Wednesday 31 October 2012

The Myths About Botox & Dermal Fillers

Botox and dermal fillers: myths and important client information

Skin Beautiful Medical and Cosmetic Clinic provides expert advanced dermal filler treatments at clinics in Exeter Milton Bristol Coventry Swansea Warwick Daventry Evesham Carmarthen Llanelli and Neath.


From every corner of the non surgical aesthetics industry there exists a multitude of myths regarding the uses, properties, legalities and ethics of Botox & dermal fillers. Some are quite surprising and none are limited to any one particular group.

In an attempt to provide the discerning public with the most accurate information possible, this article aims to clear up many of the most common myths.

Who can administer Botox injections?

Although there is widespread disparity in answering this question, the answer is a very straightforward one. At the time of writing, and under current UK law, any person can administer Botox injections, so long as certain criteria have been met. Botox is a prescription only medicine (POM). This means it must be supplied by prescription. A prescription must be obtained following a face to face consultation with an appropriate person. Therefore, if a doctor is willing to give a direction to a beautician to administer Botox there is currently no UK law prohibiting this.

Who can prescribe Botox?

I have seen several articles where doctors claim that nurses are not allowed to prescribe Botox or other botulinum toxin type-A drugs. This is quite simply a distortion of the facts. Any nurse holding a nurse independent and supplementary prescriber qualification (NISP) can prescribe Botox independently of a doctor or dentist. An NISP may also prescribe for others and give a direction for others to administer Botox too.


Who is qualified to do what?

I have seen several doctors (general practitioners) claiming to be 'best placed' or 'most suitably qualified' to deliver non surgical facial aesthetics treatments. I am sceptical that this advice is not in the best interest of the general public for several reasons:
  1. A doctor is highly knowledgeable in medicine and disease. However, no aspect of doctor training covers any part of facial aesthetics, nor does it cover the technique of injecting Botox or dermal fillers.
  2. Many doctors have absolutely no aesthetics training, qualifications or certification whatsoever. That's not to say that doctors don't make good aesthetics practitioners. There are many good aesthetics practitioners with medical backgrounds. However, to claim to be most suitably qualified on the basis of a medical degree, without having had any professional aesthetics training is perhaps misleading.
  3. Over 70% of all injections in the UK are administered by qualified RGN or RN nurses. Many doctors rarely inject patients in daily practice, but instead give the direction to practice nurses to administer injectable drugs.
  4. Specialist medical aesthetics training course for doctors, dentists and nurses are readily available, leading to certification in all manner of non surgical cosmetic and medical procedures. A medical aesthetics certificate is evidence that the practitioner can perform the given procedure safely and correctly, and, independently of any medical, nursing or dentist training and qualifications.
In my own experience, I have been told of several doctors, nurses and dentists who have injected incorrectly leaving a client(s) with bruising and other undesirable effects following treatment.

My advice to the client is: ask several questions of your practitioner. Find out exactly what training and qualifications they have, and ask whether they have evidence that they can perform the treatment you require effectively. Always ask to see professional cosmetic insurance, which is independent of any other medical practice insurance. The best cosmetic insurance available will only cover doctors, dentists and nurses who are also qualified aesthetics practitioners.

The Frozen Look!

It is not good practice to inject a client's face leaving a frozen look. Scientific literature from both independent studies and drug manufacturers state that Botox Cosmetic (and other botulinum toxin type-A drugs) should 'relax', 'reduce' or 'weaken' muscle contractions. Botox is not supposed to be administered to the extent that muscles become completely, albeit temporarily paralysed. In my own practice I refuse to attempt the 'frozen look' on the basis of such scientific evidence. Botox is supposed to achieve a reduction in the visibility of facial lines and wrinkles, not a visibly stiff face.

What is the difference between Botox and dermal fillers?

I often get asked this question by clients. For many 'Botox' has become a generically used term to describe all facial aesthetics injectable treatments. In terms of the physical and pharmacological properties of the two Botox and dermal fillers are very different.

Firstly, Botox is a prescription only medicine (POM) whereas dermal fillers are medical devices (non POM). Botox cosmetic is a drug that is injected beneath the skin to temporarily correct lines and wrinkles caused by the contraction of particular facial muscle groups. It does so by blocking the release of acetylcholine, a neurotransmitter. This in effect inhibits localised muscle contraction.

By contrast, dermal fillers have no effect on muscle contraction or in neuromuscular function. Instead they work by replacing lost volume in the skin's matrix. The active ingredient in most dermal fillers is hyaluronic acid, a substance that occurs naturally in the body. In the skin it aids hydration by holding water, which in turn gives volume to the skin. Through ageing, our skin loses its ability to hydrate itself and the resulting loss of volume yields characteristic deep lines and folds. Dermal fillers can replace the lost hyaluronic acid and allow the skin to rehydrate itself once more.

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Monday 1 October 2012

Botox & dermal fillers - The Keogh Review

The Keogh Review: Botox and dermal fillers in the UK

Skin Beautiful Medical and Cosmetic Clinic provides expert advanced dermal filler treatments at clinics in Exeter Milton Keynes Bristol Coventry Swansea Warwick Daventry Evesham Carmarthen Llanelli and Neath.


The Keogh review, once concluded, will likely change the way in which non surgical cosmetic treatments such as Botox and dermal fillers are administered in the UK. Read this article to find out more.

At the request of the then health secretary Andrew Lansley MP the NHS medical director Prof. Sir Bruce Keogh is heading a review into the practices of both surgical and non surgical cosmetic procedures. A review was deemed necessary by Mr Lansley following the scandal of PIP breast implants. However, the review is to consider a much wider scope including all non surgical aesthetics procedures to include the prescribing and/or administration of all Botox (botulinum toxin) and dermal fillers products.

The review is currently at the consultation stage with both the medical profession and the wider public being encouraged to comment on and provide evidence of various aspects pertaining to (amongst other matters) cosmetic injectable treatments. It is set to conclude in March, 2013 soon after which many of my colleagues and I expect regulation to become a part of a largely unregulated industry.

As a qualified advanced medical aesthetics practitioner I give my full support to regulation within the industry. Not least as I consider patient safety to be fundamental in any cosmetic procedure (either surgical or non surgical), but also because I believe the cosmetic industry, and, in particular non surgical aesthetics must be better defined, allowing the public to be better protected and better informed.

Possible implications for Botox & dermal fillers in UK

There are several possible outcomes following the conclusion of the Keogh review. These range from a ban on beauticians administering prescribed, injectable Botox (botulinum toxin type A) and/or injectable dermal fillers such as Juvederm, Restylane, Radiesse and Teosyal to an outright ban on all but registered physicians from administering either Botox or dermal fillers. The latter is perhaps unlikely, and more in line with other EU member states where only doctors are permitted to administer injectable botulinum toxin type A.

Between these two opposing states lies a whole conundrum of other possibilities for the aesthetics industry. For example, in the UK many nurses are permitted to prescribe, both as part of a team and also independently, drugs such as Botox. This is an exception within the EU where nurses do not have such roles.

There are further options, both along the lines of autonomous practice and regulation. One it has been decided who can and cannot administer cosmetic injectables such as Botox and dermal fillers then it must also be decided where the boundaries lie between 'practice' and 'autonomous practice.'

Botox - The current state of affairs

Currently, it is necessary only that all injections of botulinum toxin type A must be preceded by a face to face consultation with a qualified prescriber. That is to say there are no regulations governing who can and cannot administer the treatment so long as the prescription was obtained as described above.

Needless to say, the UK is severely lacking in regulation. This has led to beauty salons across the country offering "Botox injections", "anti wrinkle injections", "skin rejuvenation" and "muscle relaxing injections" as part of their beauty portfolio. In light of the Keogh review questions must be asked as to whether a prescribed drug with potentially severe consequences should be administered by a person(s) who has no medical or health care training, and, therefore no knowledge of dealing with possible complications as a result of injecting.

Prior to the announcement of the Keogh review, and despite there being no current supporting regulations in place many organisations in the UK already have strict rules effectively excluding certain groups concerning the acquisition, and administration of Botox and dermal fillers and the insurance covering such interventions. For example, my own cosmetic insurance company sent letters to all members stating that it will not renew existing policies where the insured is not a qualified nurse, doctor or dentist. Similarly, none of the pharmacies or aesthetics manufacturers that I deal with will sell or market either Botox or dermal fillers to anyone other than a nurse, doctor or dentist.

Injectable Botox & dermal fillers - How should regulation be applied?

There is little doubt that the Keogh review will ultimately lead to regulation being implemented across the cosmetic industry, but how should this apply to non surgical aesthetics such as Botox & dermal fillers?

In my own view as an experienced RGN and qualified advanced medical aesthetics practitioner any regulation must ultimately provide universal protection for the public seeking cosmetic treatments. It must also go further in addressing public awareness. When one considers a GP it is common knowledge in the UK that any such person is suitably qualified and knowledgeable to diagnose and treat illnesses. I believe it should also be common knowledge that any person administering Botox or dermal fillers is a qualified medical and/or health care professional with professional aesthetics training.

In summary, my own suggestions put forward to the Keogh review include the following
  • Botox & dermal fillers should only be administered by a practicing qualified medical or healthcare professional.
  • In addition to a medical, dentistry or nursing degree all practitioners should have suitable independent aesthetics training and qualifications and should only perform the treatments they have trained for.
  • All practitioners must hold separate professional cosmetic insurance.
  • All practice should be performed either by a qualified prescriber, or, at the very least by a qualified health care professional in connection with a prescriber.

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