Complications from medical cosmetic tourism result in costs to the NHS

While many patients venture outside of the UK for cosmetic surgery, due to the significant cost of private care in the UK, there is also a lucrative business for non-invasive aesthetic treatments abroad. In the UK, botulinum toxin injections or dermal fillers cost about £150–£350 per session, depending on the amount of product used (NHS Choices, 2016a). Chemical peels cost about £60–£100 for mild peels, with deeper treatments often costing over £500 (NHS Choices, 2016a). The cost of cosmetic micropigmentation varies from £75 for a beauty spot to £500 for lip liner (NHS Choices, 2016a). Microdermabrasion costs £40–80 for a single session (NHS Choices, 2016a).

By contrast, costs for treatments abroad can be substantially cheaper. For example, prices for botulinum toxin can be as low as £40 in Thailand, £50 in the United Arab Emirates and £60 in the Czech Republic (MEDIGO, 2017a). Chemical peels start from £22 in Thailand, £44 in Turkey and £45 in Malaysia (MEDIGO, 2017b).

Complications of non-surgical cosmetic treatment

Complications arising from non-invasive cosmetic treatments are less common and often less severe than those from surgical procedures. However, there is still a notable element of risk involved.

The most common complications from botulinum toxin and soft-tissue filler injections are bruising, erythema and pain (Levy and Emer, 2012). Erythema is also not uncommon following chemical peels, as well as irritation and burning (Levy and Emer, 2012). These side effects are generally temporary and easy to treat. More serious complications include muscle paralysis from botulinum toxin, granuloma formation from soft-tissue filler placement, and scarring from chemical peels (Levy and Emer, 2017).

Issues regarding regulation

In 2013, Sir Bruce Keogh was asked to undertake a review into the regulation of cosmetic interventions in the UK. It revealed that non-surgical interventions were almost entirely unregulated, with no restrictions on who may perform procedures (Department of Health (DH), 2013). This poses a significant risk to patients, as without accredited training, practitioners are unlikely to recognise complications of the procedures, or be able to treat them. The review committee therefore recommended approved training schemes were introduced, as well as accredited qualifications, and associated registers for both surgical and non-surgical cosmetic procedures.

The DH (2014) provided a response to this review, largely accepting many of the recommendations, but did not believe a new regulated profession for those performing cosmetic procedures should be introduced, as many practitioners were already members of professional registers and so subject to regulation. In 2015, Health Education England (HEE) unveiled new qualifications to improve the safety of non-surgical cosmetic procedures (HEE, 2015), but again did not go as far as to establish legal requirements for the administration of non-surgical cosmetic interventions.

Issues concerning regulation for non-surgical cosmetic interventions also exist in other countries. Due to differences in standards and qualifications, it can be difficult to establish the suitability of a practitioner to carry out an intervention. In Europe, dermal fillers are regarded as medical devices requiring only Conformité Européenne certification (Hachach- Haram et al, 2013). It is only in the US that dermal fillers are seen as medicines and are therefore required to be approved by the US Food and Drug Administration (Hachach- Haram et al, 2013).

Whose responsibility is follow-up care?

Follow-up care is an important part of treatment, particularly in the case of cosmetic surgery. The NHS advises that when making enquiries about treatment abroad, it is important to know how complications would be handled, what would happen if revision surgery was needed after the original procedure, and how much it might cost (NHS Choices, 2016b). Unfortunately, all too often the expectation in the UK is that if something goes wrong, the NHS will sort it.

It is believed the cost to the NHS of fixing botched botulinum toxin injections could be as much as £1 million a year (Savage, 2016). However, because of a lack of data, it is difficult to accurately gauge the cost to the NHS of fixing cosmetic complications, or to establish the numbers of complications attributable to UK private care, treatment abroad or self-administration.

It has been questioned whether cases should be considered individually, whether guidelines and standards of treatment need to be outlined, or whether treatment by the NHS should be strictly limited to acute cases only (Hachach-Haram et al, 2013).

Additionally, there is limited knowledge of public attitudes towards the regulation and safety of treatment. People considering this type of treatment need to be aware of the risks and thoroughly research the practitioners who will be carrying out their treatment. Many websites offer holiday packages of treatment, travel and accommodation, but can be misleading in what it is they are providing.

It is clear that tighter rules regarding regulation are needed globally, along with clear outlines of practitioners’ aftercare responsibilities and improved education around the possible risks for prospective patients. Without this regulation, it is evident the NHS will continue to pick up the bill when things go wrong.

References

Department of Health. Review of the regulation of cosmetic interventions: final report. 2013. https://tinyurl.com/b8qq6ek (accessed 11 January 2018)

Department of Health. Government response to the review of the regulation of cosmetic interventions. 2014. https://tinyurl.com/nnjvlym (accessed 11 January 2018)

Hachach-Haram N, Gregori M, Kirkpatrick N, Young R, Collier J. Complications of facial fillers: resource implications for NHS hospitals. BMJ Case Rep. 2013; pii: bcr-2012-007141. https://doi.org/10.1136/bcr-2012-007141

Health Education England. Qualification requirements for delivery of cosmetic procedures: non-surgical cosmetic interventions and hair restoration surgery. 2015. https://tinyurl.com/z43cs8s (accessed 11 January 2018)

Levy LL, Emer JJ. Complications of minimally invasive cosmetic procedures: prevention and management. J Cutan Aesthet Surg. 2012;5(2):121– 132. https://doi.org/10.4103/0974-2077.99451

MEDIGO. Botox injections and wrinkle treatment at clinics and hospitals worldwide. 2017a. https://tinyurl.com/yd3xzu34 (accessed 11 January 2018)

MEDIGO. Chemical peel at clinics and hospitals worldwide. 2017b. https://tinyurl.com/ycwe3y72 (accessed 11 January 2018)

NHS Choices. Your guide to cosmetic procedures. 2016a. https://tinyurl.com/yae8sdyt (accessed 11 January 2018)

NHS Choices. Your guide to cosmetic procedures: Cosmetic surgery abroad. London: NHS Choices; 2016b. https://tinyurl.com/ydckt79p (accessed 18 January 2018)

Savage M. Up to £1m a year spent fixing bad Botox. 2016. https://tinyurl.com/y7dfn9jh (accessed 11 January 2018)

Taken from Journal of Aesthetic Nursing, published February 2018.