Exclusive Interview with Dr Patrick Bowler

Dr Patrick Bowler

Dr Patrick Bowler qualified in 1974 at the Royal London Hospital and is a pioneer of non-surgical cosmetic treatments with over 25 years experience. He is medical director of Courthouse Clinics and is a founder member and Fellow of the British College of Aesthetic Medicine (BCAM). He is also a member of the Society for Laser Medicine and sits on the advisory board of Treatments You Can Trust.

The author of The Nervous Girl’s Guide to Nip & Tuck, Patrick’s opinion on the aesthetic industry is highly respected, and he is frequently quoted in the media and on television.


HA: You have been a pioneer in the non-surgical cosmetics industry with almost 25 years experience. What have been the major breakthroughs that have revolutionised the industry throughout your career?

PB: Botulinum Toxin, dermal fillers and Laser treatments are the most significant advances in the medical aesthetics sector.

Botulinum Toxin revolutionised facial treatments in the late 80’s. At first it was met with some hesitancy (after all, it is technically a lethal toxin which we are injecting!). However, BOTOX® quickly became mainstream as it was easy to administer, effective & comfortable for the patient with a very low complication rate.

BOTOX® is still the number 1 treatment today, which is quite remarkable seeing as it has been around for so long. This is a testament to its effectiveness in softening wrinkles and reducing the signs of ageing.

Lasers came in the early 90’s – amongst the first were ruby lasers for hair removal which had a treatment area of only 2mm. Nowadays technological advancements mean that lasers are far more clinically effective, quick, safe and painless.

Dermal fillers, first launched in the 1980s were initially just wrinkle and line fillers. They are very effective and widely used, but a significant step forward was the introduction of facial volume replacers, addressing in a non-surgical approach, one of the important visible effects of facial ageing.

With regard to regulations, apart from existing professional body (e.g. GMC, GDC) intervention in terms of appraisals and prescribing rights; they haven’t changed much. It is generally agreed that lack of pushing regulation in the cosmetic sector has been a disappointment. There have been plenty of cases of abuse of the system.

The biggest movement towards regulating cosmetic medicine was the Sir Bruce Keogh report which culminated, as far as training and CPD is concerned, in the Health Education England review. These recommendations have been developed by experts from all specialties and will hopefully lead to a safer, more regulated profession.

HA: How does practicing cosmetic medicine now compare to what it was like when you started?

PB: Currently our clinics are inundated with doctors who want to learn and develop their skills in cosmetic medicine. Occasionally we mentor them – this is of course all outside of a formal training programme.

Disparate doctors are running their own BOTOX® and Dermal Filler training courses who promote them in a commercial manner. These are typically weekend courses which offer a certificate that is accredited by an insurer. Having worked with some practitioners who have attended these courses, it is clear that some do not work to the necessary standards. Their theoretical knowledge is below that expected and some of the techniques taught not universally accepted.

Having a co-ordinated and standardised training schematic for the UK is an essential way forward for patient safety.

HA: What advice would you give to a practitioner just starting their career in aesthetic medicine?

  1. They must be really motivated and focused because there is increasing competition, despite the sector still experiencing huge growth
  2. Undergo approved accredited training in Dermatology, Botulinum Toxin, Dermal Fillers and Lasers
  3. Find a willing mentor and shadow them

What Harley Academy is offering is the perfect start to a career in aesthetic medicine which will hopefully set the standard for cosmetic training across the board.


HA: What do you believe should be the minimum requirement and what is the ideal standard for pre-treatment psychological assessment?

PB: Psychological assessment is a mandatory requirement for safe, professional cosmetic practice. Unfortunately commercial interests often supersede good practice and do not thoroughly assess for Body Dysmorphic Disorder.

It is challenging to make this assessment, and even the most experienced practitioners can still miss important signs from a patient with pathological opinion on their appearance.

Anything we can do to improve pre-treatment psychological assessment would be a big step in the right direction.

HA: How do you think the aesthetic medicine industry will look in the next 5-10 years?

PB: Training in aesthetic medicine will become standardised and officially recognised; to the benefit of the profession and patients.

I am hoping for stricter regulation. I would like to see regulatory bodies including the GMC and Royal Colleges recognising non-surgical cosmetic medicine and supporting a separate training pathway.

Again, as a result of poor regulation in the industry, manufacturers and suppliers can launch products which do not have sufficient clinical trial data and quality control inherent in other specialties. This has resulted in some highly publicised treatments causing serious side effects and ongoing problems.

I would like to see more clinical studies and data collection to avoid further crises inherent in bringing a product to launch without repeatable evidence of safety and clinical effectiveness.

I expect there to be newer treatment modalities for the treatment of fat and cellulite, especially with lasers and development in stem cell technology.

Growth will continue to accelerate and demand for non-invasive cosmetic medicine will be higher than ever before.

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