EWJ June 61 2025 web - Flipbook - Page 90
Personal Injury in Aesthetic
Medicine: Navigating the Risks of
Non-Surgical Cosmetic Procedures
By Julie Brackenbury, Independent Aesthetic Nurse and Medico-Legal Expert
Non-surgical cosmetic treatments such as botulinum
toxin injections, dermal fillers, and chemical peels
have become increasingly mainstream in the UK.
These procedures are often promoted as convenient,
low-risk alternatives to surgery. However, their rising
popularity has been accompanied by a growing number of personal injury claims, many of which stem
from complications that could have been avoided
through proper training, consent, and clinical
governance.
Duty of Care:
In aesthetic practice the duty of care is no different
from that in mainstream healthcare. Where standards
fall below that of a reasonably competent practitioner,
and a patient suffers harm as a result, legal liability
may arise. Many such cases involve non-medically
trained individuals performing advanced procedures
without sufficient anatomical knowledge or clinical
experience.
The Centrality of Informed Consent:
A consistent shortcoming in aesthetic injury cases is
the failure to obtain informed, voluntary, and specific
consent. Informed consent is not a signature on a
form but a process and is two-way discussion that allows the patient to make a reasoned decision about
whether to proceed.
In this article, I draw on my experience as an aesthetic
nurse and expert witness to explore the medico-legal
implications of personal injury in non-surgical aesthetic practice. I highlight key areas of risk, discuss the
importance of robust consent and documentation,
and consider the evolving regulatory landscape.
The Expanding Landscape of Aesthetic Medicine:
The UK’s aesthetic sector has experienced
exponential growth in recent years. According to the
Department of Health and Social Care (2022), the industry was worth approximately £3.6 billion in 2021,
with non-surgical procedures accounting for over 80%
of that total. Yet despite its rapid expansion, the sector
remains largely under-regulated, with no mandatory
training requirements or national licensing system
in place for practitioners administering high-risk
treatments.
Best practice:
Best practice dictates that patients should be provided
with written and verbal information outlining;
▪ The proposed treatment and how it works
▪ Likely outcomes, including limitations
▪ Common and rare risks (e.g., bruising, infection,
vascular occlusion)
▪ Alternatives, including no treatment
▪ The practitioner’s qualifications
Principles:
In Montgomery v. Lanarkshire Health Board [2015] UKSC
11, the Supreme Court held:
"The doctor is under a duty to take reasonable care to ensure
that the patient is aware of any material risks involved in any
recommended treatment."
This lack of regulation has left patients vulnerable to
harm, and legal practitioners are increasingly being
instructed to pursue claims against individuals or
clinics following adverse outcomes. In the absence of
statutory safeguards, expert witnesses play a critical
role in helping courts understand whether an injury
was foreseeable, avoidable, and attributable to
negligence.
This principle extends to non-surgical cosmetic
procedures, where practitioners must disclose all material risks to patients. A patient undergoing a dermal
filler injection must, therefore, be informed of the risk
of vascular compromise, even if such complications
are rare, because the consequences can be catastrophic. Moreover, cooling-off periods are crucial in
elective procedures. Consent obtained minutes before
treatment is not only poor practice but may be legally
indefensible if complications arise.
Common Types of Injury and Clinical Failings:
In my work reviewing aesthetic injury claims, several
recurring themes emerge;
▪ Vascular occlusion and tissue necrosis following filler
injections, particularly in the perioral and perinasal
regions
▪ Infections, including cellulitis and abscess formation,
linked to inadequate aseptic technique or poor aftercare advice
▪ Burns and pigmentation changes associated with
lasers or chemical peels
▪ Psychological injury due to botched outcomes,
deformity, or a breach of patient expectations
EXPERT WITNESS JOURNAL
Psychological Vulnerability and Practitioner
Responsibility:
Another layer of complexity in aesthetic medicine lies
in the psychological motivation of patients. Aesthetic
interventions often intersect with self-esteem and
mental health. Patients presenting with unrealistic
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