New cosmetic rules 'are appalling'
Fresh rules for the cosmetic procedures industry in England are "appalling" and pay "only lip service" to patient safety, warn plastic surgeons.
Ministers said it will become illegal to offer dermal fillers without training.
But surgeons said the decision not to classify them as prescription only has been labelled a "missed opportunity".
The whole industry has been accused of acting like "cowboys" and selling products "like double glazing".
The £2.3bn cosmetic procedures industry is dominated by the non-surgical end of the market such as fillers, laser hair removal and Botox.
They account for nine in 10 interventions and are worth 75% of the market.
Dermal fillers, used to plump up lips and get rid of wrinkles, are one major area of contention.
A review of the industry in 2013 by the medical director of the NHS in England, Sir Bruce Keogh, warned fillers could cause lasting harm, but were covered by only the same level of regulation as ballpoint pens and toothbrushes.
He said they were a crisis waiting to happen and should become prescription only.
However, this will not take place - a move criticised by plastic surgeons.
Rajiv Grover, a consultant plastic surgeon and president of the British Association of Aesthetic Plastic Surgeons (BAAPS), told the BBC: "Frankly, we are no less than appalled at the lack of action taken.
"Legislators have clearly been paying only lip service to the sector's dire warnings that dermal fillers are a crisis waiting to happen.
"The ability to classify fillers as prescription only would have allowed three birds to be killed with one stone.
"It would effectively have controlled the marketing and sale of these fillers, it would have regulated who can perform these injections and it would have provided an automatic ban on advertising.
"This is an opportunity missed."
Ministers have announced that Health Education England will review training for dermal fillers and Botox injections and legislation will be introduced to make it illegal to offer such procedures without training.
Anyone offering fillers will have to so under a named doctor or nurse, whose reputation will be on the line.
The government said it was working at an EU level to as part of a review of medical devices to change the rules on fillers.
Health minister for England, Dr Dan Poulter, said: "This package is the biggest reform the industry has seen and it is completely misleading to suggest surgeons won't be part of the consent process.
"Patients will meet the surgeon operating on them to discuss treatment and they will now have to sign the consent form in the presence of a doctor, not a sales person as has been the case in the past.
"EU legislation states fillers are not a medicine, so we cannot reclassify them.
"Instead we want to protect patients with new laws so anyone injecting fillers must be qualified and overseen by a doctor or other appropriate health professional who must see the patient to discuss treatment."
However, surgeons are still concerned that anybody will still be able to offer fillers and there will be no central register of who is qualified.
Mr Grover said the message was "roll up and feel free to have a stab".
Cosmetic surgery and interventions became an issue during one of the biggest health scares to face the industry - surrounding substandard breast implants made by the French company Poly Implant Prothese (PIP) - when a lack of records kept by surgeons meant women did not know if they were affected.
At the time there was also criticism of "win a boob job" competitions, mother-daughter offers and time restricted deals on surgery.
Ministers say other measures being announced will improve the whole industry including:
- A registry of breast implants to prevent a repeat of PIP
- A review into a system of redress if things go wrong with treatment
- More rigorous consent process to let patients have time to fully consider their decision to have surgery.
- A clamp down on irresponsible advertising with the help of the Advertising Standards Authority.
- The Royal College of Surgeons should set standards for the training and practice of cosmetic surgery
Ministers in Scotland, Wales and Northern Ireland will decide separately if they want to introduce any of the measures.
In a statement, Sir Bruce Keogh said: "This is the beginning of a journey, not the end, but I am confident these changes will create a much safer and skilled cosmetic industry which should reassure both consumers and practitioners."