BCAM Audit

Each year, members of the British College of Aesthetic Medicine (BCAM) provide details of their aesthetic clinical practice as a condition of their membership of the organisation. This process has been in place for the past nine years and helps the BCAM board to obtain a current and detailed review of the clinical practices of its members.

The latest clinical review provided pooled data from 334 doctors, which represents 95% of the current BCAM membership. There was an approximate even split in gender of the respondents, (53% were male) with two thirds being aged between 40 and 59 years old. Less than 25% of the membership has been practising for less than four years. In fact, the majority have been in practice for more than seven years and nearly 25% have been practising aesthetic medicine for more than 13 years.

Nearly half of all respondents were working full-time in aesthetics, providing no other clinical services, with a further 40% working two or three days per week. 

When we look at the range of aesthetic treatments provided almost all BCAM aesthetic doctors provide toxin and dermal filler anti-ageing treatments, while nearly half also provide both laser treatments and minor surgery. BCAM doctors also provide a wide range of additional treatments, including hair loss treatment, mesotherapy, chemical peels, various fat removal treatments, and weight loss management. 

BOTULINUM TOXIN TREATMENT 

The use of botulinum toxin for aesthetic indications was reported by almost all the respondents (96%), and nearly 90% of its use was for aesthetic treatment. However, a significant number of doctors provided botulinum toxin for medical indications too, including hyperhidrosis (16%), blepharospasm, facial asymmetry, and the management of the sequelae of stroke. Respondents to the survey reported reviews of more than 29,400 individual botulinum toxin treatment sessions, an increase in reported activity of nearly 30% compared with last year. it is considered that it reflects the increase in the number of members contributing to the review as well as increasing clinical activity, and shows progress in the aims of BCAMin reporting both the activities of the members and in providing more accurate data regarding adverse events that have occurred following toxin treatments found that while minor adverse effects, such as eyelid or brow ptosis, or a poor aesthetic result, were reported occasionally, this treatment appears reassuringly safe. In fact, 95% of respondents reported no adverse events at all. Of the total number of individual treatment sessions delivered, 115 incidents were reported by respondents (although it should be noted that this figure included minor problems such as bruising or inadequate efficacy following the treatment). 

This represents a reassuringly low level of problems with this treatment, the overall prevalence being less than four incidents per thousand treatments. Importantly, it should also be mentioned that there were no major adverse events reported by any doctor. Of the events following toxin treatment, 57 members reported at least one incident of lid ptosis, and 99 for ptosis/brow asymmetry, 55 for excess bruising, three post procedure infection, and 22 “others”. 

DERMAL FILLER/VOLUMISER TREATMENT 

With regard to dermal filler management, the survey reviewed more than 28,700 treatment sessions provided by the aesthetic doctors who responded, which represents an increase of 30% activity reporting compared with last year. 

This treatment was used for facial wrinkles in nearly one third of cases and for volumising treatments in about 40% of patients treated, figures comparable with 2017. For the remainder of patients, dermal fillers were used for lip enhancement or other indications. 

When the doctors were asked about adverse events following dermal filler treatment, 92% of respondents reported having experienced no adverse events of any sort. 

For the remainder, a total of 665 individual adverse events were described, although the vast majority of these were minor, such as bruising or an insufficient aesthetic result/ failure to meet the patient’s expectations (571). Including all figures, the overall adverse event rates worked out to be approximately 23 per 1,000, but this includes the minor self-limiting episodes. The specific replies by members to the question seeking request for additional information with regard to dermal filler treatments was generally helpful, including replies from 88 respondents. These included reports of allergic reactions, nodule formation, and excess swelling, etc. A small number of vascular incidents or suspected occlusion were reported (five) and this information is particularly helpful to the BCAM board in terms of future instruction education and support of members. In summary, in terms of the prevalence of significant adverse events, the use of dermal fillers appears very safe with the adverse event rate reported as only 3.3 events per 1,000 treatments. 

LASER TREATMENT 

The review also looked at laser treatments by aesthetic doctors. This treatment was provided by only a relatively small number of doctors (as the 2018 figures showed, only 37% of doctors provide light-based therapies in their practices). 

As last year, only one third of laser doctors provided more than 11 treatments per month. Again information such as this is helpful to BCAM in planning education and training in the future. The vast majority of laser users provide laser treatments for thread veins (65%), reduction of pigmentation (63%) or for facial rejuvenation (46%). Only a small number if respondents use laser treatments for other dermatological indications and tattoo removal (15%). 

There was a low prevalence of adverse events reported following laser treatments, with respondents documenting a total of just 83 incidents. The majority of these were minor incidents, such as bruising (14), not managing patient expectations (35), minor pigmentation changes/ hyperpigmentation (20) and hypopigmentation (1). This was in relation to approximately 12,300 treatment episodes reported over the past year. This would give a laser adverse event rate in relation to burns (14) and pigmentary change of 2.8 incidents per thousand treatment episodes. 

SUMMARY 

The feedback section was an important part of the clinical review. It enabled doctors to provide a wide range of feedback on their aesthetic work, areas that they wish the BCAM to concentrate on with regards to educated and training, and suggestions for further topics and future audits. 

One of the other most important functions of the annual clinical review, is to encourage aesthetic doctors to record their workload and the quality of the clinical services they are providing, for this to be documented in a structured way, and to be available in anonymised collated form. 

This then enables the doctors to look at their own data and compare it with the pooled data provided. By comparing audit data from their own clinical practice with national data from a large sample of aesthetic doctors, the individual doctor can report on the relative safety of their own treatments. This in turn is important information for the doctor to provide as “quality improvement” evidence for their annual appraisal. 

This pooled data represents analysis of more than 70,000 individual treatment episodes reported by nearly 350 medically qualified aesthetic practitioners from over the past year. 

The availability of the annual clinical review provides powerful information about the clinical work undertaken by aesthetic doctors and, in particular, emphasises the relative safety of the treatments provided. 

Over the next 12 months BCAM plans to revise the clinical review to make it more “user friendly”, and we are currently reviewing the data entry process. Progress on this will be reported in due course in the BCAM newsletter. 

In parallel with this there will be an increasing range of quality improvement initiatives for aesthetic doctors, to be promoted by BCAM, to supplement the quality improvement processes. Examples include the availability of approved clinical audits in relation to aesthetic treatments which are now available on the BCAM website.