Why the industry should care who’s having botox, and more importantly where they are treated. Danielle Holme explains

If you believe everything you read even the rough-and-ready Gordon Ramsay is getting his weather- beaten-features cosmetically polished. It is really not all that surprising, cosmetic treatments are a fact of life for many of us, not just the rich and famous. For many thirtysomethings, or even twentysomethings, a trip to the beautician for a botox injection is just part of their beauty routine. You do not have to look far to find a poison-frozen face. There is a lot of pressure these days to look good – whether you are male or female.

But this obsession should not just be of interest to cheap celebrity magazines, it is likely to have an impact on the claims industry. These complex treatments are rapidly moving out of the safe hands of doctors and surgeons and into the beautifully manicured but rather less medically trained hands of unsupervised beauticians. This is likely to lead to more treatment injuries. And the latest moves by the Department of Health to deregulate laser treatments could make things worse.

When patients are injured they will be calling on the claims industry for compensation. Because as cosmetic treatment expert witness David Gault says, “Once the damage is done, other than making a claim I am not sure what can be done about it. You just have to wait for it to settle down and it may never do so.” This could be a large problem too. Nonsurgical cosmetic procedures have been on the up for a number of years (between 2005 and 2007 they doubled to 472,000). And this rise is not surprising. We are constantly bombarded by casual media mentions of these treatments. You only have to pick up the latest magazine to read something about these treatments. In May Grazia referred to cosmetic treatments as if they were the latest lipstick, describing a “top to toe non-surgical makeover.” And makeover shows like 10 Years Younger also promote these procedures – with legal disclaimers, of course. People are undergoing these treatments in their lunch breaks. And now there are even mobile botox services so that people can receive their forehead-smoothing injection at home. So it is very tempting for some.

Many claims management and legal firms are already asking people with adverse effects from cosmetic treatments to contact them with claims. North West law firm TJL solicitors has a specific website for cosmetic claimants and apparently one of their specialists is working on hundreds of cases.

UNAUDITABLE

But the exact number of cosmetic treatment claims is difficult to determine. Claims managers have been passing on these types of claims, but because they fall under clinical negligence and generally they do not keep records of exactly what kind of clinical negligence cases they pass on there is not an official record.

Kashmir Ropel, of Thompson’s solicitors, says that up until now she has not progressed many claims in relation to laser and Intense Pulsed Light (IPL). “There are a lot of enquiries relating to laser hair removal, but not many turn into a claim because the injuries are usually temporary and they were told about the risk of pigmentation before it was administered.”

David Gault says in his experience, “most cosmetic treatment cases do not go to court so I have not stood in front of a judge. But they are usually settled before then.”

BBC newsreader Kate Silverton is one person whose case is being progressed. She realised how these seemingly minor procedures can lead to legal action after she opted for laser skin resurfacing to treat some minor scarring on her cheeks. She was told it was a routine procedure and she would be back to work in a matter of days – but her whole face swelled up, she had to take two weeks off work and was left with painful and unsightly swellings. She is now taking legal action, and she was treated by a qualified surgeon.

She will not be the last person. A needle prick or hair removal seems less dangerous than full blown surgery, but there are still risks. The United States is in front of the UK when it comes to cosmetic treatment uptake, and the side effects have begun to emerge. A warning about the risk of breathing problems if botox is injected into the neck went out earlier this year after 16 deaths. Only one of the people who died was undergoing a cosmetic treatment but it is still worrying. And botox is not the only non-surgical treatment popping up in beauty salons across the country, laser treatment and IPL are also very popular, but potentially just as dangerous.

Yet at the same time as side effects come to light the government is considering deregulating lasers for cosmetic use. At present higher power and potentially more dangerous high class lasers fall under Regulation 3 of the Private and Voluntary Health Care (England) Regulations 2001, and are regulated by the Healthcare Commission. There are approximately 850 establishments registered with the Healthcare Commission (HC) to provide purely cosmetic laser/IPL services. As part of the registration process the quality of treatment and the skills of staff are assessed. The HC also check that the premises and equipment are clean and safe to use.

The HC also takes action against those who are not registered. In January Mohammed Sadiq, of Henna’s World in Hounslow, was given a five-month custodial sentence, suspended for two years and ordered to pay £30,000 in costs, because he was not registered. They were not able to find evidence that his staff members had been trained and that the laser had been serviced and maintained.

Dr Rupert Gabriel, of the British Academy of Cosmetic Doctors (BACD), says, “It is common to hear of unregulated beauty salons causing burns. And this can lead to permanent damage.”

At the moment unregulated salons may be deterred by the threat of HC action, but this could become a thing of the past. In March the Department of Health launched a consultation suggesting that laser treatment should be deregulated. The Department claimed that it had reviewed the safety of a number of different treatments regulated by the Healthcare commission to “reduce the cost of regulation”. Lasers/IPL were chosen because the risk of damage from lasers/IPL is “not proportionate to the risk of harm to patients.”

This ‘cost saving’ has been questioned by cosmetic doctors like Dr Gabriel: “The Healthcare Commission is supposed to be self funded in this respect,” he says. “Thousands of pounds are paid by clinics to register.”

Yet in the same consultation document the Department of Health contradicts itself, stating that the deregulation “would generate an extra 1700 – 3400 adverse incidents per year.” And, “direct costs from having to treat the increase in adverse incidents [following deregulation], possibly all falling on the NHS, will be [up to] £1.8m.”

CLINICIANS’ ANGER

The move towards deregulation has angered doctors and surgeons concerned for the safety of patients. Douglas McGeorge, President of the British Association of Aesthetic Plastic Surgeons, is one such person. “Deregulation leaves the door open for people who are relatively unscrupulous who will not put the patient’s interest first.”

“Patients could be harmed and we should not wait for patients to suffer,” he adds.

The British Academy of Doctors has responded in the same way, member Dr Paul Myers, Director of Cosmoderm, says: “I have written to my MP, the Minister for Health and launched an online petition about the deregulation.”

The petition has over 600 signatories, many of them doctors and surgeons. Paul has very strong views about deregulation. He is concerned that if it goes through anyone will be able to buy a laser and even treat children.

He also says that the high cost of such equipment would no longer be a prohibitor, “China is churning out very cheap inferior quality laser equipment, anyone could set up laser equipment in their garage and offer treatment.”

Dr Myers says that the Department of Health has gone completely against medical professionals’ wishes. Doctors and surgeons have been asking for more regulation to include all aesthetic cosmetic treatments.

And deregulation has not gone unnoticed by claims managers either. Jo-Anne McEwen, of Easily Claim in Lancashire, says, “Deregulating the industry is bound to bring in more claims. In every industry you get cowboys and I am sure the beauty industry is no exception to that.

“I am a claims manager and I need regulation whereas someone who provides cosmetic treatments does not need to be regulated. They will not need qualifications or have to meet standards to carry out something that could potentially disfigure you for life.”

NEEDLE WORK

While the Department of Health considers this deregulation, the Independent Healthcare Advisory Services is currently introducing measures to regulate injectables. But this will be self-regulation.

It will include a set of Standards and a Code of Practice, high level training course requirements, registration and inspection procedures and complaints procedures.

And maybe high level training requirements would help reduce injuries (if people bother to regulate themselves). A BACD survey revealed that over 50 percent of its members had treated patients who have experienced complications at the hands of inexperienced or rogue practitioners. And last year the BACD urged beauty therapists to beware of rogue practitioners offering courses in injectables such as dermal fillers and anti-ageing injections without medical training and proper understanding of the risks involved.

BACD chairman Dr John Curran says:

“How is a beauty therapist to deal with complications such as anaphylactic shock without resuscitation equipment? We must protect therapists and the public from this alarming development.”

Botox is a prescription-only medicine so it should only be provided by doctors or nurses supervised by doctors. But another cosmetic doctor, Dr Paul Cronin, tells Claims Management that companies are getting around this: “I know of a major company who have nurses in Liverpool being supervised by doctors in London, clearly this is not acceptable,” he says.

Dr Cronin, who is responsible for BACD training and certification programmes, says “some corporations offer training in botox for beauticians. Apparently after the course they provide them with botox and insurance, not knowing whether they will be supervised. Who would insure these people?”

Insurers are unwilling to answer the question of whether they check how treatments are carried out or whether those administering are registered with the Healthcare Commission. One specialist beauty salon insurer says that cover for laser treatments “would depend on the person’s qualifications and the type of machine they were using.”

Lana Clements, a spokesperson for More than Business, who provide professional indemnity for beauty salons, says:

“Cover for treatments such as bleaching, body wrap and facial cleansing can be arranged simply under our package, but we do not offer quotes for salons offering botox, laser hair removal or fillers as standard.

“If one of our existing customers branched out into these activities we would consider very carefully, based on the exact nature of activities and qualifications. We will always assist existing customers where possible.

“Treatment claims are not all that common, but when an injury occurs the cost can be significantly higher.

“An increase in laser beauty treatments could increase the risk of claims brought against salons for personal injury,” she says.

FILLING THE GAP

As injectables go, fillers are more of a worry than botox because potential problems could be permanent. “It is perfectly legal to take fillers home and inject them as long as you do not use any associated prescribables such as anaesthetic,” says Dr Cronin. This is because fillers are defined as ‘medical devices’ and not medicines so they do not have to be prescribed.

According to doctors, ‘good medical practice’ is to use a temporary filler so the patient can see the results of the treatment and have the opportunity to change their mind. Any adverse reactions will also be temporary because the substances will leave the body over time. Permanent fillers are administered though. Actress Leslie Ash had a permanent filler injected into her lips and was not happy with the result.

Perhaps self-regulation will help to put more robust procedures in place. As for laser treatments, the Department of Health’s consultation closed on 10 June and the results have not yet emerged. Medical sources indicate that they have been bombarded by negative responses from doctors and surgeons. But the response from the claims industry could be mixed. “Maybe as a claims management company responses should be ‘yes deregulate and let me sit back and rub my hands together with glee’. But as someone who actually uses beauty salons I do not personally wish to be on the receiving end of it,” says Jo-Anne McEwen.