The booming cosmetic treatments industry is facing a wide-ranging crackdown over an array of dubious practices that exploit, pressurise and pose a danger to often vulnerable patients who are hoping to improve their appearance.
Tough regulation is likely after a government-ordered review heard sustained criticism of aggressive promotional tactics, salespeople rather than doctors advising on procedures, and patients being abandoned after a treatment went wrong.
New laws are looming after the review, headed by the NHS's medical director, Sir Bruce Keogh, was told that existing controls were weak and ineffective and did little to stop unqualified practitioners and to protect patients. It uncovered strong support for a ban on free consultations for cosmetic surgery, an end to two-for-one offers and time-limited discount deals on procedures, and for those considering surgery to undergo a two-stage process of written consent so they do not feel rushed into going under the knife.
The review was ordered by then health secretary Andrew Lansley in August after the PIP breast implants scandal, in which about 47,000 women in the UK received French-made silicone breast implants which turned out to have a higher than usual risk of rupturing. That led to calls for an overhaul of a business that has been criticised for years for its hard sell tactics for everything from removing unwanted hair to banishing facial lines through injections, weight loss procedures, breast augmentation and nose improvement operations.
At that time, Keogh said there was "a cacophony of concern across society" about the industry's behaviour and voiced worries that there were "some pretty grubby practices going on". He also stressed that "there are some parts of the industry that we need to clean up".
A summary of more than 180 submissions from doctors, patient groups and industry representatives to Keogh's review of the regulation of cosmetic interventions, published on Monday by the Department of Health (DH), paints a picture of an often irresponsible body image enhancement business more interested in profits than patient welfare or safety.
The responses "send a clear message that the current regulatory framework doesn't do enough to support consumer rights or patient safety," Keogh says in his foreword. "The supply and demand for procedures in this fast-growing sector has outgrown the existing legislation around the products used, the people providing treatments, and the information and advice available to the public."
While the evidence does not bind Keogh in drawing up his recommendations, which are expected in March, they do tally with his thinking on how to "deliver a cosmetic interventions industry that will lead the world in terms of patient care without stifling consumer choice".
Ministers are likely to be left with little choice but to legislate to ensure an industry estimated to be worth more than £1bn a year cleans up its act.
The summary of evidence reveals that many respondents back a two-stage consent process for surgical procedures and want medical professionals rather than sales advisers to undertake consultations. Respondents also support a ban on financial inducements or time-limited deals, which are used to persuade patients to go ahead with procedures. Some are offered discounts if they introduce a friend to the provider, or offered two procedures for the price of one – deals which surgeons and consumer groups have branded completely unethical.
Respondents also demand fuller information for patients, including them being shown photographs of the bruising and scarring that can occur, and more detail on the risks associated with surgery.
Vivienne Parry, a medical and science journalist who was on the review committee, said: "Aggressive marketing techniques are often used to maximise profit. This may be the right approach for selling double glazing but not for people having or considering whether to have surgery."
Dr Rosemary Leonard, another committee member, said: "It is wrong that the first consultation is with a salesperson rather than a medical professional. Surgery – indeed any cosmetic intervention – is a serious step and a patient must be told about the immediate side-effects after surgery as well as any potential long-term effects on their health."
Peter Walsh, chief executive of the patient safety charity Action Against Medical Accidents, which has long urged ministers to act, said: "The cosmetic treatments industry is a murky industry which preys on people's insecurity or vanity and is badly in need of better regulation.
"The suggestions for clamping down on aggressive and misleading marketing and requiring proper consent are very sensible, but the government must not shy away from the need to bring in statutory regulation of all treatment which can cause serious harm, and a guaranteed compensation scheme for those who have been harmed by negligent treatment or faulty products. It is a scandal that treatments such as cosmetic laser treatment, Botox or dermal filler injections are unregulated."
Katherine Murphy, chief executive of the Patients Association, said the rise in cosmetic surgery for non-medical purposes in recent years meant the report was welcome but long overdue: "The life-changing consequences of cosmetic surgery make it important that vulnerable and frequently ill-informed people are not victim to aggressive marketing techniques. For patients and the public to have confidence in those providing services, they require meaningful information they can understand and relate to. They need to make sure they understand the medical professional looking after them has the appropriate skills and latest techniques, and paramount to the safety of the patient is written consent."
Sally Taber, the director of Independent Healthcare Advisory Services (IHAS), which represents many major cosmetic treatment providers, said aggressive sales techniques for cosmetic surgery "are not appropriate". She also backed a ban on free consultations and supported consultations with medical professionals.
Taber added that IHAS guidance already outlaws two-for-one deals and procedures being offered as competition prizes – another suggestion from the evidence.
