Saturday 4 January 2014

Botox & dermal fillers: regulation & accountability of nurses, doctors and dentists vs beauticians & therapists

Skin Beautiful Medical and Cosmetic Clinic is a specialist medical aesthetics skin clinic for advanced wrinkle relaxing injections, dermal fillers, IV nutrition and PDO thread lift treatments in Exeter Milton Keynes Bristol Coventry Swansea Warwick Daventry Carmarthen Llanelli and Neath


If beauticians, therapists and any other person (e.g self acclaimed 'skin specialists') who are not medical and/or health care professionals are permitted to administer Botox and dermal fillers following the impending government legislation then two questions need to be addressed: Should there be a single governing body that regulates both therapists and medical/health care professionals? Should they be regulated under a separate governing body that makes concessions on the basis of their non medical backgrounds?

Should medicines and medical devices such as Botox
and dermal fillers be administered by unregulated persons? 

Why does regulation and accountability matter?

Regulation exists to protect the public against malpractice in the medical and health care professions. However, rather than being a useful tool to the public and one that hinders practitioners and practices it is actually a very helpful professional tool in our industry. It helps us to meet client expectations, to do things more efficiently and to practice in the safest and most ethical manner possible.

Thanks to regulation clients know what to expect from their practitioners, and, where there is uncertainty over how things should be done then medical and health care professionals can point to appropriate regulatory guidelines.



Could non medical/health care personnel ever be trained and qualified sufficiently to deliver cosmetic injectable treatments?



There is both enthusiasm and animosity, confusion and condemnation throughout the medical aesthetics industry over this very question. We owe it to the public as practitioners to be able to demonstrate clearly and unambiguously that we have every necessary skill and experience from the first initial contact with the patient, through consultation, patient selection, choice of product or therapy and the treatment itself to meet or exceed a basic minimum standard every time.

For beauticians, who is going to train them and to what standard? What knowledge must they possess? Surely they would require the very same knowledge as a medical or health care professional to deliver these treatments, unless we are to accept an industry with double standards?

Undermining medical and health care qualifications

There has been talk throughout the beauty industry that beauticians (with the right training) should be permitted to administer prescription only medicines such as Botulinum toxin type-A. The beauty industry, lead by calls from Molly Hanson Steel believes that 'therapists' with as little as NVQ level 3 in beauty therapy and basic anaphylaxis training are safe and sufficiently qualified to practice medical aesthetics. So what is wrong with this approach?

Firstly, to suggest that an NVQ in beauty therapy somehow equates to a medical, nursing or dentistry degree in delivering treatments that fall under the categories of medicines and medical devices is frankly degrading and discourteous to those who hold such degrees.

Secondly, if these kind of treatments were intended to be delivered through the beauty medium then why are they not part of the criteria for advanced beauty therapy training? The answer here is simple: Who is going to supply prescription only medicines found in the BNF (British National Formulary) to beauty therapists for the purpose of training? The answer is in the question. Furthermore, when one considers that none of the manufacturers or UK distributors of aesthetics medicines or medical devices will supply any of their products to beauticians and therapists and even actively investigate any third party source supplying their products to non medical and health care professionals, then it becomes clearer still that these products should not be handled by non medical or health care professionals.

Of course, for a doctor, dentist or nurse to enter medical aesthetics via the back door (i.e. with no certificates in the field and with no experience of the products or procedures that are to be used in practice) is no less honourable than the beauty path. However, a medical or healthcare degree does provide a correct foundation for specialised medical aesthetics training. It is even a prerequisite with some training providers.

Can a beautician, therapist, hairdresser or any other non medical professional ever be held accountable in the same way as a nurse, doctor or dentist?

These is no simple answer to this question. In short, the answer is no, because beauticians and therapists are not regulated in any way by a recognised governing body and cannot possibly be held accountable by a governing body or an organisation to which they don't belong. Even if it were possible, then regulation would have to somehow excuse beauticians/therapists for not understanding certain principles of professional clinical practice.

There is one other option, albeit a far cry from medical regulation. Do we become a nation whereby non surgical medical procedures are carried out under different criterion and even to differing standards; i.e. one may visit an aesthetic salon to undergo an aesthetic beauty consultation, to be treated by an aesthetic therapist administering an aesthetic injectable beauty treatment? Notice the deliberate omission of the term 'medical.' By comparison, clients may also visit a medical aesthetics clinic to undergo a medical aesthetics consultation, to be treated by a doctor, dentist or nurse administering a medical aesthetic treatment.

We simply cannot refer to the same treatment or group of treatments under two different names because of the differing qualifications and backgrounds of those administering the treatments. Allergan inc. the manufacturer of BoTox™ would only ever refer to their product as a prescription only medicine, medicine or drug. Under no circumstances would they ever supply it to a non medical professional thereby effectively ruling out the



Can a single governing body possibly regulate both medical/healthcare professionals and non medical/healthcare professionals for the handling and administration of prescription drugs and medical devices?


Surely the answer has to be no! The very purpose of a governing body is to regulate the practice, behaviour, training and development of its members. Thus, we have separate governing bodies for doctors, dentists and nurses even. Why? Simply because their roles, and therefore their responsibilities differ from one another as do their fields of practice.

If there is currently no recognised governing body for non medical/health care professionals in beauty therapy then it would be necessary either to create one for the very purpose of administering medicines and medical devices (something that would be very costly and many existing governing bodies such as the GMC, NMC, GDC would most likely not be keen to partake in) or therapists would have to be governed by an existing body with certain concessions being made.

Is the current regulation sufficient for doctors, dentists and nurses to practice medical aesthetics?

Certainly not! We need a professional register of 'qualified' medical aesthetics practitioners. That is, a register that lists only those doctors, dentists and nurses whom have specialised qualifications in medical aesthetics and, ideally, have undertaken specialised training and qualifications in prescribing the drugs and medical devices found in medical aesthetics.

Regulation must, for the sake and safety of the general public not permit 'have a go hero' types of GP's, dentists and nurses. These types walk into aesthetics with no training or certificates, then simply pick up a needle and begin injecting. Worse still, many then honour themselves with new titles such as "aesthetic doctor", or "aesthetic nurse practitioner", etc.

The public needs to know, beyond any doubt whatsoever, that every practitioner on the register has the same aesthetics qualifications, ability to consult and prescribe aesthetics drugs and medical devices and that their skill level is reflected in the treatments they offer.

Other areas of concern

One of the most strikingly repetitive scenarios I find in my own medical aesthetics practice is when meeting with a new client whom comments either about poor experiences with other practitioners or regarding a scare story that has been read via an online forum or social media site. Although it is something I have become used to I still find it hard to accept that some of these poor clients actually believe it is the norm to receive severe bruising or other injury, for an eyelid to drop or for slurred speech to occur following a treatment.

A lady client I treated last month for the first time told me she had taken a week of annual leave from work to have a dermal filler cheek augmentation. Out of curiosity I asked her why she needed a week off and she replied "for the bruising to go down!" I was dismayed! In my own practice this is unheard of. However I do often hear this from first time clients. The lady told me that this was her experience the last time she had a cheek enhancement.

Her expectations had been lowered to such a degree that she avoided all clinics for several years following her previous experience. Needless to say she was surprised when she looked in the mirror the next morning and saw a bruise free complexion and high contoured cheeks.

About the author

Helen Bowes RGN BSc (hons) NISP AMAP is a Registered Nurse Prescriber, certified Advanced Medical Aesthetics Practitioner and industry expert Key Opinion Leader for PDO thread lift.



Links:


1 comment:

  1. Thank you to Aaron for posting the comment below. Unfortunately, our webmaster will not permit the post in full as it contains a link to a plastic surgeon and was used to promote the services of this other clinic. See original comment below.

    Your comment is interesting but potentially ambiguous.

    A CERTIFIRD PROFESSIONAL IN WHAT?

    Is it correct to refer to a certified plastic surgeon as being a certified professional in non surgical aesthetics? This is both unethical and misleading. Professor Sir Bruce Keogh (head of the UK NHS) has spoken on several occasions about this kind of practice.

    Indeed there are many plastic surgeons who practice non surgical aesthetics to a high standard, but not all. Certification is exceptionally important, but it has to be in the field of non surgical aesthetics.

    Original Comment:
    I have seen a lot of issues with certification. A lot of people think they
    can do botox themselves and it leads to some awful situations. It's better
    to just go to a certified professional.

    ReplyDelete