A crackdown on cosmetic surgery, including tougher controls over who can offer treatments and how they can be marketed, is urged in a review spearheaded by the NHS's senior doctor that warns of the "normalisation" of surgical procedures in pursuit of a designer body.
The report by Sir Bruce Keogh, the health service's medical director, finds that television programmes such as The Only Way Is Essex and celebrity magazine features play a big part in the quest of women for nose jobs, breast implants and injectable dermal fillers. But few understand the safety issues and almost total lack of regulation in some areas, it finds.
The health minister Dan Poulter said he agreed entirely with the principles behind the recommendations and the government would respond fully in the summer, adding it was time for the government to intervene.
The Keogh report proposes restrictions on a flourishing industry that is worth £2.3bn and is expected to grow to £3.6bn by 2015. Fillers to smooth wrinkles and bulk out buttocks or calves, virtually unregulated even though they are injected under the skin, will become prescription-only if the recommendations are accepted.
At the moment, fillers can legally be bought online and injected by almost anyone. "A person having a non-surgical cosmetic intervention has no more protection and redress than someone buying a ballpoint pen or a toothbrush," warns the report. "Dermal fillers are a particular cause for concern as anyone can set themselves up as a practitioner, with no requirement for knowledge, training or previous experience. Nor are there sufficient checks in place with regard to product quality – most dermal fillers have no more controls than a bottle of floor cleaner. It is our view that dermal fillers are a crisis waiting to happen."
The review was commissioned in the aftermath of the PIP breast implant scandal. Implants made by the French company were found to contain substandard industrial-grade silicone. Some private cosmetic clinic chains had inadequate records of who had received the implants and did little to help their clients.
Poulter said: "While there are some responsible clinics which do take proper care of their patients, Sir Bruce Keogh's review makes clear that there is a significant risk of people falling into the hands of cowboy firms or individuals whose only aim is to make a quick profit. These people simply don't care about the welfare of the people they are taking money from.
"If anything good can come of awful episodes like the PIP scandal, it is that the safety of the procedures that people may choose to undergo has been questioned. It is clear that it is time for the government to step in to ensure the public are properly protected."
Keogh raises questions over the competence of some of the surgeons who conduct facelifts, breast implants and nose straightening. Some may have qualified in ear, nose and throat surgery rather than plastic surgery. Many are "fly in, fly out" surgeons, not based in the UK.
Cosmetic surgery and treatments are not white goods, to be sold and purchased on a buyer-beware basis, says the report. The consumers are also patients; some of them are very vulnerable and all need protection.
"At the heart of this report is the person who choses to have a cosmetic procedure. We have heard terrible reports about people who have trusted a cosmetic practitioner to help them out but, when things have gone wrong, they have been left high and dry with no help," said Keogh. "These people have not had the safety net that those using the NHS have. This needs to change."
The document details the mushrooming growth of the industry. The sector was worth £720m a year in 2005 but has tripled in value in five years. "Cosmetic interventions have been normalised. Previously undertaken discreetly, now people will admit to having had procedures and even celebrate them," the report says.
Britons now place much greater emphasis on physical perfection, Keogh's team conclude, with young people and girls in particular becoming more concerned with their appearance. According to the report, 41% of girls aged seven to 10 and 63% aged 11 to 16 said they felt some pressure to look the way celebrities do. The review wants tougher controls over "highly misleading" advertising and marketing practices, warning that "before and after" pictures can be digitally enhanced. The team is concerned about "the many TV makeover programmes where participants have procedures financed by providers … Of particular concern are TV reality drama shows in which its young stars glamorise cosmetic procedures. It is not always made clear that these celebrities have contracts with particular providers."
Simon Withey, a plastic surgeon and member of the review, said there had been a trivialisation of cosmetic surgery, with stars of The Only Way Is Essex used to promote particular surgeries. "I think shows like this probably do contribute to this trivialisation. There is a failure to inform the public of the risks of these things."
The report proposes that all cosmetic surgeons must have approved training. The Royal College of Surgeons will set standards and arrange for those who are skilled and experienced to be formally certified. Beauticians who inject will also need formal training and qualifications or be supervised by somebody with a medical background who has them.
The college called on the government to implement the report promptly. Tim Goodacre, chair of professional standards at the British Association of Plastic, Reconstructive and Aesthetic Surgeons, said: "Without a doubt this is huge progress." He particularly welcomed the publication of outcome data in the private sector for the first time.
