Can a trainee really set up a private cosmetic practice?
We had another successful expertcosmetictraining course on 9th January. This time we had a course composed of mostly trainee plastic surgeons plus several consultants. There were 17 models for the candidates to assess and practice Botox and filler injections. We covered the treatment of frown lines, forehead lines and crows feet, as will as basic and advanced techniques such as nasolabial folds, marionette lines, cheek augmentation, lip enhancement and the 8 point lift.
Feedback on the course was very good as usual, but we did have feedback requesting that the instructional videos that are sent in advance of the course should be sent earlier. We have taken this feedback on board for future courses.
One question often asked by trainees is whether they should start a practice before becoming a consultant. For example, here’s an email (edited to protect the sender’so identity) about this…
“[my consultant] does not recommend starting private cosmetic practice before one finishes specialty training, and thinks injectable procedures carry highest number of complications and lawsuits among all cosmetic procedures. This is quite different from what I learned from the course. Is this true?”
The best way to answer this question is to look at the data. As you may know, indemnity insurance is based on actuarial data regarding risks and previous claims. For this reason, certain specialties such as gynaecology and neurosurgery have relatively high indemnity premiums whilst other specialties, such as those not involving invasive interventions, are a lower risk. In terms of injectable cosmetics, so long as your practice is confined to temporary treatments with a good safety profile such as Botulinum Toxin and Hyaluronic Acid Fillers, the cost of indemnity is in order of about £1000. As temporary treatments, the risk of causing long term harm are minimal so long as techniques are undertaken in an appropriate setting and following adequate training. This is the reason why a large part of the injectables market is currently occupied by nurses who are able to obtain insurance at relatively low cost.
I would advise any surgical trainee considering setting up a cosmetic practice to have indemnity separate from their MPS or MPU professional indemnity. There are a number of providers such as Hamilton Fraser, who will provide injectables indemnity so long as you have evidence of having undertaken appropriate training.
There is the question of whether consultant colleagues will react negatively to trainees taking up cosmetic practice, prior to completing their training. Personally, I think that this is an attitude that has led to the vacuum that has been filled by non-specialists performing cosmetic interventions. For years there was a clear demand for non-invasive treatments but surgeons either felt that providing such treatment was beneath them, or that because the fees for individual treatments are relatively low compared with, say, a breast augmentation, that it injectables are not worthwhile. I have written about the fallacy of this approach Botox or BBA?
I would go far as saying that all aesthetic practitioners should be able to offer patients a holistic approach, either by providing the treatments themselves or being able to send patients on to a colleague who can provide other elements that are not part of their core competencies. You know the anatomy, you give hundreds of injections (of local anaesthetic) a year as part of your surgical practice. In fact, if you are not trained to offer these treatments are you really an aesthetic practitioner?
By the way, our next training course is on April 16th. There are only 3 places remaining so book soon to avoid disappointment.