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Nursing Expertise

by Mrs Elizabeth M Bardolph
Registered Nurse
(More about Mrs Bardolph)


Medical Aesthetics is a new and rapidly developing specialty with 60% of patients presenting for treatment because they are self-conscious about the way they look. The remaining patients have medical problems they want addressed.

According to a recent Mintel survey, there were 472,000 non-surgical treatments carried out in 2007. This compares with 230,000 in 2005. In addition, £302 million was spent on non-surgical procedures in 2007. This boom in cosmetic procedures shows no signs of abating, despite the current economic climate.

Medical aesthetics as a specialty

Medical aesthetics is an evolving specialty both academically and professionally. It still has limited understanding amongst the nursing and medical professions. Medical aesthetics ‘describes the set of non-surgical clinical procedures that aim to rejuvenate the dermis, and reverse the signs of ageing’.

These non-surgical clinical procedures include the use of the botulinum A toxin (Botox®) for reducing fine lines, dermal fillers, laser and intense pulsed light, chemical peels, facial rejuvenation and the removal of thread veins, particularly on the face and legs.

Botulinum A toxin (Botox®) – Botox is a formulation of the botulinum A toxin derived from the bacterium Clostridium botulinum. The active ingredient in Botox is a protein that prevents transmission of the electrical impulses which cause the muscles to contract. It therefore relaxes muscles, thus smoothing the overlying skin which, in turn, reduces the wrinkles. The drug is particularly useful in the upper part of the face, including the forehead and crows feet. The effects last 3–4 months.

Dermal filler – A dermal filler is a product which, when injected into the skin, lifts and supports the line or wrinkle. There are a number of different fillers, and the most common ones are made in the laboratory from synthetic hyaluronic acid. This is a complex sugar-like substance that supports the normal functions of cells and tissues. The effects of treatment using a dermal filler last 4–6 months and sometimes longer.

Laser and Intense Pulsed Light (IPL) – These two treatments work differently. Both can be used for removing superfluous hair, tattoos and superficial thread veins, and in facial rejuvenation. The most common problem associated with the treatment is the danger of burning the skin. All users of Class IV machines have to be registered with the Care Quality Commission.

Chemical peels – There is a wide range of chemical peeling products. Some aim to remove the top dead skin cells, while others penetrate deeper into the skin. Chemical peels can be used in combination with other therapies and are useful for acne, acne scarring, some pigmented areas and facial rejuvenation. They can also be used to prepare the skin prior to the use of Botox® and/or a dermal filler.

Removal of thread veins – Unsightly thread veins can be removed from the face and legs. As well as using laser and IPL, other treatments include electrolysis, microwave technology and microsclerotherapy. The latter is more suitable for the legs and should never be used on the face. Microsclerotherapy involves injecting the leg thread veins with an irritant solution, and more than one treatment is required.

Areas of litigation

There are two main areas of litigation:

  • Was the nurse’s practice that of a competent practitioner? Competent is defined as ‘demonstrates the ability to care for the client through consultation and assessment, consent, skin preparation, positioning, administration of the product and aftercare’. Although the Bolam principle applies, it could be that the courts find that common practice itself may be deemed to be negligent.
  • All nurses are required to work within their Code of Conduct as laid down by the Nursing and Midwifery Council. ‘You are personally accountable for your practice. This means that you are answerable to your acts and omissions, regardless of advice or directions from another professional’. ‘You must act immediately to put matters right if someone in your care has suffered harm for any reason’. Although the Code of Conduct is not enforcible by law, it can lead to disciplinary proceedings and may result in removal from the register with the subsequent loss of livelihood.

Both issues can be assessed by looking at:

  • the quality of the clinical records. Registrants have both a professional and legal duty of care. Their record keeping should therefore be able to demonstrate (i) a full account of their assessment and the care that has been planned and provided; and (ii) the measures taken by the registrant to respond to their needs.
  • the quality of the consultation and treatment
  • the protocol for aftercare advice
  • the complaints procedure
  • fitness to practice.


To undertake these treatments, nurses must be on the register of the Nursing and Midwifery Council. And there is a move now to say that they must be adult as opposed to paediatric nurses. The basic qualification to look out for is RGN (Registered General Nurse), now known as RN (Registered Nurse). The awarding body is the Nursing and Midwifery Council (NMC). However, many nurses also hold degrees, and the profession is moving to become a graduate profession.

Until recently, nurses gained training from a number of unregulated training courses run by product-driven companies, often with no clinical supervision or mentoring. Efforts are now being made to self-regulate training.

In response to a deficiency in this area we are developing the first Diploma in Aesthetic Medicine. This is in conjunction with the Royal College of Nursing and the University of Greenwich.

Experience in this specialty is gained through clinical work. Many nurses work for themselves or large organisations, while some combine it with their NHS commitments.


Medical aesthetics is a burgeoning specialty where the potential for litigation is high. This is due to the nature of the patients and the treatments being delivered. Nurses have a duty of care to their patients and are bound by their professional Code of Conduct. Much can be done to reduce the risks by improved standards of practice, which is ongoing.

by Mrs Elizabeth M Bardolph
Registered Nurse
(More about Mrs Bardolph)


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