According to an analysis of the U.K.’s cosmetic injectables industry by University College London (UCL) researchers, 68% of cosmetic practitioners who are administering injections, such as Botox are not qualified medical doctors.

The study, published in the Journal of Plastic, Reconstructive & Aesthetic Surgery, is the first survey of who is providing cosmetic injectable services, such as botulinum toxin (Botox) and dermal fillers, in the U.K. Currently, little is known about the background qualifications, training, and experience levels of those who are administering treatments. To fill this knowledge gap, researchers from UCL evaluated 3,000 websites to identify 1,224 independent clinics and 3,667 practitioners who were delivering cosmetic injections such as Botox.

Of the professions represented, 32% were doctors, 13% were nurses, 24% were dentists, and 8% were dental nurses. Of the 1,163 doctors identified, 41% were on the specialist register and 19% were on the GP register. Among the 27 specialties represented on the specialist register, plastic surgery was the largest group (37%) followed by dermatology (18%).

The U.K. injectables market is predicted to reach a value of £11.7 billion by 2026, but to date is effectively unregulated. The U.K. government is preparing to update policy around injectables, with a public consultation on the industry due to begin in August 2023. Recommendations are expected to inform amendments to the Medical Act in 2024.

According to study author, David Zargaran, MD, a plastic surgeon at UCL: “There are well-documented, yet to date unaddressed challenges in the UK cosmetic injectables market. Without knowledge of the professional backgrounds of practitioners, we cannot adequately regulate the industry. Our research highlights that most practitioners are not doctors and include other healthcare professionals, as well as non-healthcare professionals such as beauticians.”

“The range of backgrounds opens a broader question relating to competence and consent. One of the key challenges facing the government’s licensing scheme is to ensure that practitioners granted a license possess the skills and experience required to safely administer their treatment to minimize risks to patients,” Zargaran adds. “It is important for patients to be able to feel comfortable and confident that the person administering their treatment is competent in the procedure as a fundamental foundation of informed consent.”

As well as the professional background of those providing cosmetic injections, until recently there has been little research on the incidence of complications and the impact that these have upon patients. A second study from the same authors, published in Skin Health and Disease in July, found that 69% of respondents to the study had experienced long-lasting adverse effects, such as pain, anxiety, and headaches.

Julie Davies, director of the UCL MBA Health program and study coauthor, adds: “The U.K. cosmetic injectables industry has expanded rapidly in recent years. This has happened largely without scrutiny or oversight. Our findings should be a wake-up call for legislators to implement effective regulation and professional standards to safeguard patients from complications.”

“Although the risks associated with injections are often mild and temporary, the physical complications can be permanent and debilitating. There are also serious psychological, emotional, and financial consequences for patients when procedures go wrong,” Davies adds.