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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Skin Beautiful Medical & Cosmetic Clinic
About Helen Bowes RGN, BSc (hons), AMAP

About Botox (Botulinum toxin type A)
About dermal fillers
Botox & dermal fillers treatments

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