Derek Couper

With the consultation process by the Scottish government over the need for greater regulation around non-surgical cosmetic procedures having concluded, its findings – and resultant action – are keenly awaited.

For those of us working in professions where we see the impact of when cosmetic surgery goes wrong – and too often this is down to the work of unregulated practitioners – we are eager that greater regulation is imposed as a matter of urgency.

Cosmetic surgery, whilst once the domain of the rich and famous, is now wholly accessible. Across Scotland, men and women, young and old, turn to cosmetic procedures like Botox or fillers routinely – with other more invasive processes like liposuction and Brazilian butt lifts also seeing a huge rise in popularity.

But what many people undergoing these treatments will be blissfully unaware of is that their procedure may be undertaken by someone who is unlicensed, unregulated and without proper insurance – and therefore deeply unfit to carry out such work.

We have a situation in Scotland where, due to the lack of regulation that exists, anyone can claim to be an ‘expert’ in cosmetic procedures, even though they are far from it. Campaign group Save Face reports how it has come across practitioners offering surgical liposuction who two weeks previously were working in retail.

Although healthcare professionals delivering these treatments are subject to scrutiny from bodies including the HCPC and GMC – and new legislation in July 2024 enabled Health Improvement Scotland (HIS) to take a greater role in regulation of healthcare services – those without any healthcare training are completely outside of this orbit. They face no checks, no scrutiny, no accountability.

This is ludicrous indeed, and hugely concerning. Unfortunately, I have seen many instances of where procedures go badly wrong, and the consequences can be truly horrific and life-changing. In the worst instances, they can be fatal. But in the cases of those administering treatments who are not qualified to do so, their lack of insurance means that if something does go wrong, as well as a person suffering physical and most likely psychological consequences, mounting a legal claim to secure fair and just compensation is also much more challenging. The unfairness of this situation is truly appalling.

The consultation by the Scottish government over new levels of regulation has been welcomed as some recognition of the problem that clearly exists. The process, which ran until February 14, gathered insight on how to make this sector safer. It proposes that non-surgical cosmetic procedures should only be carried out in premises licensed by the local authority or regulated by HIS, by regulated practitioners. Further, it proposes that procedures are grouped into three levels of risk, to bring further levels of governance to the sector.

While such changes would undoubtedly be positive, they really cannot come soon enough, and should not have taken this long. A consultation process in 2022 has seen little change take effect, and the frustration and disillusionment from those who are working legitimately in this sector – as well as patients who have been harmed – is understandable. We really must continue to bang the drum over the necessity and urgency of this issue. These treatments will be being carried out by unregulated practitioners across the country at this very minute – and this cannot continue.

Regulation for everyone – whether a member of a professional body or not – is essential. A minimum standard of training and qualification is similarly something we must insist upon. This must also give rise of insurance and indemnity requirements, to ensure that people who are harmed by botched procedures can secure appropriate recourse.
We await the findings of the consultation and can only hope this leads to swift and decisive action, to address an issue that is leaving people across Scotland vulnerable to significant risk to their health and wellbeing.

Derek Couper is head of medical negligence at Slater and Gordon