Dr Patrick Bowler on Developments in Botulinum Toxin

The medical community is currently awaiting the industry’s biggest review of cosmetic surgery legislation. Professor Sir Bruce Keogh, the NHS Medical Director, is expected to give his report, commissioned in response to a request from the Prime Minister, to the Health Secretary this month. Dr Patrick Bowler qualified in 1974 at the Royal London Hospital and is a pioneer of non-surgical cosmetic treatments with over 20 years experience. He is the medical director of Courthouse Clinics and is a founder member and Fellow of the British College of Aesthetic Medicine (formerly the British Association of Cosmetic Doctors). He is also a member of the Society for Laser Medicine and Surgery and sits on the advisory board or Treatments You Can Trust.
He is the author of The Nervous Girl’s Guide to Nip & Tuck and his opinion on the aesthetic industry is highly respected; he is frequently quoted in the media and on TV.

Pressure is mounting for new laws that ban non- medics from giving injectable treatments, and Keogh
is working with experts from the fields of cosmetic and plastic surgery to ensure optimum safety for patients. Existing legislation for things like heart valves and replacement joints is being held up as an example of the kinds of regulations the industry needs. Key areas for consideration include Botox® and dermal fillers, which currently can be executed by high street beauty salons.

As it stands now, beauticians with no formal medical training can legally administer Botox®. The lax legislation on the neurotoxin has seen a rise in its unrestricted use at “Botox® parties”, and in turn a spate of negative press because of the ensuing undesired results and improper aftercare that working with an unregistered technician can result in.

The Royal College of Surgeons has called the
ethics of companies who offer these parties “wholly incompatible” with professional standards. With beauty salons, at-home parties and rough discount traders, often there is no on-site medical practitioner who patients can return to or contact should questions
or problems arise. The procedures, when done in questionable circumstances like these, don’t ensure the levels of safety patients deserve.Nowhere else
in Europe tolerates this and the RCS recognises the urgency for change. President of the organisation, Prof Norma Williams, said: “We have serious concerns that not all who offer cosmetic procedures are adequately qualified, or that patients are getting accurate information prior to treatment.”

It is being encouraged that all patients for any kind
of cosmetic treatment must undergo a psychological assessment before surgery, as well as be taught
how to select the best clinic, treatment and doctor for themselves, irrespective of price. With cosmetic surgery it is absolutely an issue of quality.

Efforts are in an attempt to quash the perceived value of surgery. The BBC last month published figures that reveal only half of those considering surgery take into consideration the qualifications of their doctor. The BBC also report that of the 1,762 people ComRes interviewed, many considered the cost of the surgery to be more important than qualification or aftercare. It’s staggering, really.

Consensus amongst professionals is that only those with recognised qualifications and training should carry out procedures, in a registered clinic, with correct equipment and resources to deal with emergencies or unplanned circumstance. Measures must also be taken to limit “discount surgery”, with schemes like social vouchers, or time-limited discounts that encourage impulsive buying over considered decisions.

Steve Cannon, chairman of the working party and
 RCS council member concludes: “With the demand
for cosmetic surgery and non-surgical treatments
rising year on year, it is crucial that the highest level of professionalism is maintained amongst practitioners.” The entire cosmetic surgery community is awaiting the verdict on the future of our industry- and patient welfare- with breath that is baited.

Dr Patrick Bowler MS.BS LRCP MRCS DRCOG