Unqualified Aesthetic Practitioners: The Patient Safety Risk

We’re exploring the patient safety risk of unqualified aesthetic practitioners in our second update from the recent high-risk cosmetic procedures inquiry.

As we reported, the government’s Women & Equalities Committee met on 9th September 2026 to hear evidence on the impact of invasive cosmetic procedures. This was provided by Ashton Collins, Director of SaveFace, and Nora Nugent, a consultant plastic surgeon and BAAPS President (British Association of Aesthetic Plastic Surgeons).

This hearing was part of an information-gathering exercise ahead of the next steps towards introducing aesthetics regulation for England, and the UK more broadly. It took place at the House of Commons and was chaired by Christine Jardine, MP for Edinburgh West (Liberal Democrat).

The government previously shared its plans to hold another public consultation on the high-risk ‘red’ category of non surgical aesthetic treatments, though this has been delayed. MPs asked Collins and Nugent what impact this announcement had had, before exploring matters further.

The Risk Profile has Escalated

Ashton Collins confirmed to the Committee that awareness around high-risk non surgical cosmetic procedures, particularly liquid BBLs, had generated some positive impact.

She recounted how, between 2023 and 2025, SaveFace was averaging "six to nine complaints every single week about these procedures”. This has now “fallen to around six complaints per month."

But, she added that the risk profile for these treatments has actually escalated as, "these practitioners are now pushing the boundaries even further, and they're now wielding scalpels."

Whilst it’s encouraging to see this significant fall in reported complications from what are actually considered surgical-level procedures, there are likely to be more. Under-reporting and inaccurately captured NHS data means we don’t yet have a truly reliable way of tracking complications from aesthetic treatments in the UK.

Unqualified practice of fillers and botox

Whilst this inquiry was specifically focused on the higher-risk category of cosmetic procedures, it was noted that there are risks associated with botox and filler in the wrong hands, too.

The UK having experienced unprecedented numbers of botulism cases over the past two years, linked back to cosmetic toxin treatments, was highlighted. However, this is not the only concern.

Although injectable treatments tend to be seen as less serious, and more of a “beauty” treatment, they are still medical procedures. The risk profile should not be minimised when considering the scope for issues when these are carried out by inappropriate, unqualified injectors.

The numerous patient safety concerns include:

• Lack of appropriate, regulated aesthetics training
• No knowledge of facial anatomy
• Unprepared to prevent, diagnose or manage complications from filler or toxin
• Use of fake, illegal or unlicensed products
• Non medics injecting botulinum toxin - a restricted prescription-only medication
• Inappropriate, non sterile surroundings leading to increased infection risks.

Regulating the Red category aesthetic treatments is important, but legislating for these Amber category treatments must not be forgotten.

How Prevalent are Serious Complications from High-Risk Cosmetic Procedures?

Collins shared that, to date, SaveFace has "helped over 1,200 women" who have had complications from either a liquid BBL, or a liquid breast augmentation. "Over 50 per cent of those women have had sepsis, or been hospitalised. A further 40 per cent of those have needed extensive corrective surgery, ongoing district nurse care."

She also revealed instances of women having to "tape their eyes together to go to sleep" following blepharostoplasties carried out "in someone's living room".

Nora Nugent reminded the committee that we often hear of the "high profile cases". However, there are "numerous others going around with life-changing complications" - complications which have "affected every area of their lives, not just their appearance".

She reminded the group that there are also people who have had "bad work" outside of this, as these treatments are now incredibly prevalent and are widely advertised, outside ASA guidelines, all around the country. 

This comment relates to the CAP Code which prevents:

• Advertising or promotion of prescription only medications, such as botulinum toxin
• Trivialising the risks of any invasive procedure
• Promotional offers or prize draws for surgical or cosmetic procedures.

"These are medical procedures, with medical complications," the surgeon stressed. She also pointed out that, although women represent the vast majority of this affected cohort, men are also having these treatments.

Why Do People Have Cosmetic Procedures with Unqualified Practitioners?

Ashton Collins was clear that people are often put in tense situations with unscrupulous individuals and feel they have to go ahead. She relayed an example of how these appointments, often advertised and booked via social media, can go.

"You pay them the money in advance. They won't disclose the location of the treatment setting until the day of. You're then met at your car by somebody who then escorts you to a property. They don't really want you to see where this property is.

"You're led with kind of blinkers on, up the stairs and into a bedroom. And therefore it's not just the settings. It's the way in which these treatments are being carried out and the sort of clandestine sort of criminal way almost that they are being presented to patients.

"When you are confronted with that type of thing as a patient and people describe this, that they feel terrified, they feel like they're in the witness protection programme.. These people are also very aggressive… If you try and raise a concern after you've had something go wrong or you're very unhappy with the outcome, they are threatening people with physical violence… We have a lot of people who are terrified to speak out."

When asked if these patients felt pressured into having treatment - as if they couldn't back out - Collins responded affirmatively.

"They describe to me feeling like there were lots of red flags and they wanted to back out… The pressure that they're put under whilst they're there is immense. They go, "Oh, no, you'll be fine," and, "Oh, you know, she's done this amount of treatments." And they're quickly shown on an iPad loads of before and after pictures… They're sort of rushed into sitting down and prepared for these treatments… They have very little opportunity to back out once they're there."

Nora Nugent listed common "red flags" reported in these situations include:

• The procedure taking place in a residential home
• Stained carpets
• Unsterile gloves
• Practitioner not wearing scrubs or other medical attire.

How Can Medical Aesthetic Practitioners Handle Patient Conversations Around Price and Risk?

Patients frequently ask medical professionals why they should choose them for their injectable treatments over a non-medic. “My hairdresser does it cheaper,” is a real line clinicians come up against time and again.

Recent Laser Clinics research found that only 35% of the 2,000 UK women surveyed would research an aesthetic treatment online before booking. Just 12% said they would ask about a practitioner's training, and 25% would check independent reviews.

Price is clearly one of the most important factors in decision making, so how do you answer questions about "Why do you charge more than my hairdresser?"? The answer largely rests on four factors: accountability, training, complications management and clinical governance.

Medical professionals are regulated by bodies such as the GMC, NMC or GPhC. This creates a formal accountability structure, including complaints processes and fitness-to-practise oversight. Non-medical providers aren't subject to the same framework.

Clinical training is another distinguishing factor. Medics complete extensive education in anatomy, physiology and pharmacology before undertaking dedicated postgraduate medical aesthetics training. This underpins safe technique and informed clinical decision-making.

Complications management is a practical consideration too. Vascular occlusion, infection and allergic reactions are recognised risks with injectable treatments. Medical practitioners are trained to identify these early and can access prescription-only treatments, such as hyaluronidase, that non-medics cannot. 

Considering these points makes the pricing explanation more straightforward. Higher fees typically reflect indemnity insurance, authorised prescription-only products, and treatment delivered in appropriate clinical settings. 

Explaining why aesthetic treatments cost more from medical professionals

When aesthetic patients raise cost or provider choice, as a healthcare professional, you can address this factually. Be clear about what's included in that price:

• Your medical expertise and dedicated postgraduate aesthetics training
• In-person consultations, your ability to prescribe or work with a prescriber
• Treatment using authentic, licensed products, properly sourced and stored
• Your insurance and accountability to your professional regulator
• Aftercare advice and the option to contact after treatment if they have any concerns
• Ability to manage complications
• Clinical surroundings and management of potential infection risks.

Remember that this is about transparency, not persuasion. Patients who understand what they're paying for are better placed to make safer, informed choices. Additionally, aesthetic practitioners who explain this clearly tend to build stronger, longer-term patient relationships.

Is cosmetic tourism slowing down?

Cosmetic tourism - where UK patients go abroad for plastic surgery and other cosmetic procedures - was also discussed at the Inquiry in connection to patient safety.

Nora Nugent was hopeful that the trend of British patients going abroad in search of cheaper cosmetic surgery procedures was slowing down "a bit". She warned that these trends tend to be predominantly price driven, so given prices are higher in the UK, it's likely to continue.

Ashton Collins agreed, adding that the way going abroad for cosmetic surgery is advertised is "very irresponsible, very misleading". It also does not take into account aftercare or follow-up once back in the UK.

This comes just months after a British businessman and influencer died as a result of penile enlargement filler injections in Thailand.

Body contouring surgery has the highest complication rates

The committee heard from Nugent how body contouring procedures are showing up with the highest complication rates, particularly abdominalplasty or tummy tuck surgery. This data comes from BAAPS members who've been contributing to a database of complications they've seen from overseas.

"Mummy makeovers" were also highlighted as a particularly risky surgery, given there are multiple procedures involved.

Whilst it was difficult for her to give an exact percentage of how many of these complications could have been avoided through better patient education, Nugent said that factors such as "very poor patient selection", "multiple medical problems, mobility problems and then undergoing a six-hour surgery" are extremely high-risk.

She felt that education could help the cohort of younger patients being "talked into [facial] procedures before they need them". Examples included a patient in her late 20s being "talked into" a facelift and eyelid surgery. It could also be effective in warning people that certain surgeries "are just not compatible with a safe recovery and a flight," as well as lack of follow-up.

Although some complications are actual medical issues, she shared that others are due to the lack of follow-up.

Reporting of complications referred to the NHS and UK surgeons

Nugent noted that the NHS is not currently capturing the data needed to understand the extent of the cosmetic tourism complications problem. This is due to the way codes are used in the NHS, and suggestions have been made to help obtain this data in a more useful way.

For now, only snapshots are being captured by the NHS, with BAAPS members separately reporting complications from overseas surgeries when patients come to see them.

Collins echoed the frustration over NHS data, and felt that reporting of these complications should be mandatory.

Keep up-to-date with aesthetics regulation in the UK

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In the meantime, if you’d like any advice on starting your career in aesthetic medicine, and choosing the best aesthetics training pathway for you as a medical professional, book a call with our team. They’ll be happy to listen to what you’re looking for, answer your questions and advise on the options that are right for you, including what will stand you in good stead for when regulation arrives.

All information correct at time of publication