An acrimonious dispute has broken out between cosmetic surgeons and the clinics that provide injectable treatments such as Botox over the launch of a scheme designed to identify safe providers and root out rogue practitioners.
Treatments-you-can-Trust, set up with funding from the Government and the cosmetic medicine industry, is a register of doctors, dentists and nurses at 156 clinics across the country who meet basic standards of training necessary to provide safe care to patients. It is intended to give confidence to patients and drive out clinics which operate with unqualified staff.
But the the register was attacked before its launch today by the British Association of Aesthetic Plastic Surgeons (BAAPS) which described it as "ineffective" and "little better than state-sponsored marketing."
The timing of the launch was also questioned after it emerged a national enquiry into the provision of cosmetic surgery, to be published on Thursday, is expected to highlight safety issues, including over-confident surgeons, shortages of equipment and absence of anaesthetic cover in many clinics.
Organisations applying to join the Register of Injectable Cosmetic Providers must show that only doctors, dentists and registered nurses are delivering the treatments. Clinics will also be subject to random visits, at 24 hours notice, by a team of independent experts to check that they comply with the Health and Safety at Work Act.
But BAAPS said the scheme made no distinction between doctors who had six years training in cosmetic surgery, such as its own members, and those who had done a weekend course.
It said organisations could register a chain of clinics for a single one-off fee when it was individual practitioners who needed to be checked. It added that the scheme was "unenforceable" and "had no teeth".
Treatments-you-can-Trust said it screened the "background" of providers before awarding them the Quality Assurance Mark. It added that all practitioners were accountable to their statutory regulators, such as the General Medical Council.
An estimated one million injectable cosmetic treatments – which are non-surgical – are delivered each year ranging from Botox to remove wrinkles to dermal fillers to plump up lips. They are admistered by staff who may have had less than a day's training and their popularity has been fuelled by TV programmes such as Nip/Tuck and cut-price offers in women's magazines.
The register has been set up by the Independent Health Advisory Service (IHAS), which represents private health providers, with £200,000 funding from the Government. The last government rejected a recommendation by the Chief Medical Offer for full regulation of the industry and the present government has continued with the same policy.
Half of the estimated 700 cosmetic clinics in England that are eligible to join the register have expressed an interest. The register only covers injectable treatments – laser hair removal, chemical peels and similar treatments offered by the clinics will remain uncontrolled.
Sally Taber, the head of standards and training for the register, said some injectors had little or no knowledge of facial anatomy and there were examples of clinics that had shared vials, stored Botox in a domestic fridge and operated in dirty premises that could lead to infection. Shockingly, many patients are unaware that a patient may have a reaction to the injectable cosmetic treatment. In these cases, it is sessential that the provider be a clinical professional who knows how to manage any medical emergencies," she said.
But the cosmetic surgeons who pick up the pieces when injectable treatments go wrong – though they do not administer them themselves – dismissed the claims. Nigel Mercer, the president of BAAPS, said: "The scheme is being used as a marketing tool, its regulation appears rudimentary and their "Quality Mark" is not recognised by the British Standards Institute."
"The IHAS scheme is not enforceable and has no teeth to stop poor practice. It seems to be sold to the profession on the basis of marketing rather than patient safety."
A survey by BAAPS revelaed one in four of its cosmetic surgeon members had seen patients who needed surgery to correct complications caused by the injection of permament fillers, mainly due to "unqualified practitioners administering them incorrectly."
A patient's story: 'It started to spread and the burning sensation got worse'
Lisa Stredwick has been in constant pain for more than two years because of lip injections. She says a register of approved cosmetic practioners would not have saved her from her medical nightmare, because her doctor was – and still is – considered an expert in the field.
Ms Stredwick had PMMA injected into her lips in 1999 on the understanding the substance only stays in the body for 18 months. Initially everything was fine; she even looked into having the procedure repeated a year later. But after nine years what seemed to be a coldsore appeared on her lip. After it swelled into a painful lump over the course of a month, she discovered that the PMMA was still present and had embedded itself into her skin cells.
"I went back to the surgeon and he looked worried, because it turned out he had other patients who had experienced problems," she said. "He administered cortisone injections but that made it worse. It started to spread and the burning sensation got worse and worse and worse.
She had surgery to try to get it removed in December 2008, but this turned out to be impossible. "You'd have to remove the whole of your lip to get rid of it, so now I've got a scar that won't heal," she said. "It's on my face, I can't cover it up with a T-shirt." Ms Stredwick is now being treated in Belgium every six weeks, but it is uncertain if she will ever be able to get the problem fixed and she says it has affected her life "big time".
The register will provide a guide to certified cosmetic professionals, but even industry recognition cannot prevent pain when the problem is with the substance itself and not how skilfully it is applied. Rob Hastings