Concerns over aesthetic regulation heard in Westminster

Houses of parliament
Feb 19, 2019
The Government has admitted shortcomings in the regulation of non-surgical cosmetic treatments.

In a parliamentary debate held last week (February 12) in Westminster Hall, Jackie Doyle-Price, parliamentary under-secretary of state for mental health and suicide prevention, admitted that the Government had “some way to go” to making sure that all those administering non-surgical treatments such as injectables are performing treatments to high standards.

MP Alberto Costa put forward the debate. Costa, who is the MP for South Leicestershire has been campaigning to bring the issue to the attention of Government after being contacted by constituent Rachael Knappier, who experienced severe complications following a lip filler treatment by a beauty therapist – a story which has had significant media coverage over the past few months.

In January he raised the issue on topical debate programme Prime Minister’s Questions, tackling Prime Minster Teresa May about the growing concerns for patient safety and regulation. He then raised a debate on February 12 and was accompanied to Westminster Hall by Knappier and Safety in Beauty founder Antonia Mariconda.

Costa said it was “beyond belief” that a foreign substance could be injected by someone with no medical expertise. He added, “As MPs we have a duty to protect the health and safety of our consumers, so allowing them to make informed choices in respect of seeking treatment from professional beauticians. It is not the case of why people are having it done. It is that we need to regulate what is being done.”

May replied, stating, ”We recognise that this growth in non-surgical treatments does increase the need for consumer protection. We are currently working with stakeholders to strengthen the regulation and we are committed to increasing the safety of these procedures in a number of ways.

“For example, better training, robust qualifications for practitioners and clear information where people can make an informed decision about their care. We would urge anyone who is looking to have a cosmetic procedure to take the time to find a reputable, safe and qualified practitioner who is subject to statutory regulation or on a voluntary accredited register.”

Her comments were echoed by Doyle-Price during the February debate after he shared the experience of his constituent Rachael Knappier, who required urgent medical attention after dermal filler was injected into an artery in her lip. She received the treatment at a “botox party”. Doyle-Price said: “We need to do so much more in terms of public education to make sure consumers fully appreciate that there are risks with injecting things into one’s face and that they make sure someone doing that has the appropriate qualifications.”

However, she added: “In wishing to regulate this sector we do not want to undermine its dynamism and its competitiveness. What we really need to do is make sure that consumers are properly educated so that they can make informed choices about where they seek treatments.”

While she didn’t respond directly to Costa’s call for “the Government to at least consider setting out a cohesive and comprehensive plan to properly regulate the non-surgical cosmetic industry”, Doyle-Price did remind those in attendance of what has been done since 2013’s Keogh review, including the training and qualification framework; and the formation of the Joint Council for Cosmetic Practitioners: “We need to work closely with the JCCP so we can develop hallmarks for people to look for so they can be sure they’re obtaining a treatment from a regulated practitioner,” she said.

Doyle-Price also reiterated that as of May 2020, all dermal fillers will be regulated as medical devices under the Medicines and Healthcare Products Regulatory Agency. However, this doesn’t mean that the products will be prescription-only.


A patient with upper lid hooding, a very common development as we age. This can cause a cosmetic problem and can prevent the application of make-up in the upper eyelids, but it can also cause a functional problem with a restriction of vision. In some patients, this leads to headaches from the fatigue of the having to constantly raise the eyebrows. This patient shows the result of a bilateral upper lid blepharoplasty performed under ‘twilight anaesthesia’ on a day case basis. The surgery is performed conservatively to ensure that blinking is not compromised and to avoid an operated look.


A patient with marked upper lid hooding and lower lid ‘bags’ causing a tired appearance

The same patient 3 months following a bilateral upper lid blepharoplasty and a ‘chemical brow lift’using botulinum toxin injections (Azzalure injections) and a bilateral lower lid transconjunctival blepharoplasty with fat repositioning (scarless cosmetic lower eyelid surgery)



The lower lid is being pulled down away from the eye to show a plug in the inferior punctum

Punctal plugs can improve dry eye symptoms and reduce the frequency of instillation of artificial tears in patients with a dry eye. Open the blog below and then click on the link  to see a punctal plug being placed in a patient. This requires no anaesthetic injections, only a drop, and takes seconds to do.


MAYWOOD, Ill — June 28, 2018 — A study published in The Ocular Surface is providing further evidence that floppy eyelids may be a sign of sleep apnoea.

Charles Bouchard, MD, Loyola University, Maywood, Illinois, and colleagues reported that 53% of patients with sleep apnoea had upper eyelids that were lax and rubbery. The most severe cases of sleep apnoea were associated with the most pronounced cases of floppy eyelids, but this association was not strong enough to be considered statistically significant.

Lax, rubbery eyelids are found in people who have lax eyelid condition, lax eyelid syndrome (lax eyelids plus conjunctivitis), and floppy eyelid syndrome (lax eyelid syndrome in obese young men).

A patient with floppy eyelid syndrome with typical drooping of the eyelashes (lash ptosis) 

It’s unclear why sleep apnoea is linked to floppy eyelids. One theory suggests the condition is associated with low-grade inflammation that causes degradation of elastin, a protein that allows skin and other tissues to resume their shape after stretching or contracting.

“Obstructive sleep apnoea is a severely underdiagnosed disease, and without treatment leads to increased morbidity and mortality,” the authors concluded. “It is the duty of today’s ophthalmologist to be diligent in making the diagnosis of lax eyelid syndrome in the ophthalmology clinic. They are in the unique position to identify patients at risk for obstructive sleep apnoea and address this critical public health problem.”




Protect yourself from the adverse effects of excessive sun exposure. Many people are unaware of the serious risks associated with sunburn which increases your risk of melanoma, a potentially lethal form of skin cancer. It also greatly increases your risk of other forms of skin cancer including rodent ulcer (basal cell carcinoma), which we are seeing in younger and younger patients. Excessive sun exposure also results in premature aging of the skin, premature cataracts and increases your risk of the development of age-related macular degeneration.

A lower lid basal cell carcinoma (rodent ulcer) in a young patient


Many benign skin and eyelid lumps/bumps/lesions including chalazia (meibomian cysts – as seen in the photograph above) are no longer being removed under the NHS (read the article about this published in the British Medical Journal today). At Face & Eye we have a team comprising consultant eye surgeons, a consultant dermatologist, and a specialist oculoplastic nurse practitioner who can treat these problems quickly and efficiently. Visit for information about the costs.

A benign upper lid papilloma

Click here to read the article from the British Medical Journal  bmj.k2903.full


Mr Leatherbarrow gave a presentation at the annual congress of BOPSS in Dublin about his experience of facial fat grafting over the course of the last 20 years, and his more recent experience since 2012 with micro fat grafting and nanofat injections of the area around the eyes. Mr Leatherbarrow spoke about the use of fat grafting in patients seeking facial rejuvenation, alone or to supplement the effects of cosmetic eyelid surgery (particularly in those patients who prefer to avoid dermal filler injections), and in patients with facial scarring and hollows following trauma. Microfat injections have become popular for the management of lower lid dark circles and tear trough defects.






Mr Ataullah gave an in depth presentation at the annual congress of BOPSS in Dublin about the risks of visual loss from the use of facial dermal filler injections. The attendees were informed about the safety precautions that should be undertaken to minimize this risk and about the appropriate immediate management of a patient should they experience visual loss from such injections. The presentation was very well received.

Specialist Treatment

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