The new year brings opportunities to improve the practice and safety of aesthetic medicine. We can look forward to the British Association of Cosmetic Nurses' (BACN) spring symposium, a major awards event to recognise the best in aesthetic medicine practice and a change to the law to protect patients.
The BACN Spring Symposium, an educational full-day event featuring renowned speakers, is to be held on 21 April at the Royal Society of Medicine in London. Last year's symposium was a great success and this year's promises to be even better. Tickets tend to sell out fast.
The Aesthetic Awards, taking place in March in London, are open to those new and established in aesthetic medicine. We hope to see BACN members putting forward strong applications and wish them all success.
We also hope that work begun in 2022 to strengthen regulation in the aesthetic sector will come to fruition in 2023 within the Health and Social Care Act. This will introduce a local authority licensing system for aesthetic practitioners carrying out non-surgical cosmetic procedures, among other changes.
As we look forward to 2023, I have paused to reflect upon the past year. Considering the changes we can hope for, has led me to consider several cases involving complications I have dealt with recently.
As BACN board members, we are often called upon to assist members if they are experiencing an issue with a patient.
BACN members, as well as those on the board, can also be called upon to assist colleagues in person or via social media, email or phone. Having the ability to contact practitioners with different skills and experience is a fabulous resource for patient safety.
While as professionals and BACN members we have great support from each other, often patients do not receive this.
Over the Christmas period, I was saddened by two cases and, although they did not involve the worst complications I have dealt with, the attitude of the treating injectors was awful, leaving the patients frightened, vulnerable and feeling embarrassed over their own naivety.
In both cases, the injectors responsible were not from professional backgrounds.
A shocking attitude from an irresponsible injector
This patient was a 30-year-old woman had no relevant medical history and no known allergies. She received toxin treatment to the glabella, forehead and crow's feet at a cost of £80 for the full treatment. She was pressurised into paying a £50 deposit.
The treatment was carried out at the injector's house in a living room with several dogs running about. The patient realised she did not want the treatment under these conditions but was too scared to say so and did not want to lose her £50 deposit. She was instructed to sign without being allowed to read the consent information – and did. She had no idea what she had signed.
She did not see a prescriber, was not told of possible risks and side effects and was not offered a cooling-off period.
After treatment, she was sent home with no aftercare and no follow-up appointment.
Three days after the treatment, the patient contacted me as her eyelid had dropped and she was frightened. She sent me a photo that showed the worst lid ptosis and Mephisto sign on the left-hand side that I have ever seen in 15 years of practice. She was unable to open her right eye and had significant lid oedema.
She was very distressed about her appearance and could not stop crying. She had the postpartum depression after recently giving birth, and wanted to feel a bit better about herself and to have lovely photos of her baby's first Christmas.
I must be completely honest about my own feelings here as I think it's important that we do address these issues. I was torn between feeling heartbroken for the state she was in both physically and emotionally and being annoyed that she had put cost before safety.
She had a full consultation with me; we made a plan and she had a positive response from apraclonidine.
After I had consulted the patient, I looked the injector up on social media and was not surprised to see a caricature of the injector in a skin-tight jumpsuit with a needle and syringe in her hand, like a cigarette. She called herself a ‘lip nurse’, although she is not a nurse. It is horrifying to know that anyone can use this term within the UK even if they have no nursing qualification despite this being very misleading to the public.
After treatment, the patient messaged the injector and said she was concerned as her eyelid had begun to drop the day after the injections and was now fully closed. She asked the injector how long this would last and what could be done to help.
The injector did not respond until 28 hours later, replying that she had never heard of this happening.
The patient then asked if the injector had a nursing background as she could not believe that she had not heard of this happening before. She was told: ‘No, I'm not and I don't need to be.’
At the time, the patient also saw her GP who did try to help but did not really know what to do.
By now, the patient was frantic and it was at this point she contacted me. I advised her that first, although this was awful for her, it would not last forever. I also advised her to check with her insurers before she drove her car as I was not sure if the problems would make her insurance void should any accident occur.
The patient informed the injector of how upset she was and that the length of time it was taking her to reply was intolerable, and that she was now unable to drive. The injector replied: ‘I'd love to see a medical record that states you cannot drive.’ She added that she does not state anywhere that she will respond 24/7 as she has a life outside her occupation.
Following this, communication completely broke down between the patient and the injector and resulted in the injector blocking the patient.
We were left unable to access any records regarding what had been injected and where. The injector informed us that there was no law against memory loss as apparently she could not remember who she trained with, what product she had used and where it had been injected.
The injector's attitude shocked and astounded me. It made it very real to me that vulnerable people are receiving dangerous treatments from people who have no responsibility or accountability to the public.
Vascular occlusion follows choice of cheap option
The second case tells a similar story. A 26-year-old woman, usually fit and well, received dermal filler to the dorsum of the nose from an injector with no professional qualification.
The patient herself is a nurse and has friends who are good aesthetic nurses, but the non-nurse injector was cheaper.
When the patient noticed her nose was turning blue and she was in a lot of pain, she contacted her nurse friends to help her as she had contacted her injector by text who replied: ‘I'm sunbathing on the beach right now – I will get back to you when I'm finished.’ It was left to the two nurse friends to treat the vascular occlusion over Christmas.
A lack of consequences for harmful practice
The attitude of these women, who have harmed other women in the quest for financial gain and accepted no responsibility, saddens and astounds me.
The fact that there are few consequences for them allows them free rein. Nurses are bound by the Nursing and Midwifery Council (2018) Code.
Even though these injectors have no professional accountability, where is their responsibility and accountability as humans?
To conclude, the injector in the first case was reported to the Advertising Standards Agency, the Joint Council of Cosmetic Practitioners and the local authority environmental health department
Hopefully, I will find out soon if there is to be any positive outcome and, more importantly, we will start to see some of this behaviour challenged.