Lessons from the GREAT WHITE NORTH

Dr Samuel Hetz looks at what the UK can learn from Canadian aesthetic medicine regulation

Aesthetic medicine is the intersection of treating skin-related conditions and enhancing physical appearance with a variety of non-surgical techniques. New treatments emerge at a fast pace, and the regulation of these practices becomes increasingly important to ensure patient safety and high-quality care. The UK and Canada, while both developed nations with advanced healthcare systems, approach the regulation of aesthetic medicine differently. By examining Canada’s regulatory framework, the UK can gain valuable insights to potentially guide future regulatory changes.

Aesthetic medicine encompasses a wide range of procedures aimed at enhancing physical appearance, from injectables like botulinum toxin and dermal fillers to laser therapies, body contouring, microneedling, photorejuvenation and more. As the popularity of these treatments grows, so does the need for comprehensive regulatory frameworks to ensure these procedures are performed safely and effectively. Looking at Canada’s approach offers an opportunity to compare, contrast, and learn.

AESTHETIC MEDICINE REGULATION IN CANADA

In Canada, the regulation of aesthetic medicine, particularly the use of injectable treatments, is marked by specific guidelines that aim to balance accessibility with safety. Notably, only physicians and nurses are permitted to administer injectable toxin treatments such as toxin and fillers. However, the path to demonstrating competency in these procedures is less defined, as no standardised training or certification is required. Practitioners must undergo some form of training, but the lack of regulation around the training ’s content or duration leaves room for variability in competence. In many instances, the burden of deciphering the competency of the practitioner is placed on the patient, which can lead to mistrust in the medical aesthetic industry overall.

A solid regulation put in place by the Canadian government is that nurses in Canada must operate under the supervision of a medical director, who can be either a medical doctor (MD) or a nurse practitioner (NP), to perform injectable treatments. This MD is responsible for purchasing the injectables and can then delegate the task of injecting to a nurse (RN/RPN), ensuring a level of medical oversight. While these nurses don’t necessarily need formal training, many MDs will require it or provide it to the nurses in their clinics. Overall, the purchasing restriction specifically helps limit the chances of injectable treatments being sold to and used by untrained professionals.

Advertising restrictions in Canada around prescription drugs are notably strict in Canada, which extends to treatments such as neuromodulators, like toxins, and fillers. Clinics and practitioners can market the name of drugs like toxins, but they are prohibited from advertising their therapeutic use cases and benefits. There are even limits on what can be included in testimonials. This regulation seeks to mitigate undue influence on potential patients by focusing advertisements on information rather than suggested outcomes, as outcomes vary.

Canada’s regulations regarding laser treatments are notably relaxed, given that incorrectly performed treatments with these devices can cause serious bodily harm. Unfortunately, there is no restriction on who can purchase, sell, or use laser devices for aesthetic treatments. While this lack of regulation raises concerns about the potential for misuse or harm, having other treatment regulations in place helps direct clients to clinics and spas that have MDs and personnel on-site performing and overseeing treatments.

HOW DOES THE UK COMPARE?

Unlike Canada, where the role of MDs and the delegation to nurses are clearly defined, the UK is still navigating the complexities of oversight and accountability in aesthetic medicine. This past autumn, the Department of Health and Social Care (DHSC) announced a governmental consultation to create a licensing scheme to regulate the administration of prescribed non-surgical cosmetic procedures. This move toward standardised licensing shows how the UK could potentially benefit from adopting a similar model to the one in Canada, where a clear hierarchy and delegation process ensure medical oversight.

While Canada has a keener eye on injectables, the two geographical locales share a need for laser treatment oversight. Both countries have seen industry professionals push for more standardised training and accreditation, as well as stricter guidelines on who can perform these procedures. As of now, it remains common practice for beauty salons, mobile practitioners and aestheticians working from home to start offering laser hair removal and laser tattoo removal services without sufficient training.

In relation to advertorial content, the UK does have restrictions on televised and social media advertisements that explicitly target underage youth with cosmetic procedure-related content.

LESSONS FROM CANADA’S APPROACH

While Canada’s regulatory framework for aesthetic medicine is not without its flaws, there are several lessons the UK could learn from. The first is the potential widespread implementation of the Canadian oversight model. The top-down oversight provided by requiring a trained medical professional to oversee nurses administering injectables ensures a level of medical supervision and accountability that would help lower the rate of untrained professionals purchasing and injecting treatments such as filler and toxins. As medical practitioners are held accountable by the General Medicine Council, Royal College of Nursing and the British College of Aesthetic Medicine, anyone who wrongfully delegated to untrained professionals would risk their own licensing.

Canada’s strict advertising rules could offer the UK a framework for preventing misleading marketing practices and focusing consumer attention on facts rather than implied results. Doing so could help lead towards a social standard that pushes individuals to seek out treatment information from reputable sources, such as trained medical practitioners. Moreover, the lack of standardised training in Canada serves as a cautionary tale for the UK. It highlights the importance of establishing comprehensive training and competency standards to ensure patient safety and care quality.

Both Canada and the UK have room for improvement in regulating aesthetic medicine, yet the cross-examination of these practices still offers some valuable insights. By adopting a more structured approach to medical oversight, considering tighter advertising regulations, and emphasising the importance of standardised training, the UK can enhance its regulatory framework. Such improvements would not only safeguard patient safety but also elevate the overall standard of care in the realm of aesthetic medicine. Canada is nowhere near perfect, so as the industry continues to grow, the adaptation and refinement of regulations will be key to ensuring that equally advanced and effective safeguards match advancements in aesthetic treatments in both countries.

DR SAMUEL HETZ

Dr Samuel Hetz is the medical director of Dermapure Wellington Village (previously Concept Medical ), a physician-led medical aesthetic practice located in Ontario, Canada. Dr Hetz completed his residency in family medicine at the University of Ottawa, followed by a fellowship in primary care skin conditions and off ice-based surgical procedures.