New developments and marketing have made an increasing range of surgical and non-surgical cosmetic procedures – including botox, dermal fillers, implants, and skin lightening, as well as newer techniques such as ‘fat freezing’ and ‘vampire’ treatments – big business and widely accessible.
The Nuffield Council on Bioethics published a wide-ranging new report, Cosmetic procedures: ethical issues, which makes a series of recommendations that highlight areas of concern for the practice and promotion of invasive cosmetic procedures in the UK.
A ban on offering ‘walk in’ cosmetic procedures to young people
Under 18s are bombarded by social media and popular culture that focus on body image. The Council is concerned that they feel the need to conform to appearance ‘ideals’. These expectations are exacerbated by apps that present cosmetic surgery as a game.
Jeanette Edwards, Professor of Social Anthropology from the University of Manchester, who chaired the Council’s inquiry, said: “We’ve been shocked by some of the evidence we’ve seen, including make-over apps and cosmetic surgery ‘games’ that target girls as young as nine. There is a daily bombardment from advertising and through social media channels like Facebook, Instagram and Snapchat that relentlessly promote unrealistic and often discriminatory messages on how people, especially girls and women, ‘should’ look.”
The report recommends that social media companies collaborate to carry out independent research to better understand how social media contributes to appearance anxiety, and to act on the findings.
Taking into account appearance pressures on young people, the Council also recommends a ban on providing invasive cosmetic procedures to people under 18, unless a team of health professionals, including specialists, GPs and psychologists, are involved.
Professor Edwards said: “Under 18s should not be able to just walk in off the street, and have a cosmetic procedure. There are legal age limits for having tattoos or using sunbeds. Invasive cosmetic procedures should be regulated in a similar way.”
More data and improved testing for unproven products and procedures
The Council’s report also calls for a complete overhaul of the regulation of products used in cosmetic procedures – particularly dermal fillers. Fillers that have no formal quality or safety approval can currently be bought freely in the UK, and there are no limits on who can inject them. The report recommends that the Department of Health should make all dermal fillers ‘prescription-only’, which, as well as placing limits on which fillers can be used, will mean that those prescribing them need to take professional responsibility for their injection.
Mr Mark Henley, a plastic surgeon and member of the Council’s inquiry group, said: “We need to overturn the belief that fillers are risk-free. I’ve seen serious and long-term injuries from fillers in my clinic. Even fillers injected properly can cause lumps [granulomas] that have to be surgically removed. They have even been known to cause blindness and loss of facial soft tissues in rare cases.”
The Council says that the Department of Health must work with professional bodies to ensure that information on the number and type of cosmetic procedures carried out in the UK is collected and made publicly available. Data and research are also needed to improve the very poor evidence base on the outcomes of procedures.
Professor Edwards said: “These procedures are not trivial. To help people make good decisions, they need access to high quality information which they often don’t get. We also need better information on whether these procedures provide the long-term physical and psychological benefits that people often hope for.”
Improvements needed for an unregulated industry
The Council believes it is unethical that there is nothing to stop completely unqualified people from providing risky procedures like dermal fillers. It says that anyone offering invasive cosmetic treatments should be trained and certified before being allowed to practise. The Council also calls for an awareness campaign to help people check their practitioner’s credentials.
Professor Edwards, said: “It should be easy for people to check that the person giving them a cosmetic procedure is properly qualified and trained, but at the moment it isn’t.”
The Council also calls on the Government to fully implement recommendations made by the Keogh report in 2013 so the public can be assured that those providing cosmetic procedures, the places where they are carried out, and the products used are all properly regulated.
(Source: Nuffield Council of Bioethics)