Impact case study database

Impact from the research conducted by the NCoB WP and chaired by Edwards [1] has been achieved cumulatively, through diverse channels, and through ongoing collaboration between Edwards and the NCoB. The NCoB report [1] makes 27 recommendations, focussing on both the ‘demand’ and ‘supply’ sides of the cosmetic industry [A]. The recommendations include calls to restrict access to certain procedures to over-18s, for the Royal College of Surgeons and other professional bodies to ensure the certification and necessary training of surgeons, and for the Department for Education to ensure young people have access to evidence-based resources on body image [1]. The research has led to impact in the following three ways:

4.1 Raising public awareness of the health risks of an unregulated cosmetic surgery industry and the need for better regulation of providers, premises and products.

The report [1] was widely publicised on launch in 2017, achieving extensive media coverage, including articles in the Independent, Huffington Post, the Mirror, the Guardian and the Telegraph [B]. Katharine Wright, Assistant Director of the NCoB, explains that “ Jeanette was heavily involved in the media at the time of the launch (including both Radio 4 and regional radio interviews)” [A] , e.g. BBC TV Six O’ Clock News; BBC Radio Manchester; BBC Radio 4’s Today; BBC Radio 5 Live; Radio London and Radio Scotland [B]. International coverage included an interview on BBC World Service’s Health Check, and on BBC World Service TV [B]. The report’s recommendation that social media sites investigate and remove cosmetic surgery apps and makeover games aimed at children was reported by the Guardian, citing Edwards. In 2018, journalist Sonia Sodha wrote a Guardian article critical of the decision of Superdrug to offer botox and dermal fillers in selected high street stores [B]. Sodha confirmed that she had used the NCoB report extensively in writing the article, finding it “very helpful and informative” [C].

Actress and playwright Monica Dolan contacted Edwards after becoming aware of the report in the press. Dolan has drawn on the findings in public discussions of The B*easts, a play about children and cosmetic surgery (which won an award at the 2017 Edinburgh Festival). Representatives of the NCoB participated in a public panel discussion on these issues after a performance of the play at the Bush Theatre, London (where it ran in February and March 2018). Dolan writes that the “report informed the discussion around [the play] …taking it further by inciting Q and As about the interface between the play and the reality out there. It gave the play more credence and certainly helped me to talk about it publicly in a much more informed way” [D] .

Gary Ross, Consultant Plastic Reconstructive and Aesthetic Surgeon, states that there are limits to regulation given plastic surgery is predominately in the private health sector [E]. Of great importance therefore “ is the cultivation of a discerning and educated public who, for example, are aware of good and ethical practice…The work of the NCoB on cosmetic procedures guided by Edwards will continue in the coming years to be valuable in raising public understanding and awareness” [E] .

4.2 Supporting professional bodies in shaping best practice and training

The research has raised awareness amongst practitioners and professionals of the broader social and cultural context that makes cosmetic procedures desirable, leading to improvements in practice and training in the UK. The report featured in outlets aimed specifically at health professionals and was cited in many professional journals [F]. The British Medical Journal published a two-page feature entitled ‘Cosmetic industry regulation is only skin deep’, and a piece appeared on doctors.net.uk (read by 51,000 GMC-accredited doctors per day; subscription-only) [F]. An article in the journal Aesthetics, highlighting links between social media and appearance anxiety, cited Edwards [F]. Drawing on the work of Edwards and the WP, the NCoB also contributed to numerous consultations, including: the Youth Select Committee inquiry on body image (June 2017); the Consultation on Draft Standards, issued in 2017 by the Cosmetic Procedures Standards Authority; the Science and Technology Committee inquiry on the impact of social media and screen-use on young people’s health (March 2018); and the Information Commissioner’s Office consultation on its draft code of practice for age-appropriate design for online services (May 2019) (see [A, H] for full list of consultation contributions).

Following the launch of the report, the NCoB hosted a meeting with Lord Lansley (who has a private member’s bill on the regulation of cosmetic surgery), the Royal College of Surgeons (RCS), the General Medical Council (GMC), and major commercial providers of cosmetic surgery [A] to discuss how to implement the WP’s recommendation that the RCS require all members who practise cosmetic surgery to participate in its certification scheme and have access to appropriate training [1]. Gary Ross, the first surgeon to be certified by the RCS, outlines how “ the GMC has acknowledged the NCoB report in 2017 in its recommendations for a more robust regulatory framework to ensure patient safety and to protect patients against many of the risks from cosmetic procedures” [E]. He explains that, since the report, there has been an increase in the number of cosmetic surgeons applying to the RCS for certification; an increased awareness of the need to assess social and psychological presentation of patients/clients prior to surgery; and a much broader agreement that cosmetic surgery should not be offered to under-18s, unless there are good medical reasons [E].

In February 2019, drawing on findings and recommendations in the NCoB report, (the WP recommended collaborative work amongst social media companies [1]), the NHS Medical Director, Stephen Powis, called for social media companies to ban celebrity ads targeted at children [I]. In July 2019, the Secretary of State for Health and Social Care announced a new partnership between the Samaritans and Facebook, Instagram, Pinterest, Google, YouTube, and Twitter to investigate the health impact of social media on young people [G].

The recommendations of the WP were also cited in the design of the Masters programme in Skin Ageing and Aesthetic Medicine (Faculty of Biology, Medicine and Health, University of Manchester), as defining best practice standards in the ethics of providing cosmetic procedures to patients/clients. The MSc Programme Director, has since been working with the NCoB on developing resources that use key findings of the report [G]. Graham states, “ we have been expanding the teaching materials around the ethical issues surrounding cosmetic procedures. We identified the 2017 Nuffield Council on Bioethics report (Cosmetic procedures: ethical issues) as an invaluable resource” [J].

4.3 Shaping the development of proposals for new legislation

The research findings have also helped shape the developments of proposals for new legislation by informing parliamentarians about implementing age restrictions on access to cosmetic procedures, and the role of social media in promoting cosmetic procedures and the adverse impact of such promotional activities on body image and mental health, especially amongst young people.

The Botulinum Toxin and Cosmetic Fillers (Children) Bill 2019-20 was introduced by Laura Trott MP following a Private Members’ Bills Ballot on 9 January 2020. In the lead-up to the bill, the NCoB report was cited in numerous parliamentary debates. In 2017, the then Parliamentary Under Secretary of State (Mental Health, Inequalities and Suicide Prevention) Jackie Doyle-Price MP invited NCoB staff to discuss priorities for meeting the Conservative Party manifesto commitment to improve regulation of those providing cosmetic procedures. During a Westminster Hall Debate in May 2019 she committed to bringing forward legislation to ban under-18s from accessing cosmetic procedures, in line with current age limits on tattoos and sunbeds, a key recommendation of the report [I]. During the debate, Alberto Costa MP stated that the NCoB “recommended that children under 18 should not be able to have these procedures unless there was an overriding medical reason for them to do so” [G].

A parliamentary question tabled by Clive Lewis MP in September 2017 asked the Minister of State for Health, Philip Dunne, if his Department would implement the recommendations of the NCoB report. In response, Dunne described the report as “ thorough and thoughtful” and said it “ will help to inform our thinking” about “ the effective registration and regulation of those performing cosmetic interventions” [H] . Bambos Charalambous MP sought the NCoB’s support in submitting parliamentary questions on the regulation of cosmetic procedures, and in introducing a debate on this issue [A]. There was also a written parliamentary question in the House of Lords, in November 2017, from Baroness Gould, on the report’s recommendation that the Home Office should clarify the marketing of ‘female genital cosmetic surgery’. She asked what plans the Government have “to issue guidance … clarifying the circumstances under which procedures marketed as "female genital cosmetic surgery" may be necessary for a woman’s physical or mental health and therefore not banned under the Female Genital Mutilation Act 2003” [H].