A new study from UCL researchers, published in the Aesthetic Surgery Journal Open Forum, has highlighted the drastic increase in practitioners, including non-medical aestheticians, administering botulinum toxin since 2023.
This study follows the UK Health Security Agency (UKHSA) issuing a warning around the dangers of unlicensed botulinum toxin, following a series of adverse reactions of botulism.
In August 2025, the UK government announced plans for reforms to further regulate cosmetic procedures, outlining a tiered approach to regulation based on the level of risk associated with procedures.
With an estimated 900,000 botulinum toxin injections carried out each year in the UK, professionals have long been advocating for increased regulation following the continued market growth.
Characterising practitioners administering botulinum toxin
The aim of the study was to characterise practitioner profiles, pricing patterns, premises types, and socioeconomic gradients in the administration of aesthetic botulinum toxin across the UK.
Researchers conducted a cross-sectional analysis of practitioners administering botulinum toxin and fillers across the UK from January to July 2025, using public data from online materials and social media.
This study was designed to provide a comprehensive national overview of:
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Who is delivering botulinum toxin treatments
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Where treatments are being delivered
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How much they cost
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How access varies by socioeconomic area
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What this means for future regulation
A 437% increase in practitioners administering botulinum toxin in two years
The study found that there were 19,702 practitioners administering botulinum toxin across 5,589 clinics – a 437% increase from 2023.
The data revealed that the demographics of those administering botulinum toxin were:
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Doctors – 28.4%
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Nonmedical aestheticians – 24.8%
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Nurses – 24.8%
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Dentists – 10.5%
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Allied health professionals – 11.2%
Notably, almost a quarter of individuals administering botulinum toxin were non-medical professionals.
How much are practitioners charging for botulinum toxin?
The study revealed that, on average, practitioners charged:
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Doctors – £187.55
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Dentists – £190.69
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Nurses – £158.32
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Aestheticians – £148.44
This data revealed that the price of botulinum toxin depended largely on the practitioner's qualification
The demand for botulinum toxin across different socioeconomic groups
The study suggests that there is a greater demand for botulinum toxin in the more deprived socioeconomic areas, where the practitioner density was 6.7% higher.
However, access to specialist doctors is lower in the more socioeconomically deprived areas, with doctor representation dropping from 34.4% in the least deprived areas to 27.0% in the most deprived areas.
“Our findings show that while more than 90% of those treatments are given in hospitals or clinics, there are a range of non-clinical settings where botulinum toxin – a prescription-only medication – is being administered, including beauty salons, spas, and even mobile setups which might lack the adequate safety infrastructure,” explains lead author Dr Alexander Zargaran, from UCL Surgery and Interventional Science.
This suggests that more socioeconomically deprived communities are more likely to receive botulinum toxin from lower-cost, non-specialised practitioners, in non-clinical premises.
What this means for the industry and professionals
Whilst this research does not delve into complication rates, data from BCAM’s clinical review found that:
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668 botulinum toxin complications from beauticians
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Fillers account for 87% of all reported complications
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1,239 reported cases have been directly linked to beauticians
Botulinum toxin must be prescribed by a qualified prescriber, through a face-to-face assessment, before administration.
Adverse implications from counterfeit botulinum toxin can include muscle weakness, drooping eyelids, dry mouth, and difficulty swallowing or speaking.
Patients are often drawn to attractive prices and deals, without realising the dangers of receiving botulinum toxin from unregulated and under-qualified practitioners.
The regulation proposed that practitioners administering botulinum toxin will need to demonstrate appropriate training, safety standards, insurance, and hygiene protocols to be licensed.
Industry response
“The aesthetics industry is evolving at an extraordinary pace, and in recent years things have drifted off course, which is why industry-wide regulation is so important,” explains Lesley Blair, chief executive of the British Association of Beauty Therapy and Cosmetology (Babtac).
“There are plenty of excellent advanced aesthetic non-healthcare practitioners in the beauty sector who are highly qualified and skilled in the modalities they safely perform, but we firmly believe that injectables should only be administered by suitably qualified medical practitioners in adequate clinical settings.
“As the sector is not regulated, there’s no formal recourse if something goes wrong, allowing unscrupulous and underqualified individuals to operate without appropriate safeguards, which in turn poses risk to public safety.”
“Over recent years, we’ve worked closely with the UK Government on its efforts to strengthen regulation in the aesthetics sector, which is essential for raising standards and improving professionalism across the industry,” continues Victoria Brownlie, chief sustainability officer for British Beauty Council.
“As treatments have become more accessible, they’ve also taken on a more frivolous perception compared with a decade ago. That’s why strong regulation is vital, to reinforce that these treatments (injectables) are procedures with real risks, requiring mandatory regulatory processes to ensure practitioner competency, safe premises, and clear avenues for recourse if something goes wrong.”
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