Why The Aesthetics Industry Should Make You Quiver

As a follow-up post to “Should We Offer Aesthetic Procedures to Cancer Survivors? All Roads Lead to Rome”, Dr Mike has figured out yet another way to combine his interest in historical warfare with the modern world of medical aesthetics. Somehow.

Let’s start with some history. In 1363, King Edward III wrote a law requiring all able-bodied men to practice archery on Sundays and holidays. This was to ensure that England maintained a pool of archers, ready for battle. And to show he was serious, he also made it illegal to play any other sports on those days, as that would be seen as a distraction. Almost 200 years later, presumably because the English had become complacent about this old-fashioned law, King Henry VIII reinforced it once more. It was not until 1960 in fact that this law was completely repealed.

Why was the law repealed? Was it because the government didn’t want people to worry anymore about having to practice archery on Sundays? Was it to protect the public against the risk of stray arrows? Actually, no. It was repealed so that sports gambling could be legalised and therefore taxed.

What does this have to do with medical aesthetics? One take-home message is that the primary driver for government decision making, aside from making our elected officials more popular in the lead up to their next election, is government revenue generation.

Currently poorly trained and unsupervised aestheticians can legally penetrate your skin with tiny little arrows of their own, to deliver treatments like botox and dermal filler. 

Sure, there are some laws which necessitate jumping through some hoops but rather than helping, one of these might be pushing practitioners to cut corners, putting the public at even more risk. Let me explain, starting with a summary of the laws in the UK that cover medical aesthetics.

The MHRA governs medicines, which means Botox is covered but not dermal filler. So anyone can buy dermal filler. For Botox the matter is more frightening. Because a prescription is needed for Botox, some practitioners who don’t have a prescriber to see their patients face-to-face and obtain the medicine legally, are buying “fake” Botox instead. This can be purchased online. The issue is that if it’s not being bought from a genuine pharmacy, there is no guarantee that it is safe. Botox is a deadly toxin, produced by a bacteria, so you can see why regulating it is important. Doctors, Nurses and Dentists (and some other medical-allied professions) answer to professional bodies and are therefore subject to regulation. Other groups routinely offering aesthetic injectable treatments do not belong to an equivalent regulatory body. Although the Health and Care Act 2022 granted powers to introduce a licensing scheme for practitioners and premises offering non-surgical cosmetic procedures, as of today this has not yet been actioned. 

Consider what happened when the US government prohibited the sale of alcohol in the 20s and 30s. As a result of a continued desire by the public to drink alcohol and the sudden lack of regulation in the supply chain, an estimated 10,000 people died from methanol poisoning. The victims were breaking the law of course - but did the “punishment” fit their crime?

By making it hard for some practitioners to obtain botox safely, but still allowing them to practice is a good example of how changing one law without considering a sector as a whole, can put consumers at greater risk. 

In the UK, we’re in a situation where one person (an aesthetics practitioner) can commit a crime, and another (the patient) risks the consequences. Isn’t that enough to make you quiver? (got there in the end)

So what’s this got to do with archery, aside from the pointy metal bits that pierce the skin?

The government hasn’t yet figured out how to profit, in terms of tax revenue, from introducing licensing for practitioners. Yes, there’s a fee for going through the process of gaining a license, but unlike with driving licenses there’s so far no equivalent to the lovely road tax, fuel tax and the many other ways they get you (20 mile per hour zones) out the other side. Of course, lots of people were dying at the hands of unsafe drivers, so in the end, the public accepted driving licenses as the new norm. Currently patient safety issues are being paraded past MPs in the hope that someone will take on the issue of licensing for aesthetic practitioners, but politicians considering the task of writing new legislation must ask themselves: how can the government make money out of this? How about via taxes paid on the purchase of Botox, the same way the government taxes petrol and diesel? Actually, as Botox is a medicine, it isn’t subject to VAT. Of course clinic revenue can still be taxed but that’s only calculated after expenses, whereas VAT is a juicy chunk right off the top. In order to tax Botox purchased by practitioners directly, yet another law would have to be rewritten.

Until the government steps in, here’s what you can do to shield yourself from those stray arrows and avoid getting shafted.

1. Ensure your product is genuine. If your practitioner is a Doctor, Dentist or Nurse Prescriber, they can prescribe your Botox themselves, so there is a very good chance they will have taken the easiest route and purchased your product from a regulated UK pharmacy. If they can’t write prescriptions themselves, no need to panic as long as you at some point, were asked to have a face-to-face consultation with one of the above prescribers. If they’re not and you didn’t, consider leaving without treatment.

2. Ensure your practitioner knows what they’re doing. How do you know if your practitioner is properly trained? This is trickier as even a Doctor can be poorly trained but still practice, whilst unregulated professionals such as beauty therapists can know their subject inside and out and get excellent results if suitably trained and experienced. Ask questions - how long have you been practicing? Where did you train? How long was your training? 

3. Like any other service, look at the reviews. Google, Trust Pilot. Are there regular reviews over a long period or did they all come in on the same day, 18 months ago at 3am? New clinics will have fewer reviews of course, and some people are late getting themselves set up online, but if that’s the case and you don’t get a good feeling, maybe consider asking friends for recommendations instead? Again, like you might do for other services.

   
   

4. Ensure your practitioner is who they say they are. This one is very tricky at present. For the medical professions listed above, you can look practitioners up online on the GMC Register (for doctors), the NMC Register (Nurses and Midwives) and the GDC Register (Dentists).

If you'd like to book an anti-wrinkle treatment appointment with Dr Mike at his private clinic in East London, you can contact him directly here.