Understanding Government Guidelines on Cosmetic Procedures

The aesthetics industry has been growing worldwide over the last few decades. Although there has been a decline in some of the more major surgeries such as tummy tucks, and breast enlargements, the anti-ageing treatments, and especially the low-invasive therapies are becoming very popular across all demographic groups.

With this high demand comes the need for better practices and higher safety standards to protect patients. Just because a procedure is considered low-invasive it does not mean it is without risk. In order to minimise poor practice standards and to lead the way on health excellence, the UK government body, Health Education England (HEE) reviewed the situation on the aesthetics industry and developed an education strategy to raise practice standards each of the non-surgery disciplines.  Working with medical experts and industry professionals the newly formed Joint Council for Cosmetic Practitioners (JCCP) is now responsible for providing precise recommendations for clinicians and education providers to follow.

The industry’s landscape today

Until these new guidelines were issued there was no guidance on who may perform cosmetic procedures. These are guidelines only but the recommendations are very clear.

No qualification requirements and an absence of accredited training courses have resulted in serious outcomes and confusion for many patients and those professionals looking for the right training course.  There have been misunderstandings of the terminology such as accreditation, endorsement, qualifications, levels and competence.

Added to the general health and safety objectives of these guidelines, there are two other critical elements intended to protect the patient/client which are:

  1. Prospective patients seeking cosmetic procedures can make informed decisions and without pressure to undergo unnecessary treatments.
  2. Realistic expectations are also tackled and it is an obligation by the PRACTITIONER to make clear what results are likely to be achieved given the patient’s condition and various factors involved.

Many professionals who hold qualifications such as medical, dental or nursing degrees (Level6) might assume they are fully entitled to practice low-to-non invasive treatments without further training.  Some clinicians are knowingly taking risks by performing cosmetic procedures without any additional specialist training or qualifications.  Others might not be not aware of the extra training required that will enable them to be fully insured to practice. If you are, or intend to start, delivering non-surgical aesthetic procedures you need to be aware of the new JCCP recommendation for competence in each of the modalities.

What treatments are affected by the JCCP guidelines?

The Specific treatments covered under the JCCP Guidelines are:

  1. Botulinum toxins (BTs) – BOTOX® is the brand name of one of the most commonly used products for wrinkle relaxation
  2. Dermal fillers (DFs) – should you include a brand as you have for BT? For example Juvederm
  3. Chemical peels and skin rejuvenation (microneedling and mesotherapy) (CPSR)
  4. Laser, Intense Pulsed Light (IPL) and Light Emitting Diode (LED) (LIPLED)

Hair Restoration Surgery (HRS) – this is an ongoing discussion which needs resolution by JCCP

Training covered for all disciplines (treatments)

The core training for any of the disciplines should include:

  • Obtaining informed consent
  • Information governance
  • Record keeping, including adverse reaction reporting
  • Providing safe premises and safe treatment rooms
  • Infection control
  • Physiology and anatomy
  • Ensuring awareness of existing medical conditions
  • Ability to recognise and treat complications such as anaphylaxis.

Other important training aspects for running a business should include::

  • Obtaining and display of Indemnity Insurance
  • Employment law
  • Keeping abreast of industry developments
  • Marketing strategies
  • Ethical business practices

Entry level education

The interventions covered by JCCP start with Entry Level 4 (degree course starting points and foundation year) as a minimum.  Students can start some applications under supervision by a fully qualified practitioner provided they are working towards the appropriate module in that discipline (or treatment).  Most start at Graduate level – Level 6 with a medical background.  This is a very important fact that so many professionals – and patients – are unaware of.

The healthcare professionals that are ideally placed to consider a new career or career-diversion by performing cosmetic treatments are doctors, dentists, nurses and prescribing nurses.

The qualifications required for registering for a training course, the resultant qualification upon successful completion and the topics covered for each course are listed below.

Botulinum Toxin (BT)

Entry Requirements:

Level 6 (Graduate Level)

Recommended Training Requirements:

Level 7 (Postgraduate level).  Successful completion entitles practitioners to administer botulinum toxins (under supervision of independent prescriber)


Level 6 (Degree level) Practical skills training under supervision includes administration of botulinum toxins to upper face

What is covered:

  • Facial and neck anatomy including relevant vessels, nerves and muscles
  • Static and dynamic wrinkling
  • Concepts of youth and attractiveness, facial contours and symmetry
  • Age-related changes which may impact appropriate use of BTs
  • Identification of contra-indications for use, eg pregnancy.
  • Biochemistry and pharmacology (eg dilution, diffusion) of various BTs
  • Mechanism of action of BTs, effects at neuromuscular junction and acetylcholine blockade
  • Reconstitute and store various BTs appropriately
  • Manufacturers’ guidelines and when to justify a deviation from
  • Accurate and appropriate injection technique and product placement (eg dose and site)
  • Adjusting toxin dose and placement for individualised treatment
  • The risks including facial asymmetry, lip drooping
  • Patient’s occupation and how this may affect management
  • Common treatment areas, danger zones and high risk areas
  • Recognition of and correct suboptimal outcomes using knowledge of facial muscle interactions
  • Molecular structure of BTs and mode of action of each component
  • The variety of BT products available and how their doses correlate to each other.

Dermal Fillers

Entry Requirements:

Level 6 (Graduate level)

Recommended Training Requirements:

Level 7 (Postgraduate level). Successful completion entitles practitioners to administer permanent fillers (GMC-registered practitioners with a licence to practise only). Also to administer dermal fillers (under supervision of independent prescriber.

Level 6 (Degree level). Practical skills training under supervision includes administration of temporary/ reversible fillers for lines and folds (precluding complex zones).

What is covered:

  • Facial anatomy including relevant vessels, nerves, muscles and fat pads
  • Volume changes associated with ageing and impact on appearance
  • Conventional concepts of youthfulness and attractiveness in relationship to facial shape and proportions
  • Patient assessment, analysing wrinkles, folds, facial shape and the development of appropriate treatment plan
  • Biochemistry, pharmacology of various types of dermal filler: permanent, semi-permanent and temporary; replacement vs stimulatory; when to use local anaesthetic
  • Selecting best products for individual need
  • Mechanistic action of stimulatory fillers
  • Skin microbiome and need for sterile technique to avoid infection.
  • Variety of injection techniques
  • Dosage, placement of product at appropriate anatomical site (eg nasolabial folds)
  • Placement of product at appropriate tissue depth (eg intradermal, sub dermal, periosteal)
  • Needle vs cannula techniques
  • Commonly treated areas, danger zones and high risk areas (eg periorbital, temple)
  • Relative risks of commonly treated areas (eg glaballa, nasolabial folds and vascular compromise)
  • Severe adverse events including vascular occlusion/embolisation and expedient emergency treatment
  • Specific adverse events including hypersensitivity, biofilm, granuloma, nodule formation, treat or refer as appropriate
  • Hyaluronidase usage if appropriate eg recognition of appropriate indication, accurate dilution and administration, complications and adverse events with hyaluronidase usage.

Chemical Peels and skin rejuvenation (microneedling and mesotheraphy)

Entry Requirements:

Level 4 (Undergraduate, A-Levels or equivalent)

Recommended Training Requirements:

Level 6 (Degree level) Successful completion entitles practitioners to deliver (subject to oversight of clinical professional): Mesotherapy without/without homeopathic topical treatment Superficial chemical peels to Grenz zone ≤1.5 mm microneedling with manual device, ≤1.0mm power assisted microneedling and ≥1.5mm microneedling for non facial areas


Level 5 (Foundation degree level). Successful completion entitles practitioners to: 0.5-1.0mm microneedling with manual device


Level 4 (Foundation degree Year One level).  Successful completion entitles practitioners to: ≤0.5mm microneedling with manual device. Superficial chemical peels to stratum corneum

What is covered:

  • Evidence base and mechanistic elements of common skin rejuvenation techniques
  • Skin anatomy—epidermis (stratum corneum and viable epidermis), dermis (papillary and reticular), hypodermis
  • Skin appendages (eg. hair follicle, sebaceous glands)
  • Depth of penetration of peel
  • Wound healing mechanisms
  • Assessment of Fitzpatrick skin type
  • Comedonal vs inflammatory and cystic acne and step-ladder algorithms of appropriate treatment
  • Cutaneous wrinkling vs skin folds secondary to deeper anatomical changes
  • Biochemistry and pharmacological or physiological actions of specific peeling agents, agents used with mesotherapy and microneedling
  • Pharmacological actions of lipolytic agents used with injection and mechanism of action of tissue response
  • Microneedling including efficacy and risks associated with needle depth
  • Appropriate clinical indications for various chemical peels, microneedling and mesotherapy
  • Appropriate clinical indications for injection lipolysis
  • Advice to patient on expected consequences and timescales (eg bleeding, erythema, peeling, induration/ oedema, pain)
  • Advice to patient on common or mild complications (eg reactivation of Herpes Simplex Virus (HSV), superficial infection) and mitigate risks
  • Advice to patient of moderate, serious or permanent complications (eg hyper or hypo pigmentation, cellulitis, scarring, textural changes and nodules, cardiotoxicity, burns, sedation risks)
  • High risk areas of treatment and danger zones

Laser Light technologies


Entry Requirements:

Level 4 (Undergraduate, A-Levels or equivalent)

Recommended Training Requirements:

Level 6 (Degree level).  Successful completion entitles practitioners to deliver ablative fractional laser treatments (exluding periorbital rim) Use laser and IPL treatments for generalised and discrete pigmented lesions (excluding periorbital rim)


Level 5 (Foundation degree level).  Successful completion entitles practitioners to use laser treatments for tattoo removal (excluding periorbital rim). Use laser and IPL treatments for benign vascular lesions (excluding periorbital rim)


Level 4 (Foundation degree Year One level).  Successful completion entitles practitioners to use lasers and IPL for hair removal/reduction (excluding periorbital rim).  Use non ablative lasers, IPL and LED for photorejuvenation, including sun induced benign dyschromia (excluding periorbital rim). Use LED for clinically diagnosed acne vulgaris

What is covered:

  • The basic principles of physics underpinning clinical application of lasers, IPL and LED treatment
  • Safety protocols including eye protection
  • Risks for patients/clients, practitioners and people outside the room and risk assessment requirements
  • Permissible exposures and nominal ocular hazard distance v. awareness of hazards to eye and skin from accidental exposure and reflection
  • How wavelengths penetrate skin and eye tissue differently, depending on diffusion properties
  • The various laser, IPL and LED delivery systems and optical radiation-tissue interactions
  • Optimisation of clinical outcomes using appropriate devices and treatment parameters
  • Common benign skin lesions and conditions such as cherry angioma, spider naevus, and rosacea
  • The limitations of laser, IPL and LED in the treatment of common benign skin lesions and conditions and when to refer on
  • Dealing with complications
  • Contra-indications for the use of laser, IPL and LED xiii. appropriate patient selection including skin type, indication and treatment choice
  • Appropriate skin preparation and role of test patch
  • The various tattoo types, inks and pigments
  • Appropriate wavelength selection for specific pigments
  • Alternative methods of tattoo removal Alternative methods of hair removal
  • Alternative procedures for common benign skin lesions and conditions
  • Q-switched laser technology and difference between active and passive
  • Fractional and non-fractional delivery
  • Ablative laser wavelengths and pulse durations vs nonablative wavelengths
  • Effects of different pulse lengths
  • Effects of different beam diameters
  • Provision of appropriate postoperative instructions including wound care and sun protection
  • Manufacturer device manuals and protocols
  • Manufacturer/supplier guidelines and device training
  • All elements of the ‘Core of Knowledge’ (a government mandated training module) for Laser Protection

If you are in any doubt about what training, qualifications and experience you need in order to be fully compliant and for conducting treatments in your clinic, contact the MATA team today.