Botox, peels, fillers and dermabrasion

Some cosmetic procedures, such as Botox injections, don't involve surgery but this doesn't mean they're without risk. It's important to use a reputable practitioner who is properly qualified. Follow these tips to find a qualified and safe practitioner.

Non-surgical cosmetic procedures involve products (such as Botox) or techniques that make the skin look smoother, or make marks on the skin look less obvious. There are also procedures to change the way teeth look, such as making them whiter or straighter.

If you're considering a procedure, find out what it involves, what the risks are and how much it costs. Ask about the qualifications and experience of the person who will be giving it to you, and check the Treatments You Can Trust (TYCT) register, which is backed by the Department of Health, to see if the provider is appropriately qualified. You can read the whole of this page, or click on these links to go straight to the relevant information:

What non-surgical treatments are there?

Where can I get a non-surgical procedure done safely?

How can I find out whether the provider is safe?

What are the risks of non-surgical procedures?

Do I need to see a doctor before I can get Botox? 

What if I feel unwell after a procedure?

What non-surgical treatments are there?

There are various procedures available, including:

  • muscle paralysis, such as injections of botulinum toxin (Botox) to relax facial muscles and make lines and wrinkles less obvious
  • dermal fillers, injected into wrinkles or creases to fill them out
  • chemical peels, which use chemicals to remove the outer layer of skin cells
  • microdermabrasion, which uses fine crystals and a vacuum to remove dead skin cells
  • non-surgical laser and intense light treatments, such as laser hair removal

Some treatments can leave the treated area sensitive or red for days or weeks.

Where can I get a non-surgical procedure done safely?

Procedures such as teeth whitening can be safely carried out in dental clinics. You can find a dentist near you.

Cosmetic injectable treatments (such as Botox) should only be carried out by an appropriately trained doctor, dentist or registered nurse in a clinical environment. They shouldn't be carried out by beauty therapists who lack the necessary clinical background.  

How can I find out whether the provider is safe?

Providers of cosmetic treatments that do not involve surgery don't have to be registered with the Care Quality Commission (CQC). The CQC is the independent regulator for health services in England.

The CQC advises that you can be at risk of harm from procedures if they're not carried out correctly. It's important to research the procedure, the provider and the person who will be carrying it out.

Doctors, dentists and registered nurses who provide cosmetic injectable treatments (such as Botox) can choose to register with the Treatments You Can Trust register. This register is backed by the Department of Health, and only accepts doctors, dentists and nurses who meet the Standards and Training principles required to give injectable cosmetic treatments safely. You can search the register to see if your provider or clinic is listed.  

What are the risks of non-surgical procedures?

"Non-surgical procedures usually involve injections of either fillers or botulinum toxin, and carry less serious risks than surgery in general," says Professor Simon Kay, a consultant plastic surgeon and member of the British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS). "However, over-correction can be difficult to treat, as can asymmetrical placement of the filler and allergic reactions."

He advises asking what can be done if these things happen, and making sure you discuss information about allergies and other potential complications of each filler.

"Usually, the manufacturers include patient information leaflets, which should cover these points," says Professor Kay. "Risks can be minimised by choosing a reputable surgeon or an established nurse practitioner who is working in a clinical environment."

Do I need to see a healthcare professional before I can get Botox?

Yes. The General Medical Council, General Dental Council and The Nursing and Midwifery Council all advise prescribers against prescribing cosmetic injectable medication by telephone, fax, video link or online. The guidance means that prescribers must meet with patients face to face before prescribing Botox and other injectible cosmetics, such as Dysport or Vistabel, to make sure they fully understand the patient's medical history and reasons for wanting the treatment.

You can read the GMC guidance on remote prescribing.

Safety checklist

Sally Taber, who manages the Standards and Training principles for TYCT, says: "There's no doubt that injectable cosmetics are extremely popular. However, a rapidly growing market such as this often leads to opportunities for bad practice. We urge everyone to think about their safety when choosing a practitioner. By following our five-point checklist, you can ensure you're in the best possible hands and look forward to seeing the results."

The five-point checklist is as follows:

  1. Qualifications: Check the qualifications of the practitioner: only regulated doctors, dentists and registered nurses are appropriately qualified to give injectable cosmetic treatment.
  2. Title: Don't be taken in by unusual or unrecognisable titles such as "Advanced Aesthetic Practitioner/Therapist". When you check qualifications, make sure that the title of doctor, dentist or registered nurse actually applies to the person who is holding the needle.
  3. Training: Practitioners need training in a variety of areas in order to give injectable cosmetic treatments. These include how to deal with severe allergic reaction (anaphylaxis) and other adverse reactions to treatment.
  4. Location: Treatments such as Botox and dermal fillers should only be carried out in a clean, safe and appropriate clinical environment to avoid infection and even permanent physical damage. Treatments should not be carried out in a home setting or, for example, in a nail bar or tattoo parlour, but rather in a clinical facility.
  5. Substance: While Botox is a prescription-only medicine, dermal fillers are not currently treated as such in the UK and can be bought in various outlets, as well as online. While this is legal, TYCT advises people to be extremely careful when dealing with any cosmetic injectables. Some dermal fillers are permanent and can be dangerous in the wrong hands. TYCT recommends that you do not buy cosmetic injectables from the internet.

What if I feel unwell after a procedure?

If you've had a non-surgical procedure and start to feel unwell, get medical help.

"The first priority is health," says Professor Kay. "If you have any alarming symptoms, such as a rash, fever, inflammation or increasing pain, go to your GP or your local accident and emergency (A&E) department.

"Less urgent problems should be dealt with by the practitioner who administered the substance or treatment. Your GP only needs to be involved if that avenue fails to resolve the issue."

Page last reviewed: 25/07/2012

Next review due: 25/07/2014

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