Botox and psychological aspect

Dr Singh who runs his botox clinic in Stevenage, Hertfordshire, in his latest blog continues the latest Government advice regarding cosmetic procedures, such as botox.

Psychological Factors

A recent market research report found that fewer than 10% of cosmetic interventions were carried out primarily for health reasons. Most people opt for cosmetic interventions based on dissatisfaction with appearance, a desire to improve confidence and self-esteem, and to look younger.3 Patient satisfaction with procedures is based on the quality of services provided but also relates to patients’ expectations and their psychological profile. There is no standardised way to measure patient satisfaction across the sector, even in the case of cosmetic surgery. A new tool to collect this information is being piloted by BAAPS.

Academic research has highlighted that those who undergo cosmetic interventions are statistically more likely to worry about their weight, have been subject to domestic violence or bullying, or be on medication for sleep disorders and anxiety. Those seeking treatments are also statistically more likely to have mental health issues.6 Such research draws attention to the potential vulnerabilities of some groups seeking cosmetic interventions. In response there have been calls for better screening of patients undergoing surgery for pre-existing psychological disorders. One screening initiative is discussed in Box 2.

Risks of Cosmetic Procedures (such as botox)

Health Risks
There are a wide range of known risks and complications associated with surgery, injectable products (botox), cosmetic implants, chemical peels and laser treatments. These range from localised infection and scarring to permanent and debilitating effects, such as blindness and nerve damage.1

There is no centralised and comprehensive data on the scale of adverse health complications associated with cosmetic treatments. This includes treatments occurring on premises registered with UK health care regulators (such as the Care Quality Commission, which regulates hospitals in England). Independent hospitals in Scotland are regulated by Healthcare Improvement Scotland. Reporting of adverse incidents is sporadic across the sector.

Systems of reporting in relation to specific products to manufacturers and regulators have also faced criticism. For example, in the wake of the PIP scandal it was estimated that only 15-18% of incidents were reported to the relevant regulator.7 Current estimates of health complications are based largely on small scale investigations by industry and professional bodies, as well as anecdotal evidence. Data on adverse outcomes from using injectable cosmetic products is given in Box 3. Even less is known about non-surgical procedures carried out on other types of premises. These may be carried out despite providers having no professional or legal responsibilities to report adverse incidents or to provide suitable aftercare.

Economic Risks

The annual cost of complications from cosmetic interventions to the NHS is unknown. However the NHS bears the costs for a large proportion of complications that result from treatments carried out by less reputable providers. This issue is particularly acute for non-surgical procedures, as there is no guarantee that practitioners will be insured, or have systems of patient aftercare in place. One recent small scale survey of admissions to a single London hospital recorded 12 cases of patients presenting with complications resulting from dermal filler injections over a 15 month period. The average cost of each patient to the NHS was over £3,000.8 This suggests significant costs to the NHS hospitals across the UK and in relation to other non-surgical procedures that carry comparable levels of risk.

Box 3. Complications Associated with Injectable Products

1.   The Independent Healthcare Advisory Service (IHAS) recently gathered data on 12 of its member clinics. It was reported that medical complications arose from 0.13% of Botox^®® procedures, 0.25% of dermal fillers procedures and 0.07% of cosmetic procedures.4 However these figures represent only those providers registered with the trade body who chose to share data.
2.   A recent BAAPS report highlighted that around two-thirds of its members had treated a patient who has suffered complications after filler injection treatments between 2011-2012.5
3.   The BAAPS report also highlighted that 84% of cases of medical complications resulting from dermal fillers that were presented to its surgeons required surgery or were untreatable.

Box 2. Identifying Vulnerable Patients

Cosmetic procedures (botox) may be inappropriate for some vulnerable patients. Academics based at the Centre for Appearance Research at the University of West England have been working with practitioners to develop standardised tools to screen patients for psychological disorders, such as body dysmorphia. The screening involves assessing patient responses to a series of questions. Patients deemed to be at risk may then be referred for further assessment. This project has received funding to roll out the screening tool to a larger number of providers during 2013.

For more information about botox hertfordshire, please call us on 0800 006 2266.