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Cosmetic treatments in the wrong hands

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(Source: Lloyd’s of London)

Cosmetic procedures like dermal fillers and laser treatments are increasingly being called into question, prompting calls for tougher regulation and minimum levels of insurance.

Cosmetic treatments – from face-lifts to non-surgical procedures like dermal fillers, Botox and laser treatments – are a booming business.

In 2005, the cosmetic sector was worth £720m, by 2010 it was valued at £2.3bn and by 2015 the sector is forecast to grow to a value of £3.6bn, according to a recent independent report into the sector: Review of the Regulation of Cosmetic Interventions.

However, many of the most popular non-surgical treatments can carry significant health risks, and yet are largely unregulated.

“A person having a non-surgical cosmetic intervention has no more protection and redress than someone buying a ballpoint pen or a toothbrush, ” says Professor Sir Bruce Keogh, NHS Medical Director and author of the report .

Dermal fillers

Dermal fillers and laser treatments are a particular cause for concern, as there are very few barriers to entry for individuals considering setting up as a practitioner; there is no requirement for knowledge, training or previous experience.

“Most dermal fillers have no more controls than a bottle of floor cleaner. It is our view that dermal fillers are a crisis waiting to happen, ” says Professor Keogh.

The review, which was undertaken after high profile industry failings with Poly Implant Prothèse (PIP) breast implants, calls for greater consumer protection through much improved regulation and training, as well as proper redress if things go wrong. It recommends making all dermal fillers prescription only, and ensuring all practitioners are registered, properly qualified and adequately insured.

The review findings and recommendations were welcomed by industry bodies, including the British Association of Dermatologists (BAD) and The British Association of Aesthetic Plastic Surgeons (BAAPS). In particular, both bodies are keen to see the recommendations on dermal fillers followed through.

Professional opinion

According to Tamara Griffiths, consultant dermatologist with BAD, specialists see more complications from non-surgical procedures – which account for nine out of ten procedures in the UK – when performed by non-specialists.

“These procedures are not risk free. In the right hands treatments like dermal fillers and lasers can be low risk, but they can have debilitating and potentially life ruining side effects, ” she explains.

The real issue is to get the right product in the hands of the right person, in the right place, says Griffiths. “The most important of these is the right person – if a practitioner is well trained and ethical, it reduces the likelihood of other problems such as poor product or inappropriate environment.”

Guiding role for insurance

Insurers have an important role to play in helping raise standards in the industry, especially at the lower end of the market, says Griffiths. Insurers could require certain levels of training and membership of a recognised body, as well as stipulating which approved products can be used, she recommends.

BAD recently wrote to the chief executives of UK insurers requesting that they limit cover to only those fillers currently on the US Food and Drug Administration approved list. The UK licenses over 100 dermal filler products, compared with the FDA’s six, according to BAD.

Griffiths believes that insurers need to examine the spirit of the Keogh Review and move with the general direction of travel for standards in the sector. “Our mission is to improve patient safety and one way to improve standards would be to engage with other groups, including insurers, ” she says.

Increasing scope from specialist

Specialist medical malpractice insurers already detail which dermal fillers can be used, but at the lower end of the market, where the insurance product is more commoditised, insurers sometimes take such issues less seriously, explains Asgar Hassanali of Lloyd’s insurance broker Lockton.

Hassanali believes, however, that if implemented, the Keogh recommendations would open opportunities for specialist medical malpractice insurers to act as a “dynamic” to improve products.

“There are specialist players that would like to come into the market in a focused way but they have been concerned by the lack of consistent education, qualifications and process. If the Keogh recommendations were to become a reality it would increase the scope of insurers in the market, ” says Hassanali.

Insurers are interested in exploring new possibilities as a result of the Keogh report and have been talking with professional indemnity brokers like Lockton. The broker has also discussed the report with cosmetic surgery groups and professional bodies that are interested in implementing the recommendations as a way of raising standards.


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