The DDU’s Jo-Anne Taylor looks at the issues that can crop up when providing facial aesthetics treatments in the last in her series on cosmetic treatments.
Many dental practices now offer non-surgical cosmetic procedures intended to enhance patients’ appearances and confidence. Dental professionals’ anatomical knowledge and technical skills make them ideally placed to undertake this work. However, they need to be aware of the associated dentolegal risks.
Case study
The following fictional scenario shows what can go wrong:
A practice decided to extend its services to include Botox and dermal fillers after taking on an associate with an interest in facial aesthetics. They had a certificate of completion on a training course and two years’ experience at their previous practice without incident.
The practice advertised its new services in its e-newsletter and on social media. For the first month, all was well. But then a patient who had received injections to the area around her eyes, forehead and mouth called. They complained of drooping in their left eyelid and said they felt embarrassed to leave the house.
An investigation revealed that the associate had made unrealistic claims to the patient about the effects of the treatment. They had assured them they would ‘look a million dollars’. Their notes made no reference to warning the patient about the risks.
While they accepted the practice’s apology and refund, the patient took to social media to discuss the experience. The practice decided to pause the service to avoid bad publicity and the associate left shortly afterwards.
DDU analysis
The DDU has opened less than 10 files between 2019 and 2022 where botulinum toxin injections or dermal fillers were provided, and one claim has been settled to date. While this is a small number, we expect cases to increase as facial aesthetics treatment grows in popularity, particularly among the under 30s (The Guardian, 2022).
Members of the British College of Aesthetic Medicine reported carrying out 315,000 botulinum toxin procedures and 282,960 filler procedures in 2022, double that in the previous 12 months (BCAM, 2023).
However, a Report by the All-Party Parliamentary Group on Beauty, Aesthetics and Wellbeing (APPG, 2021), warned the ‘explosion in treatments has also brought with it some cases of poor service outcomes for consumers’.
Causes for concern
While the number of cases is comparatively small to date, so-called ‘tweakments’ are a growing market. It is important that dental professionals who want to break into this market follow best practice to avoid tarnishing their professional reputation.
1. Legal age restrictions
Practices should confirm the age of patients who enquire about facial aesthetics treatment. Under the Botulinum Toxin and Cosmetic Fillers (Children) Act (2021) it is a criminal offence in England to administer botulinum toxin or a subcutaneous, submucous or intradermal injection or filler for cosmetic reasons to a person under the age of 18.
This applies even if the patient has permission from someone with parental responsibility. It is also an offence to book appointments or make arrangements to provide treatment to anyone under the age of 18.
2. Advertising
All marketing material must comply with the law, ethical standards and the Committee of Advertising Practice (CAP) code. The CAP has produced advertising guidance on cosmetic interventions which explains how the code applies to the marketing of surgical and non-surgical cosmetic interventions (CAP, 2021). The Advertising Standards Authority (ASA) has the power to demand the withdrawal of adverts which breach the code.
Most importantly in this context, practices should take care not to directly or indirectly promote botulinum toxin injections to UK consumers as this is a prescription-only medicine. The Human Medicines Regulations (2012) prohibit the publishing of an ‘advertisement that is likely to lead to the use of a prescription only medicine’. However, the CAP says it’s permissible to make non-specific references such as ‘consultations for the treatment of lines and wrinkles’.
Practice websites can include information about the product as a treatment option, but this should not be on the homepage. It should be ‘presented in the context of the promotion of a consultation where a range of options would be discussed’.
More generally, the GDC’s Guidance on Advertising (2013), covering online and print material, states: ‘Advertising that is false, misleading or has the potential to mislead, is unprofessional, may lead to a fitness to practise investigation and can be a criminal offence.’
It emphasises the need for ‘balanced, factual information’ so patients can make informed choices about their treatment.
3. Communication
Careful assessment of potential patients is important. Be aware that people seeking out cosmetic treatment may be psychologically vulnerable. They may have unrealistic expectations of what difference the treatment might make to their lives.
Try to find out what the patient expects and have an honest and open conversation from the outset. They should be fully informed about what the proposed treatment involves. For example, the costs, risks, benefits and the alternatives, including delaying or not proceeding with the treatment at all.
Dentists should not make unrealistic promises. They should say no to patients if they believe treatment is not suitable or in their best interests, rather than set themselves up to fail.
Give patients the opportunity and time to ask questions. Consider a cooling off period after an initial consultation so they can consider their options. As with all treatment, make a complete, clear and contemporaneous record of the discussion.
4. Scope of practice, training and indemnity
The GDC expects dental professionals to be trained, competent and to meet its ethical standards in any treatment they carry out. Its Scope of Practice (2013) includes ‘providing non-surgical cosmetic injectables’ as an additional skill that a dentist can acquire post-qualification, and it would expect a dentist to be trained and competent before they start treating patients.
Dentists are responsible for choosing an appropriate training scheme. Reputable training providers will set out clear anticipated learning outcomes, use suitably qualified trainers and have established systems of quality control. The Joint Council for Cosmetic Practitioners (JCCP) has a register of approved education and training providers (as well as practitioners).
5. Working with others
Dentists are the only member of the dental team who have prescribing rights for prescription-only medicines such as botulinum toxin (dermal fillers are not a prescription-only medicine, although it was recommended by the APPG (2021)). However, they might be asked to prescribe a prescription-only medicine for administration by someone else.
Any dentist who prescribes a prescription-only medicine for administration by a third party must be appropriately trained and competent in its use. They should carry out a full medical history and clinical assessment of the patient’s suitability.
The GDC says: dentists ‘must not remote prescribe (for example via telephone, email, or a website) for non-surgical cosmetic procedures such as the prescription or administration of Botox or injectable cosmetic medicinal products.’
In principle, the GDC would not disapprove of a dentist practising alongside another registered healthcare professional although expert legal advice and a written contract are advisable. Any professional association between a dentist and beautician or beauty salon, might be harder to justify.
6. Reflective practice
As with any area of dentistry, it’s incumbent on dental professionals to maintain their clinical standards in facial aesthetics, as well as reflecting on what can be learned from adverse incidents.
It may help to join a register of accredited practitioners such as those overseen by the JCCP or Save Face (which is accredited by the Professional Standards Authority). Both organisations have a defined assessment process for practitioners and produce standards and guidance for registrants.
For references email [email protected].
For more information visit www.theddu.com.
