Performing non surgical aesthetic procedures must be under responsibility of an accredited and qualified clinical professional. Non- health practitioners with required accredited qualification may perform the procedures but under supervision of qualified clinical professional. this is to make sure the safety of people who are seeking cosmetic and aesthetic procedures in order to enhance their skin and well being. The Aesthetic industry need regulating body to empower delivering safe cosmetic procedures. For any non surgical intervention a record of consent is necessary (must) Advertisement should be conducted in a socially responsible manner.

1. Dr. Faramarz Didar
CEO, Cosmetic Facial UK Limited
www.cosmetic facial.co.uk
info@cosmeticfacial.co.uk

2. • 2005 sir Harry Cayton (regulation of cosmetic surgery)
Increasing specialist training and○
accountability
• Provision of cosmetic surgery in England ( healthcare
commission 2007)
• Good Surgical Practice 2008
• Good Medical Practice in Cosmetic procedures
Independent Healthcare Advisory Service 2010.
• NCEPOD (National Confident Enquiry into patient
Outcome and Death 2010
Lack of appropriate facilities○
Surgeons competence○
Lack of information for patients to understand○
risks of procedures.
• RCS published this year Professional Standards for
Cosmetic Procedure

3. • 2005 sir Harry Cayton (regulation of cosmetic surgery)
Increasing specialist training and○
accountability
• Provision of cosmetic surgery in England ( healthcare
commission 2007)
• Good Surgical Practice 2008
• Good Medical Practice in Cosmetic procedures
Independent Healthcare Advisory Service 2010.
• NCEPOD (National Confident Enquiry into patient
Outcome and Death 2010
Lack of appropriate facilities○
Surgeons competence○
Lack of information for patients to understand○
risks of procedures.
• RCS published this year Professional Standards for
Cosmetic Procedure

4.  AuStralian Government in 2010
• New training Standards
• Advertising restrictions
 • Hong Kong : where to draw line between
medical treatment and the beauty one
 • Denmark has introduced new regulation
( who can perform the procedures)
 • Sweden is following Denmark
 • France set new Standards and regulation
in details

5. 1. France has passed the regulation in cosmetic
procedures in 2009.
 2. Main point of concern is cosmetic surgery.
 3. Safety of patients is paramount.
 i.There is a 15 days cooling period.
 a.This is including information about surgical fees and
services
 4. Patient information is consent is a must.
 5. Regulation of surgical facilities
 6.There are restrictions on advertising and
publicities.they all are forbidden!
 7. NSFA needs training and under supervision of a
plastic surgeon.

6.  Non- health care professional can
perform dermal filler ,weaker chemical
peel and IPL but no botulinum toxin
injection,microdermabrasion or
sclerotherapy
 1) They should hold recognized beauty therapy
qualification
 2) To demonstrate their competent
 3) Qualification should be recognized by Denish
Health Board
 4) The doctor employed them should deem their
 competent too.

7.  a-Practitioners should be register with Denish
Health board and pay1850 pounds per year:
 b. Non-surgical cosmetic procedures like
botulinum toxin injection,dermal fillers
injections , lasers or IPL,chemical peel should
be performed by:
 i. Consultant dermatologist
 ii. Plastic surgeons
 iii. Ophthalmologist and neurologist for
Botox
 iv. Nurses and junior doctors can performs
all of them but undersupervision and the
consultant remains responsible for the
procedure or any complication.

8.  1. OTC in EU is classified as cosmetic in USA
 2. New development of cosmetic regulation in
 EU.(pharmaceutical affair law):
• a. Drugs,quasi drugs or cosmetic.‐
 3. No license needed in EU or USA for manufacturing
,distribution and importation.
• a.These are license in Japan
 4. Homogenization of EU and USA' cosmetic regulation
is possible:
• a. Japan needs more serious commitment to achieve
this harmonization .

9. Safety and quality
 • To act in case of concern on patient safety
 • To protect patients and public
 1.To improve and promote patient safety via quality
assurance
 2. Regular clinical audits including feedback from patients
 3.To report adverse incidents either via using a device or
products as well as suspected events.
 4.To contribute to to confidential enquiries.
 5.To co- operate with other organization dealing with public
health.
 6.To seek advice from colleagues or defence body if any concern
regarding performance of colleague (not fit for practice and put
patients at risk)
 7.To consult a colleague if Any concern regarding health and
performance of ours
 8.To be immunized against common serious contagious disease.
 9.To be registered with a GP .

10. Knowledge ,skill and performance
License to practice
 • Must have a license to practice
 • Should be registered with GMC AND other
regulating body
 • Must demonstrate the confidence and
knowledge through appraisal and revealideation
process.
Professional performances
 1. Competent in all aspect of work
 a. Management
 b. Research
 c.Teaching


11. Knowledge ,skill and performance
To keep professional performance up to
date
 a. Participate in activities to maintain and
develop it
 b. Mentoring
 c. Up dated with guidelines and
knowledge
 d. To monitor and improve the
quality of care

12. Applying knowledge and experience to the NSFA
a. Practice in the limit of competence
 b.To provide a high quality of care
 c. To provide advice, treatment and investigation if
necessary
 d.To prescribe the medication when needed with
taking patient needs into consideration
 e.To provide the best suitable treatment based on
available evidence.
 f.To consult colleagues as needed
 g.To get the consent before implementation or
involving in patients in a research project.

13. Safety and quality, Knowledge ,skill and performance,
4. Record keeping
 a. Clear,accurate and legible records
 b. Confidentiality and data protection
 c. clinical records should include:
 i. Clinical finding with the case
 ii.The decision for treatment
 iii. Provided information to the patient
 iv. Medication or other investigation

14. Communication ,partnership and teamwork
 1.To listen to the patients
 2.To respond honestly to their question and concerns
 3. Provide enough clear information about the
procedure,complication and out come
 4.With keeping confidentiality in mind providing
information to those close to the patient.
 5. Been access able and available on duty and other
time if any concern or emergency arises
 6.To treat colleagues family and respectfully.
 7.To contribute toward teaching of staff and other
colleague.
 8.To supervise other colleague if needed.
 To explain and justify If refuses to provide a treatment .

15. To treat patients as individual and
respect their dignity
 • To be polite in the treatment procedure
 • To keep patients' confidentiality
 • To provide enough information in order
to help patient for an informed decision
 • To share treatment plan with patients
 • To correlate with colleague in order to
maximize patients' care and therapeutic
plan

16. 1. Not to use professional position in pursuing a sexual relationship with a
patient or close relative
2.To be honest with patients if things go wrong
a.To put matter right
b.To offer an apology
c.To explain fully what happened and what to expect as long and short
term effect.
d. Not to discriminate against patients or colleagues.
e.To response promptly,fully and honestly to complaints
f.To apologies when needed and appropriate.
g.To end a professional relationship with a patient just when the trust is
broken.
h.To have adequate insurance and indemnity cover.
i. To be honest about qualification and experience as well as current role
j.To be honest while designing ,organizing research
k.To be honest on providing information as well as communicating with
colleagues and patients
l. Marketing and advertising should be factual and does not exploit
patients' vulnerability(this emphasis in Keogh report too)
m.To be honest and trust worthy in writing reports and signing forms.
In area of conflict of interest ,to act in the best interest of patient and
community .General

17.  1.The report and review was initiated by PIP implant scandal.
 2. Non surgical procedures accounts for 9/10 of all procedures .
 3. NSA accounts for 75% of market value.
 4. It emphasis the consumer of this market does not have any
protection and so much vulnerable .
 5. It emphasis dermal fillers are particularly the cause of concern
 6.There is no control on fillers in comparison to purchase a bottle of
toilet cleaner.
 7.The commercial income is stalling.
 8. Dermal fillers are a sitting duck.
 9. Previous attempts failed.
 10.The report provide a framework for surgical and non surgical‐
fields.
 11. Practitioners will need to have appropriate skills as well as safe
products.
 12.The report has emphasis on individual safety and health.
 13.There is no balance between the rapidly growth of cosmetic
procedures and existing regulatory framework .

18. High quality care plus safe products(effectiveness,safety)
 i. Fillers as prescription only medical device
 ii. EU medical device to expand to cover all cosmetic
implants including fillers
 iii. UK legislation to facilitate this expansion
 1) To set standard
 2) Formal certification of all practitioners
 3) Training and experiences
 iv. RCS(Royal College of Surgeons) to established an
inter speciality committee on cosmetic surgery
 v. Performers of cosmetic procedures to get registered.
 vi. Record keeping for patients and their GPs
 vii. Skilled practitioners in line with responsible
providers

19.  People to get accurate advice
 ii.Vulnerable are protected
 iii. Accessible redress and resolutions in case
of complications
 iv. Multi-stage consent process for operation in
order to share understanding of desired out
come between patients and practitioners (RCS
to do this)
 v. Patient information leaflet by RCS
 vi. Record of consent for non surgical
procedures
 Advertisement and marketing should be up
dated in a way not to avoid inappropriate
influence on pubic.

20.  Accessible resolution and redress
• Continuity of care should be provided
in the event of complication.
• Insurance schemes to provide support
and reassurance
• Patients' access to guidance and help
in case of dispute resolution.

21.  Current situation
• No restriction on a person performing
• No qualification
• Training course by anyone to offer a qualification
• A number of self accredited training organization have
sprung up.
• Non-medical,non-dental and non- nursing practitioners
were greatly valued by consumers
 No specific accredited training on
• i. physiology
• ii. Anatomy
• iii. Infection control
• iv.Treatment of anaphylaxis
• v. Understanding of co morbidity or per-existing
health problem

22.  1. RCS to stablished Cosmetic Surgery
inter speciality committee:
• a.To set standards for training and practice of
cosmetic surgery
• b. Issuing formal certification of surgeons
• c.To work with PHSO(Parliamentary Health
Service Ombudsman) regarding dispute
resolution
• d. Regular meeting with GMC, CQC and
MHRA(Medicine and Healthcare products
Regulatory Agency)
• e.To develop A specific code of ethic for
cosmetic surgery (advertising, insurance and
psychological Assesment of patients

23.  i.Training necessary to able practitioners to
identify complications and treat them
 ii. Regular trading for practitioners to deliver
latest treatments
 iii.The curriculum and training Requirement
should be reviewed regularly.
 iv. Accountability to a professional regulator in
case of prescribing filler or performing other
potentially harmful non surgical cosmetic
procedures.

24. 2. Performing non surgical aesthetic procedures must be under
responsibility of an accredited and qualified clinical professional.
3. Non- health practitioners with required accredited qualification may
perform the procedures but under supervision of qualified clinical
professional.
4. HEE(Health Education England ) mandate should include the
development of appropriate accredited qualification for non surgical
procedures and its various professional groups.
5. All practitioners must register with annul fee to fund the registration body.
a. Accredited qualification
 b. Premises meeting certain requirements
 c. Code of practice to cover handling complain and redress ,
 responsible advertising and consent practice.
 d. Annual appraisal
6. Criteria to enter to the Registery should be:
• a. Accredited qualification
• b. Premises meeting certain requirements
• c. Code of practice to cover handling complain and redress ,
responsible advertising and consent practice

25. 7. Non- surgical premises subject to inspection by local
authorities.
• a. Awareness of requirement to operate from a safe
premises and responsibility involved.
• b.Training curriculum should include infection
control, treatment room safety and adverse incident
report.
• c. Code of conduct: minimum standards for
premises.
8. UK legislation to make fillers as prescription only
medical device. (EU Medical Device Directive to cover
dermal fillers and all cosmetic implants.)
9. For any non surgical intervention a record of consent is
necessary (must)
10. Advertisement should be conducted in a socially
responsible manner.

26. 11.The following advertisements should
be prohibited
 a.Time- limited deals
 b. Financial inducements
 c. Refer a friend, reduced price for two
people, buy one get one free
 d. Competition prize as cosmetic
intervention

27.  12. Continuity of care and follow up should be
offered
 13. Medical director on board for all
organization offering cosmetic procedures
 14. Complains investigated by the Ombusdman
should be publicly available.
 15. Adequate professional indemnity cover is a
must.The insurance status should be displayed
on the practitioner register.
 16. Creation of insurance risk pool

28.  1. It is strange attempts to justifying certain
surgical or aesthetic procedures when it comes
to particular cultures or religious tradition.
 2. Most religions like Christianity, Islam and
Judaism affect human behaviors in avarious
way.
 3.This is including affecting profoundly and
dictating some rigid positions regarding
critical health issues.
 4.This issues become more dominant in
countries where the religious leaders are
decision makers like Iran.

29.  This can be compromise sometimes in western societies as
patients invariably present with diverse ethical decision making‐
models or religious/ spiritual preferences and may not hold
western, bioethical views.
 8. Muslims today facing a crisis of knowledge or a crisis in
connecting knowledge and faith as well as other religious.
 9. A good medical practice is meant to take this diversity into
consideration.
 10.There is a challenge do up dating surgeons or NSFA
practitioners to achieve these skill.(advanced cross cultural‐
communication and consultation in the clinical encounter).
 11. If there is going to be regulation , these issues of religious
believe and regulation needs to be taken into consideration in
introducing new law and regulation.

30.  12.There is no such consideration in sir Keogh report .The
following recommendation need to be implemented:
• a. Receiving culturally/religiously acceptable care and treatment.
• b. Highly organized religions or beliefs with a centralized governing
body to express their stance on any arising issue.
• Considering religions and specially Islam and their influence on
decision making and inform consent as a part of report
recommendations:
• d.Islam shares the same code of morality as Judaism and Christianity.
 a.It is just different in some a. doctrinal area.
b. However,there are simple prohibited or allowed (hallal and
haram) declaration for given products or technologies.
 c.Physicians need to master these spirituals issues as there might
be some discrepancy in the consultation or clinical encounter.
 d.This raised the concern that how religion should be integrated
with health care and in this case cosmetic surgery and
beautification.

31.  Awareness of requirement to operate from a safe
premises and responsibility involved.
 Holding accredited qualification from a well known
training body(university)
 Registered with a regulatory body as well as GMC or
DMC.
 holding an Adequate professional indemnity cover
for the procedures performing
 To be honest on providing information as well as
communicating with colleagues and patients
 To be honest and trust worthy in writing reports and
signing forms.
 In area of conflict of interest ,to act in the best
interest of patients
 Regular clinical audits including feedback from
patients.

32.  specific accredited training on:
• physiology
• Anatomy
• Infection control
• Treatment of anaphylaxis
• Understanding of co- morbidity or per existing health‐
problem
• Updated with Regular training for practitioners to deliver
latest treatments.
• Up dated with Training necessary to able practitioners to
identify complications and treat them.
 Awareness of advanced cross cultural communication and‐
consultation in the clinical encounter

33.  Keogh-Cosmetic-Interventions-Final-Report 2013
 General medical council ,2013. Good Medical Practice.
 Royal College of Surgeons, 2008. Good surgical Practice,
 Royal College Of surgeons,2013. Professional Standards for Cosmetic Procedure.
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Aesthetic Surgery (JPRAS), 64(1), pp. 11-16.
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