The rise of 'tweakments': What to look out for when getting cosmetic injectables

Fresh concerns have been voiced over the lack of regulation in the UK's cosmetic industry, Chloe Keedy reports

Words by Elaine McCallig, ITV News Digital Content Producer

Who doesn't have one or two lumps and bumps they wouldn't mind having nipped and tucked? For those seeking a more youthful complexion or fuller lips, so-called "tweakments" may be the answer.

Non-surgical cosmetic procedures such as Botox and dermal fillers are quickly becoming more and more popular in the UK, with one cosmetic doctor telling ITV News that demand at his practice has rocketed by at least 50% since the Covid lockdowns came to an end.

In a 2022 audit, the British Association of Aesthetic Plastic Surgeons (BAAPs) found that demand for Botox treatments rose 124% compared to the previous year, with their members carrying out 6,639 treatments last year.

Accessibility to treatments, social media, and their popularity among celebrities are just some of the reasons the market is ballooning in the UK. Another potential reason for the rise of "tweakments" is the increased awareness many of us gained of our own appearance after sitting through video calls during lockdown.

According to a new UCL study, the UK injectables market is predicted to reach a value of £11.7 billion by 2026, but to date it is effectively unregulated.

Here, ITV News outlines what you need to know before booking in a "tweakment".

How can you make sure you're going to the right person for a treatment?

Research is key, Dr Vincent Wong tells ITV News, because in the UK there are a wide range of injectors, including medical professionals and non-medical professionals.

"The key thing is to understand their qualification first and foremost, what level of training they have had to do the procedure that they are looking to do, and also any complications - how would they manage a complication if something goes wrong?" the cosmetic doctor said.

It's also important that the injector is fully aware of what could possibly go wrong, including minor things such as pain, redness and swelling, and how they can be remedied.

Make a list of practitioners you think you would like to see and could potentially trust and go to see them, Dr Wong says, but stresses that people should not rush into any treatment.

He advises people not to be shy when it comes to quizzing your injector on their experience and how they have handled things that have gone wrong in the past.

Raising awareness for how to find the right practitioner is all the more important now "tweakments" have become more popular.

Dr Wong says he has seen an increase in demand for facial aesthetics procedures, especially after Covid - a phenomenon those in the industry have coined the "Zoom boom".

"Zoom boom" refers to how people have become more aware of their appearances due to seeing themselves on video calls more often over lockdown.

At his practice, demand has gone up by between 50 to 60 per cent since lockdown ended, he estimates.

What are the risks?

For dermal fillers, the risks can range from infection, to filler migration, and lumpiness.

"All of these procedures are quick and they look relatively easy, but even in the best hands things can go wrong and when it goes wrong, it can be quite serious," Dr Wong said.

"The key thing with going to see a qualified and competent person is that they will be able to recognise the complication and also manage that complication correctly."

But when things go badly wrong, vascular occlusion can occur - and this can lead to permanent blindness. Vascular occlusion is when filler blocks or puts pressure on blood vessels, stopping blood from passing through.

Genee Schock, a patient safety advocate, told ITV News she had been having Botox for over a decade without side-effects, but in 2015 she developed flu-like symptoms after getting the treatment.

"Then all hell broke loose," she said. "I became really ill with severe side effects."

The side effects she suffered included panic attacks, internal shaking, tinnitus, blurred vision, nausea, vomiting, facial twitches, pain in her neck, tingling in her hands and feet, constipation, and bladder issues "to name a few".

After researching the treatment on the internet, she concluded that these side effects were caused by Botox. She said some doctors she has seen have agreed the side effects may have been caused by Botox.

She is now using social media to ensure people are aware of the risks before getting the treatment.

What are the rules around who can and cannot carry out these procedures?

In the UK today, there is no specific legislation around who can administer these treatments.

A new study from University College London (UCL) suggests that more than two-thirds of people who are administering cosmetic surgery injections such as Botox in the UK are not qualified medical doctors.

The study, published in the Journal of Plastic, Reconstructive & Aesthetic Surgery, is the first survey of who is providing cosmetic injectable services, including botulinum toxin (Botox) and dermal fillers, in the country.

Researchers from UCL looked at 3,000 websites to find out about background qualifications, training and experience levels of those who were administering treatments.

They identified 1,224 independent clinics and 3,667 practitioners who were delivering cosmetic injections. Of the professions represented, 32% were medical doctors, 13% were nurses, 24% were dentists and 8% were dental nurses.

Experts suggest that without knowing the professional backgrounds of practitioners, the industry cannot be properly regulated.

But the fundamental issue around the lax legislation is ensuring competence around the delivery of the injections, Dr David Zargaran, UCL Plastic Surgery, an author of the study, told ITV News.

Competence is essential, he says, to ensure complications can be recognised and managed when and if they arise.

"These injections are not risk-free, complications can arise... whilst many can be mild and transient, some can be permanent and debilitating," he said.

What is the government doing?

The UK government is preparing to update policy around injectables, and a public consultation on the industry is due to begin in August 2023.

Recommendations are expected to inform amendments to the Medical Act in 2024.

As well as the professional background of those providing cosmetic injections, until recently there has been little research on the incidence of complications and the impact that these have upon patients.

In 2013, the government commissioned Professor Sir Bruce Keogh to review the regulation around cosmetic interventions. In his report, the former NHS England National Medical Director said: "A person having a non-surgical cosmetic intervention has no more protection and redress than someone buying a ballpoint pen or a toothbrush."

Dr Zargaran says "an opportunity was missed" a decade ago when the recommendations laid out in Sir Bruce's report were not legislated.

He hopes any government intervention will improve and protect patient safety across the UK, and include safeguards for redress when things go wrong.

A blueprint the government could perhaps draw upon when considering what deems someone competent to carry out these treatments are the recommendations laid out in a 2015 Health Education England framework, Dr Zargaran suggests.

Dr Wong would like to see training standardised, and believes there should be a qualification or similar to be able to carry out the procedures. The industry should be regulated, he said, and called for aesthetics medicine to gain recognition as a specialty.

Professor Julie Davies, UCL Global Business School for Health, a co-author of the UCL study, said: “The UK cosmetic injectables industry has expanded rapidly in recent years. This has happened largely without scrutiny or oversight.

“Our findings should be a wake-up call for legislators to implement effective regulation and professional standards to safeguard patients from complications.

“Although the risks associated with injections are often mild and temporary, the physical complications can be permanent and debilitating.

“There are also serious psychological, emotional, and financial consequences for patients when procedures go wrong.”

As well as the professional background of those providing cosmetic injections, until recently there has been little research on the incidence of complications and the impact that these have upon patients.

A second study from the same authors, published on July 3, found that 69% of people who responded to the study had experienced long-lasting adverse effects, such as pain, anxiety and headache.

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