Zargaran, David; (2023) Evaluating the Public Health Impact of the United Kingdom Aesthetic Botulinum Toxin and Dermal Filler Market. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Background: The rapid growth of the United Kingdom (UK) aesthetic injectables sector, limited legislation, and lack of empirical research poses a significant public health challenge. Objectives: To quantify the risk to patients, as captured through Government databases, meta-analysis, as well as to create a database profiling aesthetic practitioners and their compliance with existing legislation. Finally, to evaluate the lived experience of patients who have experienced a complication and propose methods to improve patient safety. Methods: The UK’s Medicines and Health Regulatory Agency (MHRA) database of reported complications was evaluated then compared with a meta-analysis of the expected complication rate. A database of practitioners was created, cross referencing this with professional databases to identify the professional profile and background experience. Practitioner compliance with legislation was assessed, followed by a national survey of 656 patients with complications. Finally, Delphi consensus methodology was implemented to survey 122 industry practitioners and experts to propose a series of recommendation to improve patient safety. Results: We identified 188 complications over a 30-year period from MHRA records. The meta-analysis yielded an expected complication rate of 16% for Botulinum Toxin administration to the upper face. Registered doctors accounted for 32% of UK practitioners, with the remainder from a variety of professional and non-professional backgrounds, with 88% of practitioners breaking Advertising Standards Authority Rules. Our patient survey identified the physical, emotional, psychological and financial burden of complications. The Delphi study generated 38 recommendations, informing a unifying framework – the 5Ps to help contextualise future public health analyses Conclusion: This PhD provides a unique and in-depth insight into the aesthetic injectables sector, providing an important foundation for regulation to improve patient safety and safeguard public health. Current lack of regulation poses systemic risk to patients, and work is needed to reform the sector to provide robust safeguards.

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