A groundbreaking study by University College London (UCL) researchers has revealed a staggering 437% rise in the number of practitioners administering botulinum toxin in the United Kingdom over just two years. With 19,702 practitioners now operating across 5,589 clinics, this dramatic expansion has brought concerns surrounding safety and the lack of regulation into sharp focus.
Surge in Non-Medical Practitioners
The study, published in the Aesthetic Surgery Journal Open Forum, examined data from January to July 2025 to characterize the profiles of practitioners, pricing trends, and accessibility across socioeconomic groups. Among the practitioners identified, 24.8% were non-medical aestheticians - a significant portion of those administering botulinum toxin, a prescription-only medication. Other groups included doctors (28.4%), nurses (24.8%), dentists (10.5%), and allied health professionals (11.2%).
The lead author, Dr. Alexander Zargaran of UCL Surgery and Interventional Science, highlighted the diverse range of settings in which these treatments are delivered. "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", he explained.
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Socioeconomic Disparities in Access and Safety
The research also revealed disparities in the availability and quality of botulinum toxin treatments across different socioeconomic groups. Demand for these treatments was found to be 6.7% higher in more socioeconomically deprived areas. However, access to qualified doctors was notably lower in these regions, with the percentage of doctor practitioners decreasing from 34.4% in the least deprived areas to just 27.0% in the most deprived areas. This trend indicates that individuals in more deprived communities are more likely to receive treatments from lower-cost, non-specialized practitioners, often in non-clinical premises.
Pricing Trends Driven by Practitioner Qualifications
The cost of botulinum toxin treatments showed significant variation based on the qualifications of the practitioner. On average, doctors charged £187.55 per treatment, while dentists charged £190.69. Nurses and aestheticians offered treatments at lower prices, averaging £158.32 and £148.44, respectively. These figures suggest that patients may be drawn to non-medical practitioners due to their lower fees, despite potential risks.
Calls for Regulatory Reform
The rapid growth of the botulinum toxin industry has fueled calls for stronger regulation. In August 2025, the UK government announced plans to introduce a tiered regulatory system for cosmetic procedures, designed to address safety concerns and ensure appropriate training, safety standards, and hygiene protocols. These measures aim to protect patients from risks associated with unregulated treatments and counterfeit botulinum toxin products, which can cause adverse effects such as muscle weakness, drooping eyelids, and difficulty swallowing.
Lesley Blair, chief executive of the British Association of Beauty Therapy and Cosmetology (Babtac), emphasized the importance of regulation, stating, "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. 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."
Victoria Brownlie, chief sustainability officer for the British Beauty Council, echoed this sentiment. "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", she said.
Growing Concerns Over Safety
While the study did not analyze complication rates, data from the British College of Aesthetic Medicine (BCAM) has previously reported troubling statistics. Beauticians were linked to 668 botulinum toxin complications, while filler treatments accounted for 87% of all reported complications. Overall, 1,239 reported cases were directly tied to beauticians. These findings underscore the urgent need for tighter regulations in the aesthetics industry to mitigate risks and enhance public safety.
As the market for botulinum toxin treatments continues to expand, the push for comprehensive regulation remains critical to ensuring patient safety and raising professional standards across the sector.
