Evolution of Botox Training
In this article, Dr. Faizeen Zavahir discusses the evolution of Botox training available in the UK for consumers and current aesthetic regulations.
For over a hundred years, Botulinum Toxin (BTX) has been derived from Clostridium botulinum, an anaerobic species of bacteria. Seven different strains exist, but only serotypes A and B, are used clinically. Facial rejuvenation is considered as one of the most common reasons for BTX treatment, used to treat glabellar lines, crow’s feet and forehead lines. 1 According to the American Academy of Facial Plastic and Reconstructive Surgery’s 2018 survey, the number of BTX treatments have risen by 22% from 2013, among 22-37-year-olds. 2 Clearly, there is a market for BTX consumerism, which explains an additional increase in the number of healthcare professionals moving into aesthetics. 3
Yet, one pressing issue exists, have the lessons from several decades ago been learned? For example, in 2010 the PIP (Poly Implant Protheses) implants manufactured by unapproved silicone gel, affected nearly 100,000 women across the UK.4 Following this in 2013, Health Education England (HEE) commissioned a review of regulations directed by NHS Medical Director Professor Sir Bruce Keogh stating
‘At the heart of this report is the person who chooses to have a cosmetic procedure. We have heard terrible reports about people who have trusted a cosmetic practitioner to help them but, when things have gone wrong, they have been left high and dry with no help. These people have not had the safety net that those using the NHS have. This needs to change.’ 4
In 2014, HEE published new standards on levels of qualifications providers should hold before performing different types of non-surgical procedures. Finally, in conjunction with Cosmetic Practice Standards Authority, the Joint Council of Cosmetic Practitioners (JCCP) released an updated framework, designed to set appropriate guidelines by accepting qualified healthcare professionals for BTX and Dermal Filler injectables training. 5,6 Since, the industry has taken severe steps in evolving BTX and Dermal Fillers injectable training courses.
Bitesize Botulinum Toxin and Dermal Fillers training days
In the UK, there are myriad of options for BTX and Dermal Fillers including training days, 2-day foundation weekends, Level 7 Certificate and the Level 7 Diploma. Singular training exposes new delegates to BTX and Dermal Fillers practice, but they don’t count towards any accredited qualification. Comparatively, foundation days are specific training days that can count towards further accredited qualifications, if the trainee decides to pursue these options. For example, Harley Academy, Cosmetic Courses and MATA (Medical Aesthetics Training Academy) offer different examples of foundation days. Cosmetic Courses expose you to upper face BTX procedures, introduction to lip and cheek augmentation, the necessary theoretical and hands-on-experience. Harley Academy follows a similar structure, but they do not offer any real hands-on practical unless you were to complete their Level 7 Certificate. Comparatively, MATA offers a foundation weekend including theory covering facial anatomy, patient assessment, contradictions and injection technique in the morning, before practising under aesthetic experts covering crow’s feet, forehead and glabellar lines. Additionally, the second day teaches theory covering skin anatomy, skin ageing, patient assessment and injection technique. In the afternoon, delegates are exposed to clinical training involving lip fillers, nasolabial and marionette lines. After completion, of these bitesize training days, many delegates are keen to pursue either a Level 7 Certificate or Diploma.
What are my options for a Level 7 Certificate?
In the UK, the Level 7 Certificate is an aesthetic postgraduate (PG) qualification recognised by industry leaders as a vocational equivalent to a master’s degree. Harley Academy, Cosmetic Courses and MATA (Medical Aesthetics Training Academy) all offer a Level 7 Certificate. Harley Academy and Cosmetic Courses are awarded by IQ (Industry Qualifications) and regulated by Ofqual [Regulated Qualifications Framework (RQF). Comparatively, MATA is awarded by OTHM, but their qualification is still Ofqual regulated. Significant differences exist between the learning frameworks and methods of assessment for aesthetic trainees. 7,8
Fig: Comparison of Current Level 7 Providers
For instance, IQ certificates explore eight core units covering: principles and practice of BTX, dermatology, dermal fillers, cosmetic psychology and history of aesthetic medicine. Candidates are assessed by SAQs (Short Answer Questions), logbook, clinical observation days, supervised practice days and a final Objective Structure Clinical Examination (OSCE). IQ certificates equal 28 credits, taking roughly 6-18 months. 8 Comparatively, MATA’s OTHM Level 7 Certificate in Clinical Aesthetic Injectable therapies (equating to 34 credits), extensively covers four units: introduction to aesthetic therapies, patient medical assessment, principles of aesthetic injectables and management of hyperhidrosis. 9 Hyperhidrosis (excessive sweating) is an exclusive topic, teaching trainees to recognise the condition and manage complications effectively. For example, at least 1% of the UK population have excessive sweating, with nearly 90% of the cases that are treatable with BTX treatments. Additionally, MATA offers an exclusive OTHM Level 7 in Clinical Aesthetic Injectable Therapies Diploma (equating to 60 credits). 9
Is a Level 7 Diploma worth my time?
By now, you’re probably thinking what the point is in pursuing a Level 7 Diploma when I could just do a shorter Level 7 Certificate? It’s a valid question, many delegates have the exact question when considering the available aesthetic training courses. MATA is the only independent academy that has worked to produce a The MATA Level 7 Diploma in Facial Aesthetics (incorporating the OTHM Level 7 Certificate in Clinical Aesthetic Injectable Therapies); includes over 150 hours of learning content, 2 foundation days, 2 advanced days, exclusive mentorship days and online support with their online webinars. The MATA Level 7 Diploma in Facial Aesthetics (incorporating the OTHM Level 7 Certificate in Clinical Aesthetic Injectable Therapies, including four foundational units with three additional units. Comparatively, this qualification is weighted as 60 credits, nearly twice the content of available Level 7 Certificates. 8-9
Significant differences between the IQ and OTHM qualifications 8-9 are the differences in course credits, E-learning content and methods of assessment. For example, OTHM favours a 3:1 ratio, equating to more practical performance exams than core-knowledge material. Additionally, delegates are not assessed with OSCEs, they are continually tested with DOPs (Direct Observation Practice), this ensures trainees are well-prepared for executing BTX and Dermal Filler treatments. Additionally, it is a prerequisite to keep a logbook for observed and demonstrated BTX and Dermal Filler practical execution. This ensures all delegates acquire enough experience and develop the confidence to perform aesthetic procedures and manage any arising complications.
Although, the exact route to acquiring an aesthetic qualification is entirely dependent on the healthcare professional and their aims. For example, if a client wishes to start their own business, then it would be advantageous for them to consider a diploma. Not to mention, a new diploma in a competitive industry is fantastic for setting you apart and opening further financial doors.
Dr Faizeen Zavahir (MB.CHB, MRCS, MSC) is the Medical Director at Juvea Medical and the Medical & Aesthetic training academy (MATA). Mr Zavahir created Juvea Medical clinic in Harley Street with a vision to provide a personal client journey which safely and effectively delivers results. MATA was officially launched in July 2015 to improve standards of training in the industry.
- Thomas Walker and Steven Dayan, ‘Comparison and Overview of Currently Available Neurotoxins’, The Journal of Clinical Aesthetic Dermatology, 7 (2014), 31-39 (pp. 33-36).
- American Academy of Facial Plastic and Reconstructive Surgery (Washington DC: Facial Plastic Surgery,2013) < https://www.aafprs.org/media/stats_polls/m_stats.html> [accessed 05 March 2019]
- Natasha Singler, More Doctors Turning to the Business of Beauty (New York: The New York Times, 2006) < https://www.nytimes.com/2006/11/30/us/30plastic.html> [accessed 04 March 2019]
- Department of Health and Social Care, ‘Recommendations to protect people who choose cosmetic surgery’, (UK: GOV.UK, 2013) <https://www.gov.uk/government/news/recommendations-to-protect-people-who-choose-cosmetic-surgery> [accessed 05 March 2019]
- JCCP, JCCP Press Release January 2018 < https://www.jccp.org.uk/NewsEvent/jccp-press-release-january-2018> [accessed 05 March 2019]
- Health Education England, PART TWO: Report on implementation of qualification requirements for cosmetic procedures: Non-surgical cosmetic interventions and hair restoration surgery, The Department of Health, (2015), 1-30 (pp.15- 22).
- Ofqual, ‘OTHM Level 7 Diploma in Clinical Aesthetic Injectable Therapies’, (UK: Ofqual, 2019) < https://register.ofqual.gov.uk/Detail/Index/42522?category=qualifications&query=Level%207%20Clinical%20Injectable%20Therapies> [accessed 05 March 2019]
- Industry Qualifications (IQ), ‘IQ Level 7 Certificate in Injectable for Aesthetic Medicine Specification’, (UK: IQ, 2018) < http://www.industryqualifications.org.uk/qualifications/database/iq-level-7-certificate-in-injectables-for-aesthetic-medicine/getfile?filename=l7-cert-injectables-for-am-specification.pdf> [05 March 2019]
- OTHM Qualifications, ‘OTHM Level 7 Certificate/Diploma In Clinical Aesthetic Injectable Therapies’, (UK: OTHM, 2018) < https://www.othm.org.uk/doc/specification/OTHM_L7_Clinical_Aesthetic_Injectable_Therapies_spec_2019_03.pdf> [05 March 2019]