Dermals fillers are not approved for use in patients under the age of 21, as there are potential physical and psychological risks
With numbers steadily growing towards nearly 1000 members, the British Association of Cosmetic Nurses (BACN) continues to expand as an association. Our online regional meetings have been a success, with members registering to participate via Zoom.
Now that the short survey has been completed, we are in the process of collating the results, and a report will be published at a later date. So, here is a preview of some the responses. When asked why they joined the BACN, 90% of respondents stated they wanted to be part of professional organisation. Of that 90%, 44% noted the importance of having access to support from other nurses, while 23% wanted information to help them re-open their businesses once lockdown restrictions had been lifted. In response to when members started their aesthetic practice, 48% have experience of 5 years or less, with 30% having less than 3 years' experience, and 51% of our membership has over 5 years' experience, with 30% having over 10 years' experience. Some 1% of our membership have not started practising yet. Finally, 71% of our members are prescribers. So, thank you to all of our members who participated.
Changes in the industry
There is a lot going on in the aesthetics industry. The Chartered Institute for Environmental Health (CIEH) has produced two reports focusing on how to improve the regulation of cosmetic treatments, which can be downloaded from their website. Furthermore, on 16 October 2020, a Private Members' Bill was heard in Parliament regarding the second reading of the Botulinum Toxin and Cosmetic Fillers (Children's) Bill, which makes it an offence to treat people under the age of 18 with botulinum toxin or dermal fillers. As well as this is the Committees of Advertising Practice (CAP) and Broadcast Committee of Advertising Practice (BCAP) public consultation to introduce tighter restrictions regarding cosmetics interventions advertising aimed at under 18s across all media platforms. This would introduce age-based constraints on the targeting, scheduling and placement of advertising of any surgical or non-surgical cosmetic interventions. At the time of writing, there is nothing prohibiting the context in where or when these adverts appear, and these age-based constraints would include appearing after TV programmes that could appeal or are directed particularly to audiences below the age of 18. The BACN is morally and ethically opposed to treating under 18s. Regardless of which insurer indemnifies your practice, you have no cover to treat those aged under 18 for cosmetic or aesthetic reasons. As a professional organisation, the BACN has responded to this call for response.
Dermal fillers are not approved for use in those under the age of 21, as there is no efficacy or safety data available. Performing aesthetic non-surgical procedures on younger people has potential physical and psychological risks. The facial structure is still developing and fillers might impact this negatively or cause damage to underlying anatomy. Furthermore, adolescence or young adulthood can be a time of emotional instability, with vulnerabilities over self-esteem and body image developing, as well as the potential for appearance-related concerns coupled with bullying and idealised imagery from television, magazines and social media platforms compounding these psychological factors. Regardless of their ability to consent, and regardless of their parent's readiness to consent on their behalf, these treatments for aesthetic motivations should not be available to anyone aged under 18 years, and until there is legislation in place, this responsibility falls on the shoulders of the practitioner (Nuffield Council on Bioethics, 2017).
Medical aesthetics functions with the aesthetics industry, and therefore, as a sector, is dependent on a marketing approach. As nurses, we may feel uncomfortable with the idea that we are part of an industry that includes commercial enterprise, pharmaceutical manufacturing, research, development, supply and business acumen. This generates massive revenue. However, the need to be business savvy and profitable versus the need to be medically motivated does not have to be conflicting. Being committed to patient wellbeing highlights the need to consider the ethics and brings us back to the argument of ‘clients’ or ‘patients’. Our patients are consumers; sometimes they shop around and make spontaneous choices based on price or special offers. They can be seduced because of images they see. Our patients have social media accounts, and are exposed to social influencers who, often, have several thousands to millions of followers. This can increase patient awareness regarding what aesthetic treatments are available, but, sometimes, this has little emphasis on the journey from assessment to post-treatment, which can result in patients having unrealistic expectations, and not being fully cognisant of the possible financial commitment, complications and the time it may take to achieve the results they want. Providing a medically evidenced-based treatment, with the end goal of achieving good patient outcomes, is paramount, and patient vulnerability should always be considered (Vlahos and Bove, 2016; Abelsson and Willman, 2020).
An inquiry into body image: the findings
A recent survey, published by the Women and Equalities Committee as part of their Government-funded ‘Changing the perfect picture: an inquiry into body image’, had 7878 responses between 6–19 July 2020, with a focus on how different groups felt about their body image and what influenced those feelings (House of Commons and Women and Equalities Committee, 2020). Some of the key findings are interesting and relevant. They found that six in every 10 women had negative feelings about their bodies.
Transgender respondents also felt negatively about their body image, and this was impacted by gender, body dysmorphia, transphobia and the threat of being harassed. Black, Asian and minority ethnic (BAME) respondents also stated that representation in the media and advertising had a negative influence on their body image, because of the lack of plus size images, natural hair or people with darker skins, and this reinforced colourism and racism across all platforms.
Men felt the pressure to conform to masculine stereotypes (i.e. being muscular) and were often targeted by advertising algorithms that encouraged them to gain muscle mass. Homosexual men felt this pressure to conform more so, as they face appearance-based discrimination via social media and dating apps.
The study also found that lockdown made 55% of adults and 58% of those under 18 feel ‘worse’ or ‘much worse’ about their appearance, while 14% of adults and 16% of younger people reported feeling ‘better’ or ‘much better’ about their body image during lockdown.
The pandemic and mental health
COVID-19 continues to create havoc and chaos, and, depending on where we are in the four counties, some will be entering or have entered into further restrictions phrases. This will impact on us all in some way. With isolation and loneliness affecting many of our families, colleagues, patients and friends, the value of human contact is so important. Having just completed Mental Health First Aider training (MHFA England), I now feel better equipped in supporting those who I am in contact with, both professionally and personally, who may be struggling with their mental health.