Avoid a Botched Job

We speak with the national register of accredited practitioners, Save Face, about the lack of legislation in the non-surgical cosmetic industry and discuss their mission to make a positive impact.

Did you know that practitioners who administer non-surgical cosmetic procedures require no specific qualifications or certification by law? As the popularity of these treatments grows, so does the risk involved for potential clients. Save Face—a national registry of accredited non-surgical aesthetic practitioners—discusses the dangers that exist for patients, the psychological effects of a botched job and how consumers can avoid such an experience. 

Question: What impact do you hope Save Face will have on the non-surgical cosmetic industry as a whole? 

Save Face: Save Face is a government-approved register of healthcare professionals who provide non-surgical cosmetic treatments. Entry to the register is only open to registered medical professionals who can demonstrate that they are insured and have received certified training. All premises are inspected. Practitioners must operate against best practice standards and have policies and procedures that demonstrate this. 

The ultimate goal is for the Save Face Kite Mark to become a default factor in the decision-making process for someone who is considering a non-surgical cosmetic treatment. Through our public awareness campaigns we hope to continue to educate the public about the unnecessary risks they may be taking by choosing a practitioner who isn’t accredited. 

The reality is, these sorts of procedures are becoming increasingly popular amongst men and women of all ages and consequently the number of unscrupulous practitioners is also rising. For Save Face, the objective and message is simple: to provide an accessible service that enables people to obtain non-surgical cosmetic treatments easily and safely. Save Face removes the ambiguity and uncertainty on behalf of the patient, empowering them with a service that means they no longer have to take practitioners at face value. 

Q: Why do you think that this particular industry isn’t governed by the same rigorous regulations that others are? 

SF: This field of practice is quite unique. Though medical in nature, there is no provision, nor ever has there been in the NHS, which has left training and standards to evolve organically and without recognised accreditation. The client base is healthy and treatment is a choice rather than a necessity. Unlike other medical procedures, it is possible to provide these in a variety of venues with relatively low capital cost and overheads.

Because of the association with beauty, the vanguard of early adopters commonly provided services in association with beauty salons. This chartered new territory without reference to any expert authority to interpret and apply regulation developed with accountable institutions in mind. Given the exponential growth of the market and the commercial gains to be made, it is no wonder that providers have exploited the apparent loopholes in legislation and regulation and seized the opportunities to practice with apparent impunity. The resulting diversity of practice and growing accessibility of services—left unchecked for over two decades—has led us to where we are today.

Non-surgical cosmetic services may be provided by anyone, anywhere. Where legislation and regulation are breached, sanctions are not robustly applied and fail to deter. It is reliably estimated that there are some 10,000 providers in the UK alone. Approximately 800 belong to professional associations providing influence, guidance and political representation on standards and education related specifically to aesthetic medicine. This suggests there are thousands who don’t know what they don’t know and likely do not care.

Q: What are some of the potential risks of having a non-surgical procedure at a clinic that is not accredited?  

SF: As our investigations continue to demonstrate, finding a safe, reputable practitioner can quite simply be a lottery. Sadly, dotted in amongst all of the reputable practitioners, there are a mass of unscrupulous people masquerading as trained professionals. They have often had little or no training and purchase cheap illegitimate products over the internet.

Frighteningly, these treatments are all too often considered and categorised as everyday beauty treatments like having your hair or nails done. In reality, it is a clinical procedure that can have disastrous consequences when it is administered by the untrained and unqualified.  

It’s because of this that the consumer is blind-sighted by cheap deals and how glossy the website and clinic décor might be. People so often neglect to pay any real attention to the fundamental thing that is essentially the difference between a good treatment and what can be a nightmare: the skills and qualifications of the person holding the needle.

In the last 12 months, we have seen an alarming increase in the number of reports regarding procedures gone wrong and rogue practitioners. Figures have almost trebled in comparison to the previous year, with a total of 934. Over 83 percent of the reports we received were about treatments that were administered by beauticians, hairdressers and other non-healthcare professionals. Upon further investigation, a staggering 30 percent of all complaints we received were performed by people who had set themselves up with no relevant training whatsoever and were believed to be purchasing their products such as dermal fillers and botulinum toxin (Botox) over the internet.

We received complaints relating to the following procedures (in order of the most numbers received):

•   Dermal fillers, which included lip fillers, cheek fillers, facial fillers to improve the appearance of skin folds and wrinkles, tear trough fillers to reduce eye bags and non-surgical nose jobs

•   Botulinum toxin

•   Laser treatments 

•   PDO thread lifts 

•   Chemical peels 

•   Blepharoplasty; non-surgical eye lift using plasma skin-tightening technology. 

79 percent of the complaints we received were related to dermal fillers, which can present serious risks if complications are not identified and managed properly. The vast majority of which were lip filler procedures. The most common complaints were:

•   Poor/uneven results

•   Unsightly lumps and nodules

•   Unusually painful swelling and bruising

•   Infection; more than 20 of the people who reported complications following botched lip filler treatment had to seek treatment from their doctor

•   Three women suffered vascular occlusion or impending necrosis (tissue death), which could lead to permanent compromise of healthy tissue

Q: What are the psychological effects of having a ‘botched’ treatment? 

SF: Being a victim of a botched procedure has so many ramifications both physically and mentally. Many people spend months contemplating a procedure to address a particular concern and restore their confidence, only to be left feeling worse and more self-conscious than they did before. It has a devastating effect on their state of mind. We have had people contact us who won’t leave the house or that cry when they look in the mirror and have had to be prescribed anti-depressants.

In most cases they have no way of seeking redress from the person who treated them as they have ceased trading or have no insurance. In fact, 72 percent of all complaints we received last year were from patients who had found the practitioner on social media pages such as Facebook and Instagram. This is a major concern and something that has escalated enormously in the last few years. Social media has become a hotbed for unscrupulous practitioners to advertise unethical deals and offers, which flout advertising rules. These practitioners only have Facebook or Instagram pages and often do not disclose the full name of the practitioner. This makes them nigh on impossible to trace when things go wrong, and when that happens, more often than not, they close down their page and then set up another one using a different business name. It is a vicious cycle which is opaque and impossible to police. 

Patients who fall into the wrong hands end up paying the price in every possible way: emotionally, financially and physically.

Q: In 2013 the Department of Health (DoH) commissioned a review into non-surgical aesthetic procedures, in it they described dermal fillers as a ‘crisis waiting to happen’. Do you agree with this assessment? 

SF: Absolutely. We have received an increasing number of reports from patients who have been injected with cheap products that have been purchased over the internet from China. Our statistics confirm that dermal fillers can cause serious complications if they are not administered by a trained healthcare professional that is competent in identifying and treating side effects. When untrained practitioners administer unidentified products that have been purchased over the internet, the consequences could potentially be life-threatening.

Q: Generally, what legal rights do patients have if a non-surgical procedure goes wrong? What advice would you give to somebody in this position? 

SF: Unfortunately, if a client has been treated by someone that is uninsured and unaccountable, there is little than can be done. Sadly, where there is legislation in place, little action is taken to act as a deterrent for those who continue to flout the rules. We are contacted all the time by patients who have fallen into the wrong hands and have been completely ignored by the practitioner when something has gone wrong. We support them in every way that we can. We recently published a guidance document called the Anatomy of a Complaint, which informs patients how and where they can make a complaint.

Q: What specifications must a practitioner meet in order to be included on the Save Face website? 

SF: Each and every practitioner and clinic listed on our register has been inspected against our robust set of standards. Entry to the register is only open to doctors, nurses, dentists and prescribing pharmacists. Although minor, these treatments are medical procedures, which we believe should only be carried out by trained healthcare professionals. 

We visit each clinic location and undertake all the necessary checks to ensure that the practitioner and the clinic have met each of our standards before they are listed on our register. When a patient uses Save Face to find a practitioner they can be assured that: 

•   They are who they say they are

•   They are a registered nurse, midwife, doctor, dentist or prescribing pharmacist with specialist training and insurance in each treatment listed on their profile

•   They use licensed products sourced from reputable suppliers

•   They have all of the necessary paperwork in place to protect you from undue risk and harm

•    Their practice standards meet the requirements to provide you with safe treatments, in a safe environment

Full details of the assurances that come with selecting a Save Face Accredited practitioner can be found on our patient charter. 

Q: Are there any success stories you can share with us that involve a patient finding a safe and reliable clinic through your service? 

SF: We have had over 5,000 positive reviews from patients that are published on our website. Getting feedback from patients who have found a practitioner that they can trust and are happy with via the website is the best feeling and what makes it all worthwhile.

Q: You have recently received a considerable amount of press coverage regarding your involvement in exposing a fake doctor who had administered fake Botox treatments. Is this part of a wider initiative to stamp out dangerous practitioners? Do you have any plans in place to facilitate the discovery of other similar cases?

SF: We have an endless list of unscrupulous practitioners we are currently investigating to ensure that they are exposed and are brought to justice—each has involved a breach in regulations. We are working with several patients who have been affected by practitioners who have left them with irreversible damage. We will ensure that they get the help and support they need and that these practitioners are stopped from operating in the future.

Q: Do you have any upcoming projects scheduled in order to further your reach or spread your message? 

SF: We are currently working on new projects with our ambassador Dr Christian Jessen and will be launching the next round of our TV advertising campaign in the next couple of months. We also have several ongoing TV and media projects that we are currently in the process of finalising.

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