Aesthetic medicine ‘overwhelmingly a young and female issue’ reveals latest survey of aesthetic doctors and dentists
Latest data from the British College of Aesthetic Medicine (BCAM) reveals an overwhelming 88% of patients seen by aesthetic doctors and dentists in the last 12 months are female, with 21% of women patients less than 35 years of age. Most popular patient treatment choices are Botulinum Toxin (Botox)®, Dermal Fillers and Laser treatments.
This pooled data represents analysis of more than 225,000 individual treatment episodes reported by 270 medically qualified Aesthetic practitioners over the last year (1). The survey results support the findings of market research company, Mintel, that 46% of Britons now believe non-surgical procedures are increasingly becoming a part of everyday beauty routines (2).
Mr Greg White, Chief Executive of the British College of Aesthetic Medicine, said, “The good news is women clearly feel confidence in accessing treatment from BCAM members, all trained medical professionals specialising in Aesthetic Medicine. Especially so since our field is still open to non-medical practitioners as well, with their tangle of professional registers and standards.
“Interestingly we are pleased to hear that many patients are especially seeking the help of our BCAM registered Doctors and Dentists for advice and treatment of complications made by practitioners outside BCAM.”
* 64% of BCAM doctors reported treating other practitioners’ Botox issues
* 77% reported treating other practitioners’ Dermal Filler complications
* 25% of respondents reported treating laser/IPL problems and 25% thread lift problems
White added, “Patient safety is paramount. Our survey identifies serious issues which need to be addressed, ideally through tighter regulation. But equally important must be what the survey says about the pressures of body image issues on young people, in particular young women. ‘Take the TV programme Love Island - a show which has been accused of planting 'unrealistic' beauty standards upon young viewers. I support the Head of the NHS, Simon Stevens, in his recent comments that the NHS should not have to pick up the pieces of a mental illness crisis amongst young people as a result of body image pressure.’”
Dr Uliana Gout, BCAM Board and Director of PR & Media commented, “We are proud to release our annual BCAM Survey – one of the handful of global surveys focusing on our industry – highlighting the latest trends within the UK Aesthetic Medicine arena. We hope this information will guide the evolution of this specialty and provide invaluable information both to the industry and patients alike.”
Dr Paul Myers, BCAM Board and BCAM Appraisal Clinical Lead, added, “This is now the sixth consecutive annual report we have provided and is the most comprehensive review of aesthetic work provided by our members, representing more than 225,000 individual treatment episodes in the last year. We are developing a significant database covering the range of treatments our members provide and crucially the adverse event rates which remain reassuringly low. Continuous monitoring of our work clearly has an important bearing on safety and provides scientific based reassurance to patients who use the services of BCAM members.”
1 British College of Aesthetic Medicine Practitioner Audit 2018-2019
2 www.mintel.com/press-centre/beauty-and-personal-care/nip-tuck-or-fill-31-of-brits-are-interestedin-
having-cosmetic-surgery-in-the-future
THE REPORT IN FULL: THE BCAM ANNUAL REVIEW 2018 by Paul Myers
Each year members of the British College of Aesthetic Medicine provide details of their aesthetic clinical practice, as a condition of their membership of the organisation. This process has been in place for the last nine years. The process helps the BCAM board as it provides a current and detailed review of the clinical practices of their members. This supports the making of strategic decisions at board level. For the individual doctors contributing to a mandatory clinical review, this is a enables them to compare their own practice data such as clinical activity and significant adverse events with pooled data from nearly 350 doctors providing similar clinical services.
There follows a brief review of the results obtained in the year 2017 / 2018 . 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% male) with two thirds being aged between 40 and 59 years old. Less than 25% of the membership have been practising for less than four years and in fact the majority had been in practice for more than seven years, including nearly 25% of are the total who had been practising aesthetic medicine for more than 13 years. When compared with last year's data this reflects a gradual increasing in experience of the membership. 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. Thus the vast majority of aesthetic doctors in BCAM, concentrate on the specialty, and do little other work in addition.
When we look at the range of aesthetic treatments provided almost all BCAM aesthetic doctors provide toxin and dermal filler anti-ageing treatments, and nearly half in addition provide both laser treatments and minor surgery. There is a wide range of other treatments that are provided by BCAM doctors including hair loss treatment, meso-therapy chemical peels, various fat removing treatments and weight loss management. As last year the latter range of treatments are practised by a wide range of doctors.
BOTULINUM TOXIN TREATMENT
The use of Botulinum toxin for aesthetic indications was reported by almost all of the respondents,(96%), and nearly 90% of this was for aesthetic treatments, but a significant number of doctors provided this 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 this reflects the increasing numbers of members contributing to the review as well as an increasing clinical activity, and shows progress in the aims of BCAM in reporting both the activities of the members as well as providing more accurate data such as adverse events reporting figures. The clinical data regarding adverse events that have occurred following toxin treatments, and while minor adverse events such as eyelid or brow ptosis, or poor aesthetic result were reported occasionally this treatment appears reassuringly safe, with 95% of respondents reported no adverse events at all. Out of the total number of individual treatment sessions there were reported 115 incidents by the respondents, although this 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 4 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, 3 post procedure infection, and 22 "others". The specific replies by members to the question seeking request for additional information with regard to toxic treatments was generally helpful, including replies from 53 respondents.
DERMAL FILLER / VOLUMISER TREATMENT
With regard to dermal filler management , the survey reviewed more than 28,700 treatment sessions provided by the aesthetic doctors responding, 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 this was used for lip enhancements 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 patient's expectations (571). Including all figures, the overall adverse event rates worked out to be approximately is 23 per 1000 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 et cetera. 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 prevalence of significant adverse events the use of dermal fillers appears very safe with the adverse event rate being reported at only 3.3 events per 1,000 treatments.
LASER TREATMENT
The review also looked at laser treatments by the aesthetic doctors. This treatment was provided by only a relatively minor 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%) with a further minor for other dermatological indications and for tattoo removal (15%). There was a low prevalence of adverse events reported following laser treatments for example a total of only 83 incidents were reported by all the respondents, the majority of these being minor incidents such as bruising (14), or not managing patient expectations, (35). The remainder included minor pigmentation changes / hyperpigmentation, (20) or hypo pigmentation (1). This was in relation to approximately 12,300 treatment episodes reported over the last 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
Other treatments were also reported by the respondents of the survey including minor surgery treatments which was reported by more than one third of the doctors. An important part of the clinical review was in a feedback section in which doctors could give a wide range of feedback regarding their aesthetic work, areas that they wish the college to concentrate on with respect to education and training, and suggestions for further topics for future audits. One of the 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 for this to be available in anonymized collated form, as provided in this report.
This then enables the doctors to look at their own data and compare it with the pooled data provided, for example in the prevalence of significant adverse events. By comparing audit data from the doctor's own clinical practice with pools 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. Thus information from this report can be used to support doctor’s appraisals, for example comparing their own clinical activity and significant event reporting with standardised data, for example:
- Toxin Treatment Significant Adverse event rate 4.0 events per 1,000 treatments
- Dermal filler. Significant Adverse event rate 3.3 events per 1,000 treatments.
- Laser treatment. Significant Adverse event rate 2.8 events per 1,000 treatments
This pooled data represents analysis of more than 70,000 individual treatment episodes reported by nearly 350 medically qualified aesthetic practitioners from over the last 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. It is planned that over the next 12 months the clinical review described here is to be revised 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 such as the clinical review described. Examples include the availability of approved clinical audits in relation to aesthetic treatments which are now available on the BCAM website.