Botulinum Toxin and Cosmetic Fillers (Children) Bill

Claire Brader

A botox injection being administered on a woman's face, injected in the lip

The Botulinum Toxin and Cosmetic Fillers (Children) Bill (HL Bill 180 of session 2019–21) is a private member’s bill sponsored in the House of Lords by Baroness Wyld (Conservative). It was introduced in the House of Lords on 12 March 2021 and is due to have its second reading on 16 April 2021. Laura Trott (Conservative MP for Sevenoaks) sponsored the bill during its House of Commons stages. The Department of Health and Social Care published explanatory notes to the bill in preparation for its introduction into the House of Lords.

What are botulinum toxin and cosmetic fillers?

Botulinum toxin is a naturally occurring substance produced by bacteria. When injected, it relaxes the surrounding muscle and temporarily freezes it. This can have the effect of smoothing out lines and wrinkles in the skin caused by facial expressions. Botulinum toxin is a prescription-only medicine that can also be used to treat several medical conditions. There are several trade names used for cosmetic treatments made with botulinum toxin, the most common of which is ‘Botox’.

Cosmetic fillers, also known as ‘dermal fillers’, involve substances such as hyaluronic acid being injected beneath the surface of the skin to add volume and fullness. Hyaluronic acid naturally occurs in the human body and is key for skin moisture.

The explanatory notes to the bill state that children are able to access botulinum toxin and cosmetic filler procedures on the commercial market in the same way that adults can, with no prior medical or psychological assessment required. Whilst botulinum toxin must be prescribed, practitioners who perform the procedures are not required to have medical qualifications. Practitioners can choose to join a register, such as the voluntary register provided by Save Face, however this is not required by law. Equally, there are no mandatory competency or qualification frameworks in place.

How are they currently regulated?

Regulation of cosmetic procedures remains limited. In 2012, following the Poly Implant Prothèse (PIP) breast implant scandal, the Government announced that Sir Bruce Keogh, the then NHS medical director for England, would review the regulation of cosmetic interventions.

Sir Bruce Keogh’s final report found that, amongst other things, non-surgical cosmetic procedures were almost entirely unregulated. He provided recommendations to improve the safety of individuals undergoing such procedures. The NHS considers non-surgical cosmetic procedures to include botulinum toxin injections and cosmetic fillers.

The Government published a response to the Keogh report in 2014 and agreed with the majority of recommendations. It committed to consider ways that training and qualifications could strengthen sector standards. It also said it would consider how far supervision from regulated professionals could support the self-regulation of the sector.

Several years later, a 2017 report by the Nuffield Council on Bioethics on ethical issues of cosmetic procedures highlighted several concerns. This included “inadequate” controls on the safety of some products used in procedures, and the absence of any statutory requirements for practitioners who perform such procedures to have particular qualifications or experience.

The 2017 Conservative Party manifesto included a commitment to ensure the effective registration and regulation of those performing cosmetic procedures.

The explanatory notes to the bill state that the Government has been exploring regulation of premises, practitioners, products and consumer safeguards.

What would the bill do?

The bill contains six clauses.

Clause 1 would make it a criminal offence for a person to give botulinum toxin or certain filler injections for cosmetic purposes to a person under 18. The exception to this would be if the person administering the injections could show that they were an approved person at the time of the offence. This would mean they:

were a registered medical practitioner;
were a registered health professional (such as a registered nurse, dentist or pharmacist) acting in accordance with directions of a registered medical practitioner; or
had taken reasonable steps to establish the person’s age and reasonably believed they were 18 or over.

Clause 2 would make it an offence for business owners, in the course of their business, to allow a person other than an approved person to administer botulinum toxin or a filler for cosmetic purposes to a person under the age of 18 in England. The business owner would have a defence if they could prove that they exercised due diligence and took all reasonable precautions to avoid committing the offence.

Clause 3 applies to corporate bodies. If the offence in clause 2 is committed with the consent or connivance of a director, manager or secretary of a corporate body, such individuals (and the corporate body) would have committed the offence.

Clause 4 relates to enforcement powers. No new enforcement or investigatory powers would be created, but instead local authorities (referred to in the clause as local weights and measures authorities) would use existing investigatory powers in the Consumer Rights Act 2015.

Clause 5 would allow regulations which are consequential on the bill to be made by statutory instrument.

Clause 6 refers to the bill’s territorial extent and commencement. Most clauses in the bill would extend to England and Wales only. Exceptions to this would be clause 4(3) and clause 5 which would extend to the UK. Clauses 1 to 4 would come into force at a time stipulated by the secretary of state in secondary legislation. Clauses 5 and 6 would come into force on the day that the bill receives royal assent.

House of Commons stages

The bill was first introduced in the House of Commons on 5 February 2020. Its sponsor was Laura Trott (Conservative MP for Sevenoaks).

Second reading

The bill’s second reading debate took place on 16 October 2020. Introducing the bill, Laura Trott highlighted the lack of regulation in the area.

Referring to a 2018 survey, she said that 100,000 under-16s had undergone cosmetic enhancements that year, the most common of which were cosmetic fillers. She referred to the potential impact that such procedures could have on the mental and physical health of young people, and highlighted complications that could occur through such treatments:

Botox and fillers can be incredibly dangerous. Complications can include, but are not limited to, blindness, breathing difficulties—if it is injected into the neck—infection and the filler moving away from the intended treatment area into other areas of the face. Many people, mainly women, have been left with rotting tissue, lip amputations and lumps. I remind the House that, if any of these complications occurs, the practitioner injecting the substance needs to have no medical training whatsoever, so neither will they be able to deal with the potential complications, nor are they required to have insurance, so they do not have to pay for the very expensive cosmetic surgery that may be required to fix the problem.

Referring specifically to Botox, Ms Trott said that, once prescribed, doctors can delegate responsibility for injecting it to “anyone at all with no qualifications”.

The bill received widespread support during the debate. Several members expressed their shock at hearing that children were legally able to access such cosmetic procedures.

Justin Madders, the Shadow Minister for Health and Social Care, supported several aspects of the bill, but highlighted the enforcement responsibilities that would fall to local authorities which, he argued, had already “had their funding stripped over the past decade”. He raised questions about how comprehensive the enforcement regime could be.

The Minister of State for the Department of Health and Social Care, Edward Argar, said that the Government fully supported the bill. He agreed with its aims to protect young people from such cosmetic procedures. He also highlighted the value of non-surgical cosmetic procedures to the economy, stating that the market was predicted to rise to over £3.6 billion in the UK by 2021.

Money resolution

The House of Commons approved a money resolution on 17 November 2020. The UK Parliament guidance on money resolutions states that, where a new bill proposes spending public money on something that has not previously been authorised by legislation, a money resolution must be agreed by the House of Commons.

The explanatory notes to the bill state that the bill could result in an increase in revenue support to enable English local authorities to carry out the new enforcement powers in clause 4.

Public bill committee

The public bill committee debate took place on 25 November 2020.

During this stage, several amendments were tabled but subsequently withdrawn. This included three amendments to clause 1, tabled by Carolyn Harris (Labour MP for Swansea East) and Judith Cummins (Labour MP for Bradford South). They sought to amend the bill to ensure that medical practitioners could only provide non-surgical cosmetic procedures to a person under 18 years if it was medically necessary.

Laura Trott agreed with the amendments’ sentiments but argued that the bill already had safeguards in place to ensure that under-18s would only receive non-surgical cosmetic procedures where medically necessary. She said:

[…] UK doctors must be registered and hold a licence to practise with the [General Medical Council (GMC)]. The GMC publishes specific ethical guidance that says that doctors performing cosmetic interventions can provide treatment to children only when it is deemed to be medically in the best interests of the patient.

The Minister for Patient Safety, Mental Health and Suicide Prevention, Nadine Dorries, said that a post-implementation review of the regulations would assess whether any wider unintended consequences had materialised.

Kevan Jones (Labour MP for North Durham) tabled probing amendments to highlight concerns about the advertising of certain cosmetic products, for example on social media websites.

The minister acknowledged Kevan Jones’s comments and committed to take them away for review. Laura Trott also agreed that further work was needed in this area, and committed to making these points during debates on forthcoming online harms regulations.

Following the debate, all amendments were subsequently withdrawn and the bill was reported without amendment.

Remaining stages

The report stage and third reading debate took place on 12 March 2021. Two amendments were tabled but subsequently withdrawn.

Following the short debate, the bill received its third reading. Laura Trott paid tribute to all contributors, in addition to the work done by Save Face, an organisation that provides a national register of accredited practitioners of non-surgical cosmetic treatments. The minister, Nadine Dorries, reiterated the Government’s full support for the bill. Alex Norris, the Shadow Minister for Health and Social Care, described the bill as a “great piece of legislation” that Labour fully supported.

Reaction to the bill

Organisations in the medical and cosmetic industries have also supported the bill.

A statement published by the British College of Aesthetic Medicine described the bill as a “welcome step toward[s] long-overdue tightening of regulation surrounding the accessibility of aesthetic interventions”. The British Association of Oral and Maxillofacial Surgeons (BAOMS) also welcomed the bill. Caroline Mills, the BAOMS lead on facial aesthetic/cosmetic surgery is cited in the BDJ in Practice journal as saying:

BAOMS is pleased that Health Minister Edward Argar has given his backing to this bill, and for his department’s commitment to explore increased oversight of aesthetic practitioners. We want this to be the first step towards wider regulation across the industry to protect anyone in the UK undertaking non-surgical cosmetic procedures.

Dr Tristan Mehta, founder and CEO of aesthetic medicine training provider Harley Academy, hoped the bill would pave the way towards statutory regulatory requirements across the entirety of aesthetic medicine in the UK.