Education on cosmetic treatments vital while legislative reform is underway

Educating Gibraltar on the potential harm of medical cosmetic treatments is vital while legislators try to keep up with this innovative market.

A wholescale reform of the law regulating Gibraltar’s medical cosmetic industry is currently underway, with the Minister for Health Gemma Arias Vasquez and Public Health Director, Dr Helen Carter, meeting just last week to continue work on the legislation.

Work on this reform began in 2023 after concerns that uncertified individuals can legally practice in Gibraltar.

Under current law, those administering non-prescription injectables do not need medical training.

The need for legislation was also brought into focus after growing concerns over the industry and the use of unregulated products and procedures, concerns that were brought into sharp focus in Gibraltar after someone was hospitalised following an injectable cosmetic treatment.

“We're actually going to implement regulations on beauty treatment, on beauty salons, on people that are providing treatments that are beyond the usual,” Mrs Arias Vasquez said.

“If a hairdresser is a hairdresser, we're not going to get involved, but if a hairdresser is providing quasi-medical treatments, at that point there's going to be some form of regulation over the treatments.”

She added that the regulation would ensure that when medical treatments are offered there is some oversight by a medical professional.

Mrs Arias Vasquez said the consultation process has not yet begun as the regulations are being drafted.

She has previously highlighted that this legislation is complex as it would totally reform the medical cosmetic industry in Gibraltar and ensure training standards are set.

Dr Carter added there have also been a couple cases attending A&E due to cosmetic treatments, and in the meantime while the law is drafted, she highlighted the need for education.

Dr Carter underscored the importance of safe cosmetic procedures, pointing to an incident in Northeast England where 38 patients had botulism poisoning from Botox injections and six were admitted into critical care.

She alerted HM Customs in Gibraltar to look out for the contaminated Botox from South Korea.

Although none was found locally, Dr Carter said, the incident in the UK highlighted the potential harm that can be caused by bootleg cosmetic services.

She advised that anyone receiving Botox should check that what they are receiving comes from a properly marked, unopened bottle.

“Harm can happen, and what we're trying to do is minimise that risk of harm, and working with the Office of Fair Trading around how best can we do that in the Gibraltar context,” Dr Carter said.

She highlighted developments with invasive treatments, describing how the fast-paced beauty market can introduce new methods faster than legislators.

But she acknowledged a reality, adding: “We will never keep up with the beauty treatments.”

In response, the Government is undertaking a dual exercise of legislating and educating the public.

Treatments such as Botox, which freezes facial muscles in a bid to reduce the onset of wrinkles, is a prescription drug under Gibraltar law.

This means doctors who prescribe the drug assume responsibility that the person delivering the treatment is capable and trained.

For dermal fillers, injected usually to plump up areas of the face and body, there is no need for a prescription in Gibraltar. This means that, currently at least, less oversight is needed.

It is also understood there is currently no legislation specifically for cosmetic medical treatments which sets a minimum age requirement in Gibraltar.

In the UK, a law introduced in 2021 means it is illegal to administer Botox on someone under 18 years old.

For Dr Carter, fillers concern her more than Botox, and St Bernard’s Hospital is stocked with filler dissolver in case of emergency.

She said she is aware of one or two cases which have presented to A&E in Gibraltar requiring treatment.

Dr Carter described how fillers, when injected into an artery, can lead to necrosis and disfigurement.

“It's a known side effect of fillers,” she said.

“Different people have different facial anatomy. If you inject here, you can hit an artery and you would know straight away because the skin would start blanching, would start going white.”

“You sort of massage it to try and see if you can get the artery back going again if you don't need to inject a dissolver in.”

“A good, well-trained doctor, dentist, health professional would know what to look for. They would know instantly.”

“They would have filler dissolvers in their practise and be able to do that on site.”

“But people who've not undergone that most rigorous training may not know what to look for.”