key: cord-0932298-8p5mpug0
authors: Asfour, L.; Stagnell, S.; Griffiths, T.W.
title: Nonsurgical cosmetic practice and COVID‐19
date: 2021-05-12
journal: Clin Exp Dermatol
DOI: 10.1111/ced.14693
sha: 739712cc9626681ca73a6309c04fc62700eea073
doc_id: 932298
cord_uid: 8p5mpug0

The societal impact of the Covid-19 pandemic is profound, with most face-to-face interaction replaced by "virtual" working/socialising. An unanticipated consequence is increased dissatisfaction with on-screen appearance, resulting in a hefty 57% uplift in interest in facial cosmetic procedures--a phenomenon dubbed the "Zoom Boom.1 " This includes interest in botulinum toxin and dermal filler injections, which had already accounted for 75% of the pre-pandemic cosmetic market-share.2 The market demand, accelerated by the surge in interest during the pandemic, should motivate an increased understanding by healthcare professionals; especially as complications will undoubtedly continue to fall at the doorstep of an already overstretched NHS.

Dear Editor, The societal impact of the Covid-19 pandemic has been profound, with most face-to-face interaction replaced by 'virtual' working/socializing. An unanticipated consequence is the increased dissatisfaction of individuals with their onscreen appearance, resulting in a hefty 57% uplift in interest in facial cosmetic proceduresa phenomenon dubbed the 'Zoom boom'. 1 This includes interest in botulinum toxin and dermal filler injections, which had already accounted for 75% of the pre-pandemic cosmetic marketshare. 2 This market demand, accelerated by the surge in interest during the pandemic, should motivate increased understanding by healthcare professionals, especially as complications will undoubtedly continue to fall at the doorstep of an already overstretched National Health Service.

Furthermore, increasing numbers of senior specialists, generalists and even those early in training, have been engaging in nonsurgical cosmetic practice. As with other aspects of our work, we must remain mindful of unconscious bias and conflicted interests, particularly where financial gain is involved. Professional behaviour and transparency is required, aligned with the General Medical Council (GMC) generic professional capabilities and specifically with its Guidance for Doctors who Offer Cosmetic Interventions. 3 The Director of Education and Quality at Health Education England has observed that 'social media has changed what is acceptable for professionals to do'; however, it is necessary for us to continually reflect upon and accept constructive feedback in order to develop a culture that champions professionalism. 4 Regulation of the nonsurgical cosmetic sector is fragmented, owing to the wide range of practitioner background, ranging from GMC-registered specialists such as dermatologists and plastic surgeons, to peripatetic injectors with no qualifications. Complicating matters further is the increasing cohort of so-called 'DIY injectors'; members of the public who purchase products, often of dubious provenance, online and then self-treat. 5 The recent breast implant (poly-implant prostheses) scandal emphasized the consequences of erratic regulation in cosmetic surgery. The subsequent Review of the Regulation of Cosmetic Interventions led by Sir Bruce Keogh in 2013 shone a damning spotlight on the nonsurgical sector, citing an alarming disregard for patient safety. 2 This galvanized pre-existing nascent attempts to increase regulation, led by medical and nursing professional societies. 6 With multistakeholder involvement and subsequent public consultation, training frameworks for all learner groups in five main techniques used in nonsurgical cosmetic practice (botulinum toxin, dermal filler injection, skin rejuvenation, laser/light therapy and hair restoration) were published in 2015 by HEE. 7, 8 In 2018, at a launch in the House of Lords, the Cosmetic Practice Standards Authority (CPSA) and the Joint Council of Cosmetic Practitioners (JCCP) arose as the winning partnership tasked with raising standards of practice at national level, in the absence of direct regulation.

The CPSA, founded by the British Association of Aesthetic Plastic Surgeons, the British Association of Plastic Reconstructive and Aesthetic Surgeons, the British Association of Dermatologists and the British Cosmetic Dermatology Group is a charitable incorporated organization. Membership includes representation from the founding organizations, the JCCP and patient groups. Multistakeholder workshops and public consultation led to agreed professional standards of practice for all five cosmetic techniques outlined in the HEE frameworks.

The CPSA aims to instil professionalism and champion patient-safety. 9 Supervised practice and development of support networks are instrumental to its ethos, along with the concepts of continuous learning and accountability. In collaboration with the JCCP, further aims include promotion of adverse-event reporting and data collection; including horizon-scanning to raise an early alarm for procedures emerging as outliers in terms of risk.

The JCCP manages the register of practitioners to ensure compliance with CPSA standards. 10 It holds an impressive clutch of supporting bodies across multiprofessional groups, including the GMC, General Dental Council, Nursing and Midwifery Council, and those representing the pharmaceutical and beauty therapy sectors. It also works in recognized partnership with regulators such as the Care Quality Commission, the Medicines Clinical and Experimental Dermatology 1 ª 2021 British Association of Dermatologists and Healthcare products Regulatory Agency, the Advertising Standards Agency, the Office of Qualifications and Examinations Regulation, and environmental/public health institutions. In collaboration with patient support groups and engagement of relevant practitioners, it offers an accepted kite-mark for delivery of high-quality service.

In a sector where a consistent minimum standard of professionalism and lifelong learning is sorely lacking, the CPSA standards and JCCP register have implemented initiatives for the diverse and fragmented practitioner cohort where overarching regulatory bodies may not exist. The stakes are even higher in the current climate, due to the 'Zoom boom' phenomenon and the usual associated procedure-related risks. However, inadvertent dissemination of coronavirus due to nonadherence to government guidance on personal protective equipment and lockdown restrictions by rogue practitioners only adds to the mix. For those who engage in nonsurgical cosmetic practice, enrolment onto a voluntary register not only signals that your individual practice is aligned to agreed professional standards, but is an act of solidarity to support high standards, transparency and professionalism across a sector in dire need of these.

L. Asfour, 1 S. Stagnell 2 and T.W. Griffiths 1,3

Zoom boom' sees rise in cosmetic treatment calls. BBC

Review of the regulation of cosmetic interventions. Final report

GMC guidance for doctors who offer cosmetic interventions

Promoting professionalism: five minutes with Sheona MacLeod

Self-injection of dermal filler: an underdiagnosed entity?

Non-surgical invasive procedures such as dermal fillers should also be regulated

Part one: qualification requirements for delivery of cosmetic procedures: nonsurgical cosmetic interventions and hair restoration surgery

Part two: report on implementation of qualification requirements for cosmetic procedures: Non-surgical cosmetic interventions and hair restoration

Cosmetic Practice Standards Authority

Joint Council of Cosmetic Practitioners. Check The JCCP Register