Where exactly is your bottom line?

Following the shocking death of Alice Webb, Cheryl Barton stresses the importance of policy change

The death of Alice Webb at Gloucestershire Royal Hospital on September 24, following complications from a Brazilian butt lift (BBL) procedure sent shockwaves through the sector. Eight months later, injectable BBL treatments continue to be advertised and promoted on social media platforms. So-called ‘training academies’ maintain offers for one-day training sessions, using injectable products with little or no clinical data and there is a plethora of insurance brokers ready to offer schedules for those with the intent to treat. If Webb’s death does not change policy, what will it take, and just how many deaths are considered too many?

Last month, my clinic in Sheffield received several online requests for BBL treatment. This was somewhat unexpected, especially when we don’t endorse the procedure, or advertise or promote cosmetic buttock augmentation. Neither the surgical nor the injectable implant method, using any of the soft tissue expanders including fat, is recommended by us for cosmetic enhancement. We also consider that those seeking this treatment as a cosmetic enhancement for buttock augmentation possibly sit within the most vulnerable of our patient cohorts.

The death of Webb, a young mother of five children, has led to the arrest of two individuals on suspicion of manslaughter (2024).1 The criminal investigation is active, so I am unable to discuss it any further here, but I eagerly await the coroner’s report.

Following Webb’s death, many professional associations and associated bodies issued press releases, some of them collaborating with an allied organisation or body to jointly publish their responses. Press releases are an effective communication and publishing tool, used to raise awareness and generally inform the public of a current news story, to be replicated and republished so that the message is widely disseminated and broadcast both digitally and in print. Webb’s untimely death following this high-risk intervention, performed outside of a healthcare environment, brought universal condemnation from almost all professional associations within the aesthetic space.

In the Joint Council for Cosmetic Practitioners (JCCP)’s press release in collaboration with the British Beauty Council (BBCo) and the Chartered Institute of Environmental Health (CIEH), they called upon the UK Government and the devolved nations to introduce emergency legislation, ensuring that BBLs are now only to be performed by “appropriately qualified General Medical Council (GMC)-registered doctors”.2 The British College of Aesthetic Medicine (BCAM) along with the British Association of Medical Aesthetic Nurses (BAMAN – formerly BACN), issued a joint press release, with both associations calling for the BBL procedure to “only ever be carried out by appropriately qualified registered doctors, dentists and nurses”.3 In October 2024, the British Association of Aesthetic Plastic Surgeons (BAAPS) also issued a lengthy press release on the dangers of the injectable BBL, stating that “nobody should be performing BBL procedures – this scope lies uniquely within the specialist qualification of GMC registered plastic surgeons”.4

It is less than satisfactory that our professional associations did not reach an agreed consensus before communicating their stance to the public. Hence, it is unsurprising that members of the public are perplexed over what qualifications and requirements they, as potential patients, should be looking for when sourcing a provider when contemplating undergoing this procedure.

These professional organisations are our trusted bodies, and we all turn to them for guidance. The public should, as a minimum, receive a clear, cohesive and uniform message that reinforces the point.

We are collectively sending out an ambiguous, some might say a dangerous, message to the public when we do not speak with one voice, especially when considering the significance of this tragic, unprecedented death. We should not then be too surprised when underqualified practitioners project themselves into this space, especially when the procedure is something all “practitioners who inject” can perform, and the lay groups are insured to perform it.

It is my view, and one shared by almost all of my surgical colleagues, that this procedure should not be in the hands of anyone other than our GMC specialist plastic and reconstructive surgical colleagues and, at this point, only for the treatment of disease or injury, until we have published data and evidence on the safety of this injectable procedure using injectable soft tissue expanders. Our plastic surgeon colleagues have been warning us and the public about the risks associated with this procedure for many years now. They have issued many press releases warning the public and highlighting the dangers of the procedure and currently have a moratorium on the intervention that includes both the surgical implant and the injectable implant for cosmetic appearance. It may be this moratorium on the surgical implant that is driving those seeking this intervention into the lay sector.

The BBL is a very high-risk procedure. When death is reported as an outcome in 1:3000, maybe even as high as 1:2000, I believe this is one injectable intervention too far for nurses, GPs, midwives, pharmacists and dentists, and it should never be offered or administered within the lay arenas, or outside of a CQC-registered healthcare establishment.

It is my view, and that of my surgical colleagues, that rather than supporting the intervention, and listing who can, we should all be joining our plastic and reconstructive surgical colleagues in calling for a total prohibition on this procedure here in the UK.

When the stakes are this high, we should adopt the precautionary principle based on public health and prohibit advertising, promotions, and training, as well as inform insurance brokers that this intervention is unsafe when undertaken for cosmetic appearance and maintain this prohibition until or unless there is agreed published data on its safety profile.

CHERYL BARTON

Cheryl Barton is a very experienced registered nurse with over 25 years of full-time practice within the NHS and over 20 years in independent healthcare practice. Barton holds a postgraduate diploma in Cosmetic Medicine, graduating with a distinction. She is a nurse prescriber and NMC registered nurse, a full member of the Royal College of Nursing (RCN), British Association of Medical Aesthetic Nurses (BAMAN), and a member of the British Dermatology Nursing Group. She was also a founding member of the Private and Independent Aesthetic Practitioners Association (PIAPA). Barton is an expert witness to the courts, appears in press and broadcast media nationally, and works tirelessly campaigning to improve regulation within the aesthetic sector to ensure safer patient journeys.