represents the victims of botched cosmetic procedures, including one patient who went blind in one eye immediately after being injected with a dermal filler.
"Profits before patients, that's what happens. Surgery is sold like double glazing and it's totally wrong.
"I think it is very difficult for there to be any rational and reasonable opposition to [the recommendations], they're really sensible common sense suggestions."
Sally Taber, director of the Independent Healthcare Advisory Services, which represents the cosmetic surgery industry, praised the review.
"There has been so much bad practice out there, it's very welcome," she said. But she remained "concerned" at a lack of extra protection for people having laser procedures.
Ms Taber added: "Surgeons being on a specialist register will be an issue because we have got a lot of surgeons who fly in, fly out, as such, so that will be an issue that will be controversial."
The British Association of Aesthetic Plastic Surgeons welcomed the report saying it was "thoroughly relieved" with the findings and that there was an "urgent need" for dermal fillers to be classed as prescription medicines.
The British Association of Plastic, Reconstructive and Aesthetic Surgeons said there had been an exponential increase in the number of cosmetic interventions and that it hoped "they achieve parliamentary approval and support quickly".
