Friday 2 May 2014

Is Your Clinic/Practitioner Selling You Treatments You Don't Need?

The choice of cosmetic skin treatments is often entrusted to medical and health care professionals, with varying results. How do you know if you are being sold a treatment you don't need?


Guidelines given to doctors & nurses by the GMC/NMC state that treatments should only be given on clinical grounds. However, many practices are guilty of providing inappropriate or unnecessary treatments, products or services to their clients.

Is your clinic or practitioner selling you treatments you don't need?

What does "on clinical grounds" mean?

A medical or health care professional must only provide treatments where there is clinical evidence of a need for such treatments. For example, a visible skin condition. Therefore, offering a BOTOX™ treatment where there are no wrinkles present is not only unethical but also infringes such guidelines.

Furthermore, practitioners must consider the effectiveness and appropriateness of any treatment offered and must undertake a risk assessment too. If a practitioner believes a treatment to be inappropriate or ineffective then it must not be offered to the client.

How do I know if the right treatment has been offered?

Your practitioner is responsible, accountable even for any advice given and any treatment offered. He or she must not offer a treatment where, for example, the condition does not warrant the treatment, where there is insufficient evidence of the condition, or where it is believed that the treatment will be ineffective in treating the condition.

An example of an inappropriate treatment might be a premature BOTOX™ or dermal filler treatment (i.e. administered whilst the effects of a previous treatment are still visible), where a product has been over prescribed (i.e. the effects of the product have reached saturation point and any further product administration is completely ineffective) or where a practitioner charges for a product that is not needed. It can also relate to the selling of creams or lotions which are unsuitable for the condition for which they are prescribed.

In my own clinic I have encountered many clients whom have been persuaded into buying products at other clinics which the practitioner or therapist has insufficient knowledge of in relation to the client's condition.

I have concerns over many non medical or non prescription only 'skin care products' that are recommended and sold by therapists. Advising the public to buy a beauty cream to treat acne, for example is completely unacceptable. Not only would a therapist have no clinical knowledge of acne as a medical condition but they do not have access to any prescription products that are proven to effectively treat this condition.

Some examples of bad practice 

Last week a new client came to our clinic wanting a dermal filler lip enhancement. The lady in question was approximately 30 years old and with almost flawless skin. During an extensive consultation she informed me that a nurse in the Coventry/Rugby area had persuaded her to subscribe to a 2 year course of acid skin peels for a condition of sun damaged skin. However, despite the fact that she had only just began the course there was no clinical evidence of sun damaged skin whatsoever.

In the beauty industry I have witnessed therapists making comparisons between off the shelf skin creams and BOTOX™, a prescribed medicine. This too is unacceptable. A practitioner or therapist should only talk about a product, or products they have qualified knowledge of, including making comparisons between products.

How can I be sure I am getting a treatment or product that I actually need?

As with anything in medical aesthetics a thorough consultation is essential. If your practitioner is not prepared to spend sufficient time with you to explain the choice of treatment, therapy or product and to answer your questions then I would suggest finding another clinic.

Your clinical practitioner demonstrate knowledge of your condition and choice of therapy and should explain why the proposed treatment is appropriate for your condition. By all means do ask him/her exactly what qualifications they have relevant to your condition and treatment offered. If you need further reassurance then ask to see evidence of treatments performed by the practitioner.

If you are being offered a course of treatments then you should be assessed at intervals so that the practitioner can determine the progress and that the treatment continues to be appropriate for your needs.

A word about promotional treatments and packages

"Buy 2 areas of BOTOX and get a 3rd area free!..." "BOTOX save 10% when you bring a friend..." "Free BOTOX when you buy dermal fillers!"

These offers and many others like them are at best unethical whilst some may actually pose a risk to clients seeking treatments. Why? Simply because prescription medicines such as BOTOX™ must only be given following a face to face consultation. Furthermore, NHS boss Prof. Sir Bruce Keogh has also spoken of his desire to bring an end to unethical promotion of prescription medicines.

The key to many of these bad practices is predetermination.

What is predetermination and why does it matter?

Predetermination occurs when a practitioner agrees to supply, administer or prescribe a product to a client before conducting a face to face consultation. It may also relate to packages or promotional sales of treatments as these treatments are "sold" thus the practitioner is potentially discounting other more appropriate treatments.

The questions which need to be answered are how can it be determined that these "packaged" or "sold" treatments are in any way appropriate for "all clients" and how they can be determined as suitable for clients' whose conditions have yet to be examined by a qualified practitioner.

Other considerations

If getting the right treatment for your skin is important to you then arrange for a paid consultation with a suitably qualified medical aesthetics practitioner or dermatologist. Consultations should not cost as much as £100 or £150 but for less than half that amount you could get a proper diagnosis and avoid further unwanted expenses from unnecessary treatments later on.

About the author:

Helen Bowes is an experienced advanced medical aesthetics practitioner and critical care nurse. She operates 11 specialist skin clinics across England and Wales providing some of the most advanced dermal filler procedures in the UK. Helen is the only practitioner in the UK to have clinically developed her own advanced dermal filler systems for lips, cheeks and non surgical facelift. These unique treatments are exclusive to Skin Beautiful clinics.

Skin Beautiful Medical & Cosmetic Clinic was one of the first in the UK to undertake Allergan Juvederm certification for Vycross dermal fillers: Volbella, Volift and Voluma and remains one of very few UK clinics with specialist medical aesthetics qualifications and certification for every treatment provided.

Skin Beautiful clinics are held at Exeter, Milton Keynes, Bristol, Coventry, Swansea, Warwick & Stratford, Daventry, Evesham, Carmarthen, Llanelli and Neath

Links:

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Advanced Dermal Filler Systems by Helen Bowes
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Sunday 28 July 2013

Botox & dermal fillers: Are doctors & nurses honest about qualifications?

Why many 'fully qualified' doctors and nurses are misleading the public over Botox & dermal fillers qualifications

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.

How honest are UK doctors and nurses about qualifications?

Government commissioned report: Critical of doctors, nurses who lie about their ability and/or qualifications in aesthetics including Botox & dermal fillers


Professor Sir Bruce Keogh, the NHS medical director in England, in his report into the review of reconstructive and cosmetic interventions raised high level concerns at those who call themselves 'aesthetics practitioners.'

He further criticises doctors, dentists and nurses who call themselves 'specialists', 'consultants' or 'best placed' in aesthetics especially where they have no qualifications or formal training.

Under the microscope

Doctors, nurses, aesthetics practitioners and their qualifications

The number of doctors and nurses in the UK who claim to be 'fully qualified' is significant. The number who claim to be fully qualified and have neither received any aesthetics training or hold any aesthetics qualifications is frankly astounding!

For many, their reference to being 'fully qualified' relates only to a medical or nursing degree. Furthermore, some nurses, especially RN's do not even hold a nursing degree. So to claim to be 'fully qualified in aesthetics' or 'fully qualified in Botox and dermal fillers' is not only deceptive, but also highlights practitioners' using an academic qualification (often taxpayer funded) completely out of context. The NMC own code of conduct outlaws the practice of nurses claiming to be qualified where they do not hold an official post or qualification.

Claims made by UK doctors (GP's) in medical aesthetics practice

"All our doctors are registered with the General Medical Council"
Well, I should hope so too. Otherwise how would they be obtaining the Botox and/or dermal fillers in the first place? The GMC do not provide any training, qualifications, accreditation or certification to doctors practising aesthetics. I therefore question the purpose and validity of such a claim in reassuring the discerning public over injectable aesthetics treatments such as Botox or dermal fillers.
"All treatments are carried out by our expert medical doctor"
An expert medical doctor is not an expert specialist aesthetics practitioner.
"Only fully trained and qualified doctors should be trusted with these treatments"
This statement is frankly nothing short of pure and unadulterated deception. A GP with an medical degree knows absolutely nothing about aesthetics. A medical degree is awarded on the basis of knowledge of disease and medicine.
"...our skilled medical Doctor, Dr XXX XXXXXX offers an extensive range of simple non-surgical treatment....Speak to our specialists today"
Again, potentially deceptive. Skilled in medical practice, perhaps, but that is not transferable to aesthetics. A doctor calling him/herself 'skilled' because of a medical degree does not qualify him/her as a 'specialist' in aesthetics. Just another way of deceiving the public.

Many of these claims are simply a case of doctors using their medical qualifications to warrant their existence in aesthetics practice. Of course, there are many excellent doctors in aesthetics practice. That is not the point here. It is about using a qualification and title out of context to to gain trust in the general public.

The prevalence of this practice amongst certain groups of aesthetics practitioners suggests complacency over one's title. As if to say 'I'm quite well qualified thank you and so don't need an aesthetics qualification!' It should come as no surprise then that a much lower percentage of doctors attend specialist medical aesthetics training courses than nurses do before setting up clinics to provide Botox and dermal fillers treatments.

Do the facts support the doctors' claims?

Are doctors really best placed to provide these treatments?

Not only do nurses represent the largest contingent of aesthetics practitioners in the UK, but are also the largest contingent with specialist medical aesthetics training and qualifications.

Furthermore, figures provided by the British Association of Cosmetic Nurses (BACN) suggest that at least 54% of all dermal filler treatments in the UK are provided by nurses, versus just 13% by doctors. The figure for nurses to include those that work non independently (i.e. within clinics) is estimated at over 70% for dermal fillers. Similarly, nurses provide more Botox treatments in the UK than all other groups combined, at 52%. In 2009, 40% of all dermal fillers purchases in the UK directly from manufacturers was made by nurses.

Given the above figures and the huge volumes, one might expect the highest number of incidents, claims and injuries of Botox and dermal fillers treatments to be from nurses. However, nurses represent only 14% of paid insurance claims. Furthermore, the leading medical aesthetics insurance company reported only 10 complaints made against nurses for dermal fillers treatments in the past 5 years.

General practitioners often refer patients to specialists and specialist nurses for treatments and therapies outside of their normal practice. In contrast, it is almost unheard of for a GP to refer a patient to a certified medical aesthetics practitioner for an a Botox or dermal fillers treatment. On occasion when I see an experienced doctor from general practice promoting him/herself as a leading authority in aesthetics without mention of independent medical aesthetics qualifications then I am always highly sceptical.

What about our own clinic?

I could not possibly be so hypocritical as to write this article without making reference to my own clinic 'Skin Beautiful.' We often refer to our clinic as 'advanced' and 'expert' Why? Simply because I hold independent industry leading advanced medical and cosmetic aesthetics training and qualification certificates. I also have a registered advanced practitioner number from the medical aesthetics training company who certified me. This is something I would strongly urge all clients to request before trusting a practitioner with an advanced treatment.

The advantage of the practitioner registration number is that any potential client may (and I hope many will) contact my training company to verify not only my qualifications but also my ability to perform advanced Botox & dermal fillers treatments.

...and the 'expert' bit

The advanced training is and qualification is quite simply just that. The practitioner attends a taught course, performs a range of advanced Botox & dermal fillers treatments and if the standard is acceptable to the awarding body then a certificate is awarded. It's very much like a taught undergraduate degree as opposed to a post graduate research degree where the student must invent, discover and/or improve upon existing methods in his/her field of expertise.

That's exactly what we've done. Science is evolutionary, and we're not a clinic to rest on laurels. Over the past 6 months we have been busy analysing and evaluating existing dermal filler treatments and techniques. From this point we have clinically developed our own dermal filler treatments. These treatments involve techniques quite unlike any other clinic or practitioner offers. Additionally, the treatments offer a noticeable improvement on traditional lip enhancement and cheek augmentation.

The treatments are:
LIPS! by HELEN BOWES®
CHEEKS! by HELEN BOWES®

Aesthetics is a science and if we all claim to be advanced practitioners then there needs to be some advancement from within. Otherwise, as new innovative products reach the market then many practitioners who rest on their laurels will be left behind.

About the author:
Helen Bowes RGN, BSc (hons), AMAP is a qualified advanced medical & cosmetic aesthetics practitioner and clinical director of Skin Beautiful Medical & Cosmetic Clinic. Helen provides advanced Botox & dermal fillers treatments at clinics in Exeter Milton Keynes Bristol Coventry Swansea Warwick Daventry Carmarthen Llanelli and Neath.

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Friday 10 May 2013

Good practice begins with a proper consultation

Good practice begins with a proper consultation. How should cosmetic consulting for Botox & dermal fillers be done correctly?

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.

Judging your practitioner

Before you agree to an expensive Botox or dermal filler treatment it's important to know that your practitioner is knowledgeable in the procedure and in the products being injected (implanted) into the skin.
The right time and place to judge the level of competence of the practitioner is during the consultation. There are a few basic principles that simply must be adhered to. As a client you are paying not only for a cosmetic Botox or dermal fillers treatment, but also for the expert advice of the practitioner.

Obtaining informed consent

Consultations should be extensive. So much so, in fact, that the treatment time should equate to only a fraction of the total appointment time. Any practitioner offering a cheek augmentation or lip enhancement in 30 minutes cannot possibly be performing an appropriate consultation. Consultations should begin with a discussion about your expectation(s) to include treatment options and information about those treatments including types of products, their properties and limitations.

If a practitioner cannot explain these basic principles then it is likely that the client will be left not fully understanding the proposed treatment. By explaining everything about the proposed treatment, the products involved and client expectations the client can then give informed consent. That is, the client should be empowered by knowledge to make the right choice about any proposed treatments.


Questions to ask your practitioner

In order to determine practitioner knowledge and competence first research information on the proposed treatments. A good place to begin is the website(s) of the manufacturer of the Botox or dermal filler. Here you can learn about product properties, limitations, longevity and possible side effects. This is a good way to help determine your own expectations based on product knowledge. Then during consultation ask your practitioner the following:


  1. Which treatment is best for my condition?
  2. Which product(s) will you use and why?
  3. How does the product work?
  4. How long can I expect it to last?
  5. Can I see your aesthetics qualifications?
  6. How many times have you performed this procedure?
  7. Can I see evidence of your work (e.g. images)
A good consultation will likely include information that answers many of the above questions. A good practitioner should be forthcoming with such information. A consultation is not a sales pitch, and should never be used as one. Instead, it should be a two way interactive process where client and practitioner learn about one another, their expectations, etc before agreeing to an appropriate treatment (if at all).

About before and after images

Many clinics promote before and after images including our own. Whilst I see nothing wrong with displaying genuine images it is extremely important that the practitioner explains the context of these images. That is, the images demonstrate the potential of the product and do not guarantee every client will look exactly as in the after image following a single treatment. I always use my own before and after images where possible. I believe it demonstrates my ability and understanding of a particular procedure more so than giving a false impression of outcome. For example, if I am explaining the intricate procedure of lip contouring to a client then it is helpful to point to an image of a treatment I performed to facilitate this understanding to the client. Generic before and after images do not portray this same understanding and do nothing to demonstrate the practitioner's ability to perfirm the procedure correctly.

What else should a good consultation offer?

A good consultation must also include a complete overview of medical history, lifestyle and assessment of the appropriateness of a cosmetic treatment. This information must be conveyed back to the client too.

Above all, a consultation should allow you, the client to ask a series of questions so that you are happy you have sufficient knowledge to decide whether to proceed with the proposed treatment. Clients should never enter into an agreement for a treatment blindly, putting all faith and trust into the practitioner that the outcome will be OK. This does not demonstrate informed consent.


Blog author: Helen Bowes RGN, BSc (hons), AMAP, BACN

Helen Bowes is a registered general nurse with advanced training and qualification in Botox and dermal fillers procedures. Helen holds regular clinics for Botox and dermal fillers treatments at Skin Beautiful Medical and Cosmetic Clinic throughout England and Wales.

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Friday 28 December 2012

Ten Questions to Ask Your Practitioner

Ten questions to ask your aesthetics practitioner before agreeing to a Botox or dermal filler treatment.

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.

Botox & dermal fillers treatments are expensive and can be highly problematic, even dangerous if not administered correctly.

 On the one hand Botox & dermal fillers treatments can be personally uplifting and a lasting, worthwhile investment. However, many clients don't know what to ask their practitioner before agreeing to expensive treatments.
 

This short guide will help clients seeking treatments to ask the right questions and find the right 'suitably qualified' practitioner.


 

1. What aesthetics training/assessment/qualifications have you taken?

Perhaps the single most important question to ask your practitioner. After all, why are you paying so much money for your treatment(s)?

Firstly, just to dispel any confusion over training and qualifications...

A qualified doctor, dentist or nurse is NOT a qualified medical aesthetics practitioner.
Any suggestion to the contrary is entirely misleading. Please take this into account.


However, a qualified medical aesthetics practitioner must not only be a qualified doctor, dentist or nurse but, in addition, he/she must also carry additional certificates for professional independent medical aesthetics training and qualification. Otherwise who do you think trained your practitioner to inject Botox? Well, it certainly wasn't the university they attended. Nor was it the house doctor or ward sister who mentored them during undergraduate training.

There are so many practitioners practising aesthetics in the UK who have had no formal aesthetics training or qualifications at all. To say to a client "I'm a fully qualified doctor/dentist/nurse" is not good enough. Many doctors and nurses don't routinely use needles, and even then they would know nothing about placement or injection technique with something as specialised as Botox or dermal fillers.

 

2. How much post qualification experience do you have?

Again, a similarly important question and one I would urge you to ask before booking an appointment. Many practitioners promote themselves as "highly experienced" or "best placed" to carry out treatments. If they haven't had formal medical aesthetics training then they are neither highly experienced nor best placed in the true sense of the meaning. Of course, experience is all very well, but not if it isn't accompanied by medical aesthetics knowledge.

As an example of this I recently visited a client whom had been treated with Botox by a "highly experienced" doctor. Unfortunately, the doctor had no aesthetics qualifications which became all the more apparent when the client told me about the treatment. The doctor had not only misplaced the injection(s) but didn't give enough injections either. Had she taken proper medical aesthetics certificates then she would have known not to make these mistakes.

So, do ask not about experience, but post medical aesthetics qualification experience, and, if necessary ask to see certificates too.

 

3. What cosmetic insurance do you carry?

It is absolutely essential that your practitioner has not only insurance, but the right professional cosmetic insurance and enough of it too. A practising doctor with medical practise insurance or a nurse with RCN insurance will not be insured in the £millions for mishaps of the non surgical cosmetic type. So how do I know if my practitioner has the right type of insurance?

A separate professional cosmetic insurance policy should be in place and visible to all clients prior to treatment. Aside from the name and formal qualifications of the practitioner, date and indemnity it should also list the products that the practitioner is insured to use (e.g. Botulinum toxin type A: Botox, Vistabel, Xeomin, and dermal fillers Juvederm, Restylane, Teosyal, Belotero, etc).

 

4. Have you been independently trained and assessed in the treatment I require?

Let's suppose you are seeking a lip augmentation treatment and your chosen practitioner is a 'qualified medical aesthetics practitioner.' A lip augmentation is an advanced aesthetics treatment that requires skill and advanced knowledge, none of which are covered by a basic Botox or dermal fillers training and assessment course. Advanced treatments require advanced independent medical training and assessment.

In some cases practitioners (e.g doctors, dentists or nurses) may have been trained by a pharmaceuticals company to use certain products. One particular problem with this is that there are many dermal fillers on the market whose physical properties are very different from the one they trained with. For example, a practitioner that trained with a non cross-linked filler such as Belotero would not have been trained or assessed to work with a cross-linked dermal filler such as Teosyal.

Some aesthetics companies manufacturing dermal fillers offer free training courses for doctors and nurses working in aesthetics clinics and in return expect the clinic to use only their product. This leaves the practitioner with no knowledge of other products, and unable to offer impartial advice to clients seeking treatment. As for the treatment itself, where an unfamiliar filler is used there may be a certain amount of guess work involved if the practitioner has no qualified knowledge of the filler's physical properties.

 

5. Can I see some examples of your own work?

I cannot stress enough how important this is. You need to see before and after images of the very treatment you are seeking where the treatment was recently carried out by the practitioner. Generic images (widely available across the internet) are not sufficient. Authentic before and after images not only prove the practitioner has experience of the treatment you require but also his/her relative skill/competency level.

 

6. Which product(s) do you use and why?

This question is a good way to determine whether the practitioner was independently trained in the medical aesthetics industry. I know of many doctors in the industry that use only Restylane dermal fillers and only Botox or Vistabel botulinum toxin type A. These are all quality, licensed products, but there are others on the market that may in be better suited to individual clients.

It is also a good way to test the practitioner's knowledge of not only his/her products but also the field of aesthetics too. Some practitioners may use only one type of dermal filler because they don't know anything about other types.

 

7. How much product will you use?

This question really must be asked every time you have a treatment. Not only do you want to know that you will receive the right amount of product as per prescription (if applicable), but also as a way to evaluate total cost of the treatment. A cheap initial treatment can quickly become a very expensive overall treatment if the practitioner charges you for additional product or "top up treatments."

Professionally, I would advise that clients should receive either a full syringe of product in one treatment, or, at the advice of the practitioner should receive a lesser amount with the option of a fortnightly review and free top up from the original syringe.

 

8. How long will the treatment(s) last?

For your investment you are going to want to know that the treatment will last a reasonable duration. This is another way to judge your practitioner's knowledge of aesthetics products.
Generally speaking a botulinum toxin type A treatment (Botox, Vistabel, BoCouture, Azzalure) administered as a wrinkle reducing treatment should last beyond three months. However, any practitioner giving guarantees of longer durations may not understand the scientific nature of Botox in the body. Shortly after three months neuromuscular function is restored and muscles are again contracting. It is only a matter of time before the lines and wrinkles reappear. No guarantees over this should be given as it is a matter not determined by the action of Botox on the neuromuscular system.

Some practitioner may tell you that the effects of Botox injections can last for up to 6 months. I believe this advice to be accurate as the operative word here is "can" and not "will." Perhaps the best guide to longevity is 3-6 months.

With dermal fillers clients should expect a minimum of 6 months and possibly longer. Some dermal fillers can last for as long as 18 months, but these are normally of the semi-permanent type, and are more costly to have treatment for. Professionally I advise 6-9 months for most dermal fillers.

 

9. What happens if I need more product?

...or, you could just ask: "Do you offer free top up treatments?" However if the answer is "No" then you need to know what the alternative is. It's about evaluating the total cost of treatment. Whilst I would advise caution where practitioners charge high prices and offer free top up treatments (especially where a top up is not required) I would equally advise caution against cheap treatments where no free top up treatment is offered. Clients should by paying only for the product they need and not paying for what they don't need (expensive treatments with optional free top up).

Of course, clients would expect to pay additional money where they decide to have fuller cheeks of lips. No practitioner is going to offer a free syringe of dermal fillers. However, it is the duty of practitioners to make clients aware of exactly what they are being charges for.

Ask your practitioner to advise you on the overall cost of treatment including a top up where it is necessary.

 

10. What is your medical background?

By asking this question one can determine whether the practitioner is actually a beautician or therapist administering Botox or dermal fillers as opposed to a doctor, dentist or nurse. Beauticians will not be medically insured and will not be able to obtain medical supplies legitimately from pharmacies or pharmaceutical suppliers.

Go one stage further and ask not only about training, but also about academic qualifications. Many older and highly experienced nurses in the UK have no university degrees or diplomas even. This does not necessarily detract from their ability to deliver aesthetics treatments, but it may be worth noting that some independent medical aesthetics training companies will not accept nurses without a formal academic nursing qualification. Furthermore, there are many qualified nurses that have little if any exposure to dealing with complications in daily practice. Botulinum toxin type A injections can lead to complications. It is important that your practitioner knows how to deal with any that arise quickly and competently.

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Friday 16 November 2012

Botox - How Qualified is Your Practitioner?

Is your medical aesthetics practitioner suitably qualified to administer your Botox or dermal filler treatment? Many aren't. This article explains why.

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.


Experienced doctor, qualified GP, registered dentist or trained nurse. Which one is qualified to administer Botox or dermal fillers?

The answer is none of them! It may come as a surprise, given the way in which many doctors, GPs and nurses advertise their aesthetics services that many have no independent training or qualifications in administering injectable Botox or dermal fillers.


Whilst Botox (botulinum toxin type-A) is a prescription only medicine and is therefore prescribed by a doctor, dentist or nurse prescriber this tells us nothing about the actual process of injecting or administering the product. Ironically, a GP may promote Botox in such a way as "All injections by a fully qualified GP" and yet during a normal GP surgery he/she would delegate the task of routine injections to a practice nurse.

This scenario becomes all the more ironic when considering that Botox and dermal fillers require specialist knowledge regarding placement and injection technique and yet a doctor who doesn't even inject flu jabs is somehow able to offer Botox injections.

Fully Qualified!

What exactly does this mean? It would probably be better for your GP or nurse to answer this question, but I will attempt to interpret the hidden small print.

In most cases where a doctor or GP makes reference to qualification then it should be interpreted as being qualified as a medical doctor. The same applies to dentists and nurses whom claim to be either 'registered' or 'qualified.' For example, a registered nurse (without a nursing degree) or registered general nurse (having a BSc. degree in nursing).

In addition, some doctors, GPs, nurses and dentists also mention 'registered with GMC, NMC, GDC, etc.' This is in reference to the governing council of whichever field they practice in. For example, a GP would have to be registered with the General Medical Council to practice. Similarly a nurse would have to be registered with the Nursing & Midwifery Council to practice on a hospital ward, as a health visitor, etc.

Fully Unqualified Practitioner

I'm sure by now you will have noticed the absence of any suggestion of being a 'qualified aesthetics practitioner.' This is quite blatant. Many GPs will point to their medical qualifications to reassure the client. That is until the client asks what training and qualifications they have in aesthetics. This is a question I once posed to an anonymous GP run 'skin clinic.'

A lady client had approached me following a treatment at another clinic and complained about results from a recent cheek augmentation. She wanted to disclose the name of the clinic to me and I called to enquire about a treatment. When I asked about the practitioner I was told that a fully qualified GP would be performing the treatment. When I further asked about his aesthetics qualifications I was told that he was fully qualified in all non surgical procedures. However, when I asked which medical aesthetics company trained the GP I learned that he had received no training or qualifications in aesthetics whatsoever. I politely told the receptionist that I would not be wanting treatment from a practitioner that has never been trained with Botox or dermal fillers.

Questions to Ask Your Practitioner

If you are considering investing money in a non surgical treatment then you have every right to know about the training and ability of your practitioner. Firstly, ask how they learned to inject Botox & dermal fillers and ask who trained them. Then ask what qualifications they have in aesthetics.

You want to know for certain before any treatment commences that your chosen practitioner has received training and is qualified in the exact procedure being given. It is of little comfort to know that a practitioner has attended a short half day course and watched a demonstration of frown lines being treated when you are wanting an advanced procedure such as a jaw definition or cheek enhancement.

Recognised Qualifications

A practitioner that is properly qualified will have been trained and systematically examined by a trainer when performing a live, unassisted treatment. Only once the trainee has proven to be competent in all procedures then a certificate is awarded. It is evidence that a practitioner can perform a treatment safely and correctly.

There are several medical and aesthetics training companies in the UK. A respectable training company will require a minimum nursing, dentistry or medical degree and post qualification practice before enlisting applicants. They will also require trainees to prove their ability in injecting for every treatment that the training course requires before issuing a certificate.

On completion of the course(s) the certificate will provide evidence of a practitioner's ability to perform a treatment in a safe and professional manner. A certificate should also carry a practitioner number too.

**An important note about aesthetics certificates**

A certificate in administering Botox and/or dermal fillers is a document providing evidence that the practitioner has performed relevant treatments unassisted and satisfied the examiner(s) in his/her ability and competence in performing these treatments. This is not the same as a certificate of attendance on a training course where delegates sit and watch routine demonstrations by an demonstrator.

There are many different aesthetics training courses for Botox and dermal fillers throughout the UK, ranging from half day demonstration courses to full 3 or 4 day medical assessment courses. A certificate of attendance is not a certificate of examination and provides little, if anything in terms of evidence of the competency and suitability of the practitioner to administer Botox or dermal fillers.

In support of Safe and Ethical Treatments

There are many doctors, dentists and nurses whom deliver a very high standard of professionalism in aesthetics. This blog in no way constitutes an attempt to single out certain types of practitioner. It was written in an attempt to inform the general public seeking Botox or dermal fillers treatments as to the meaning of 'fully qualified' and how it should apply to aesthetics.

As a qualified advanced medical aesthetics practitioner I understand that when a client approaches me wanting a treatment that it is my professional obligation to ensure the client knows exactly who I am and how suitably qualified I am to perform the required treatment.

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