Who Can Perform Botox and Filler Treatments in the UK?

The UK does not yet have legislation to prevent non-medical professionals from delivering injectable cosmetic treatments. But, this does not mean the government or the medical community find it acceptable for non-medical professionals to perform toxin and filler injections.

I’m a qualified beauty therapist. Can I train in injectable treatments?

Though there are training providers that will accept beauty therapists onto courses to learn injecting techniques, the general consensus in the aesthetics industry, and the entire medical sector, is that injectable treatments should only be performed by qualified and experienced medical professionals.

This means that reputable clinics and medi-spas will only employ medical professionals such as doctors, nurses, and dentists to administer toxin and filler treatments. So, even if you have completed practical training courses on injectables, you are unlikely to find employment as an injector if you are not a medical professional.

Though current legislation does not prevent therapists from performing injectable treatments, it is likely that regulations will be introduced at some point. The 2013 Keough Report, a review commissioned by the government, set out recommendations for the regulation of cosmetic practice in the UK. The report highlighted the need for better regulation of the industry, to ensure that cosmetic practitioners are adequately trained.

Commenting on the report, Rajiv Grover, then President of the British Association of Aesthetic Plastic Surgeons, stated that ‘aesthetic injectables should only ever be provided by medical professionals’ as ‘dermal fillers have clear benefits but also risks – it is not just about who can wield a syringe but who will have the capabilities to deal with any possible complications.’

In 2016 Health Education England reports were published on the standardisation and regulation of the provision of cosmetic treatments. These official statements still offer just guidelines instead of establishing legal requirements, but they reaffirm that the medical community and the Department of Health are taking steps toward stricter regulation. Accredited cosmetic training can be very costly, and it may end up being a waste of time if you are not a medical professional.

If clinics won’t employ therapists to perform injectables, can therapists practice independently on their own clients?

All aesthetic practitioners, from therapists to doctors, need to have indemnity insurance to cover themselves for medical malpractice claims. If you are the practitioner delivering a treatment, you are responsible for the outcome, and if you make a mistake or a patient is unhappy, they may try and claim against you for negligence.

Insurance policies cover you for legal fees and damages, but reputable cosmetic insurers will only provide cover for medical professionals such as doctors, nurses, and dentists to administer toxin and filler injections. Therapists may qualify for cover for other aesthetic treatments such as skin peels, micro-needling or laser treatments, if they meet the insurer’s requirements.

Quite simply, if you perform injectable cosmetic treatments without the correct insurance and medical training, you are putting yourself and your patient at risk.

Why can’t a beauty therapist provide Botox injections?

Botox and other branded muscle-freezing toxins such as Azzulure and Bocouture are classed as prescription-only medicines in the UK, which means they can only be prescribed and given to a patient by a qualified prescriber. Only medical professionals can qualify as prescribers.

Therapists can only perform Botox injections if they work alongside a prescribing clinician. The prescriber cannot dispense the toxin remotely; they must be present at a consultation. The prescriber also has responsibility for the outcome of the procedure. As doctors and nurses are unlikely to want to take responsibility for a non-medical professional, and both the injector and the prescriber would want to receive payment, this set-up just doesn’t offer many benefits for either party.

Dermal fillers aren’t prescription medicines, so is it ok for non-medical professionals to perform filler injections?

Injectable treatments may be ‘non-surgical’, but they involve a medical procedure. Dermal filler injections are not superficial beauty treatments, they are needle injections that penetrate the skin to a depth that increases the risk of complications.

Doctors, dentists, and nurses learn how to safely administer dermal injections as part of their medical training. Though Beauty Therapy NVQs may include some information on anatomy and skin structure, they do not have practical lessons in medical procedures and how to handle complications. Medical professionals are taught how to use needles and cannulas safely, they are also taught about how to deal with problems that may arise from allergic reactions, infection, or an error by the injector.

Would you have a tooth extracted by a beauty therapist who had learned that one procedure but had no other medical training? Or would you prefer a qualified dentist to do it? It’s a question of knowledge and experience, not aptitude. It’s simply about what each has been trained to do, and the risk they could pose to a patient. It’s not illegal for beauty therapists to perform filler injections, it’s just not a good idea in terms of patient safety.

I’m a registered nurse; how do I go about becoming an aesthetic nurse injector/prescriber?

If you are a registered nurse, you will already have had some training on injecting, but you will need additional training in aesthetic procedures. If you want to work independently and prescribe toxins for your patients, you will need to have completed the V300 Non-Medical Prescribing course.

References and further reading

Review of the Regulation of Cosmetic Interventions (The Keogh Report), Department of Health, 2013

Qualification requirements for delivery of cosmetic procedures (part one), NHS/Health Education England, 2016

Beauty therapists to be banned from offering fillers unless qualified, The Guardian, 2013

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