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Staying Safe

If you’re contemplating a tweakment, this is what you must know


Houston, we have a problem

There is a dire lack of proper regulations around tweakments in the UK, which means that it is up to you, the patient, to make sure that the practitioner you are planning to visit is good at doing the job you want them to do, and doing it safely.

I stress this because many people somehow think that, because cosmetic procedures are (or certainly ought to be) ‘medical’, they will be subject to the sort of laws that govern other medical practice in this country.

But they’re not.

There is no central government register of qualified practitioners who can carry out tweakments. Just have a look at some of the issues facing consumers today in the various tweakment areas:


This is a prescription-only drug, so has to be supplied by a medical professional who is qualified to prescribe — a doctor, a surgeon, a dentist, or a nurse-prescriber (a qualified nurse who has taken a further course to become a non-medical prescriber) or a pharmacist-prescriber. The injections can legally be given by someone working under the supervision of that qualified professional, though the prescriber is the one who takes responsibility for the treatment.

The makers of Botox, and the makers of other wrinkle-relaxing toxins such as BoCouture, and Dysport/Azzalure, are scrupulous about only supplying their products to medical professionals. Does that mean that the system is watertight? Unfortunately not. Unscrupulous practitioners find ways around the system.

Facial Fillers

These are classed as medical devices, but they do not need a prescription. That means anyone can buy them and inject them. Yes, anyone. You or I could do it…  There are no restrictions on who can take a training course in dermal fillers, and some of these courses are only a day or two long. There are no requirements to show competence in injecting fillers before a practitioner sets up in business.

Also, not all fillers have been thoroughly tested for safety and effectiveness. In the USA, facial fillers are classed as ‘cosmetic devices’ and are regulated by the Food and Drug Administration (FDA). Only the specific fillers that get through the lengthy FDA approval procedure can be used, and then only by medical doctors.

Lasers, ultrasound machines, radiofrequency and ‘plasma’ generating devices

It’s much the same as with fillers. Anyone can use them and offer treatment with them. Laser clinics no longer need to be regulated by the Care Quality Commission (CQC) the government’s health regulator for England. Laser clinics used to need CQC regulation, but the regs were changed in 2010 and now only cover premises offering surgical procedures where instruments are inserted into the body. So premises that offer treatments involving a scalpel, or a liposuction cannula, need to be regulated, but anywhere that does cosmetic injections and laser treatments do not.


How to find a good practitioner

All this means it is vital to find a good, experienced practitioner.

If possible, get a personal recommendation for a practitioner from someone you know who has tried the treatment you are interested in and has had a good result.

In the practitioner finder on this site, you can see whether a practitioner is a doctor, surgeon, dentist, dermatologist or aesthetic nurse. Advice on tweakments usually says: ‘Check your practitioner’s qualifications.’ An appropriate medical qualification is a good place you start.

There are few specific qualifications relevant to tweakments – if you’re lucky, your practitioner might have done an MSc in Aesthetic Medicine – but you can also check to see if they are registered with one of the following associations, all of which insist on high standards of competence and safety.

– British College of Aesthetic Medicine (bcam.ac.uk)
The BCAM used to be called the British Association of Cosmetic Doctors, and its main aim is to encourage safe and ethical work in the cosmetic and aesthetic area. All members are registered with the General Medical Council (GMC), and many of them are GPs who have moved over to cosmetic practice. To keep up their membership, they have to attend regular educational and scientific meetings and need to get their membership revalidated every five years.

– British Association of Aesthetic Plastic Surgeons (baaps.org.uk)
BAAPS surgeons are all listed on the GMC’s specialist register, and the organisation is dedicated to safety and education in cosmetic surgery. Why have I listed a surgeons’ association on a site about non-surgical tweakments? Because many surgeons offer these tweakments alongside their surgical work.

– British Association of Cosmetic Nurses (bacn.org.uk)
The BACN represents nurses who do cosmetic treatments and promotes patient safety via a strict code of conduct. They’re great campaigners for improving the regulation of cosmetic procedures, too.

– British Association of Dermatologists (bad.org.uk)
There are relatively few consultant dermatologists in the UK. Most of them concentrate on skin conditions, but some are also cosmetic dermatologists, who do aesthetic procedures.

– British Association of Plastic, Reconstructive and Aesthetic Surgeons (bapras.org.uk)

– British Dental Association (bda-dentistry.org.uk)
If your practitioner is a dentist, they should be registered with the BDA. Some people might wonder why you would go to a dentist for cosmetic procedures, but some dentists are brilliant at fillers and Botox. And when they move over to aesthetic work, they have the advantage of having a thorough knowledge of facial physiology, from their dental studies.

– General Medical Council (gmc-uk.org)
If the practitioner is a doctor, check that they are registered with the General Medical Council.

– General Dental Council (gdc-uk.org)
If the practitioner is a dentist, check with the General Dental Council.

– Joint Council for Cosmetic Practitioners
Then there are voluntary quality-assurance schemes such as Treatments You Can Trust, which has now become part of the Joint Council for Cosmetic Practitioners (jccp.org.uk). This provides information and advice about treatments, and has a list of accredited practitioners, all of whom have to meet the JCCP’s entry requirements, pay the registration fee, and sign up to the code of conduct.

– Save Face (saveface.co.uk)
Another voluntary register which also lists practitioners who have met the organisation’s standards and have paid the registration fee.

Which is all good, but as with previous voluntary registration schemes, these two cannot compel practitioners to register with them. Dodgy practitioners won’t ask for registration but, confusingly, plenty of great practitioners don’t register with the sites either, simply because they don’t have to, they don’t have the time, and they are busy enough already.


18 questions to ask your practitioner

You often have just one opportunity to ask the questions you need to ask to maximise your chances of staying safe and that’s at the consultation stage. I’ve drawn up a list of 18 questions to ask your practitioner based on the many, many consultations I have been through. If your practitioner can’t – or worse, won’t – answer any of these questions, I’d advise looking elsewhere. For your own sake.


Finding a clinic offering reputable products

Allergan (the makers of Botox and of Juvederm fillers) offers a ‘clinic finder’ tool on its website at www.this-is-me.com.

Galderma, makers of Restylane fillers, has a clinic finder on www.proofirl.com.

Sinclair Pharma, whose brands include Silhouette Soft threads, and the injectable fillers Ellansé and Perfectha, have clinic finders on these pages:

All these websites only list clinics and practitioners that have been trained and approved to use the products by the manufacturers.

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