Personal Injury in Aesthetic Medicine: Navigating the Risks of Non-Surgical Cosmetic Procedures

Published in the June 2025 edition of Expert Witness Journal. By Julie Brackenbury, Independent Aesthetic Nurse and Medico-Legal Expert.

Non-surgical cosmetic treatments such as botulinum toxin injections, dermal fillers, and chemical peels have become increasingly mainstream in the UK. These procedures are often promoted as convenient, low-risk alternatives to surgery. However, their rising popularity has been accompanied by a growing number of personal injury claims, many of which stem from complications that could have been avoided through proper training, consent, and clinical governance.

In this article, I draw on my experience as an aesthetic nurse and expert witness to explore the medico-legal implications of personal injury in non-surgical aesthetic practice. I highlight key areas of risk, discuss the importance of robust consent and documentation, and consider the evolving regulatory landscape.

The Expanding Landscape of Aesthetic Medicine

The UK’s aesthetic sector has experienced exponential growth in recent years. According to the Department of Health and Social Care (2022), the industry was worth approximately £3.6 billion in 2021, with non-surgical procedures accounting for over 80% of that total. Yet despite its rapid expansion, the sector remains largely under-regulated, with no mandatory training requirements or national licensing system in place for practitioners administering high-risk treatments.

This lack of regulation has left patients vulnerable to harm, and legal practitioners are increasingly being instructed to pursue claims against individuals or clinics following adverse outcomes. In the absence of statutory safeguards, expert witnesses play a critical role in helping courts understand whether an injury was foreseeable, avoidable, and attributable to negligence.

Common Types of Injury and Clinical Failings

In my work reviewing aesthetic injury claims, several recurring themes emerge:
▪ Vascular occlusion and tissue necrosis following filler injections, particularly in the perioral and perinasal regions
▪ Infections, including cellulitis and abscess formation, linked to inadequate aseptic technique or poor aftercare advice
▪ Burns and pigmentation changes associated with lasers or chemical peels
▪ Psychological injury due to botched outcomes, deformity, or a breach of patient expectations

Duty of Care

In aesthetic practice the duty of care is no different from that in mainstream healthcare. Where standards fall below that of a reasonably competent practitioner, and a patient suffers harm as a result, legal liability may arise. Many such cases involve non-medically trained individuals performing advanced procedures without sufficient anatomical knowledge or clinical experience.

The Centrality of Informed Consent

A consistent shortcoming in aesthetic injury cases is the failure to obtain informed, voluntary, and specific consent. Informed consent is not a signature on a form but a process and is two-way discussion that allows the patient to make a reasoned decision about whether to proceed.

Best practice

Best practice dictates that patients should be provided with written and verbal information outlining:
▪ The proposed treatment and how it works
▪ Likely outcomes, including limitations
▪ Common and rare risks (e.g., bruising, infection, vascular occlusion)
▪ Alternatives, including no treatment
▪ The practitioner’s qualifications

Principles

In Montgomery v. Lanarkshire Health Board [2015] UKSC 11, the Supreme Court held:

"The doctor is under a duty to take reasonable care to ensure that the patient is aware of any material risks involved in any recommended treatment."

This principle extends to non-surgical cosmetic procedures, where practitioners must disclose all material risks to patients. A patient undergoing a dermal filler injection must, therefore, be informed of the risk of vascular compromise, even if such complications are rare, because the consequences can be catastrophic. Moreover, cooling-off periods are crucial in elective procedures. Consent obtained minutes before treatment is not only poor practice but may be legally indefensible if complications arise.

Psychological Vulnerability and Practitioner Responsibility

Another layer of complexity in aesthetic medicine lies in the psychological motivation of patients. Aesthetic interventions often intersect with self-esteem and mental health. Patients presenting with unrealistic expectations, body dysmorphic disorder (BDD), or seeking to 'fix' deeper emotional issues may not be suitable candidates for cosmetic procedures. Thus, Aesthetic Practitioners have a duty to identify red flags and refer on when appropriate. Administering treatment to a psychologically vulnerable individual without assessing their suitability may amount to a breach of duty if harm ensues.

The Joint Council for Cosmetic Practitioners (JCCP) and General Medical Council (GMC) both advise that practitioners should be trained to screen for mental health conditions and know when to decline treatment (JCCP, 2021; GMC, 2016).

Medico-Legal Case Examples

Case One: Lip Filler Vascular Occlusion
A 32-year-old woman attended a high-street clinic for lip augmentation. Within hours, she developed greyish discolouration and intense pain around the injection site. She contacted the clinic but was advised to monitor the area at home. By the time she was reviewed, necrosis had set in, requiring urgent hospital referral.

Expert opinion concluded that the practitioner failed to recognise a vascular occlusion and delayed appropriate treatment with hyaluronidase. The case settled in favour of the claimant.

Case Two: Laser Burn and Pigmentation
A client of South Asian heritage (Fitzpatrick Skin type IV) underwent laser hair removal at a beauty salon. No patch test was carried out, and incorrect wavelength settings were used. The Claimant sustained superficial burns and developed post-inflammatory hyperpigmentation. The clinic had no medical oversight, and the practitioner lacked formal training.

A claim for personal injury was successful on the grounds of inadequate assessment, lack of informed consent, and breach of duty.

Judicial Commentary and Legal Precedents

Several landmark cases continue to inform how courts approach personal injury in cosmetic practice:

In Montgomery v. Lanarkshire Health Board [2015] UKSC 11, the Court held:

"The doctor is under a duty to take reasonable care to ensure that the patient is aware of any material risks involved in any recommended treatment."

In Bolam v. Friern Hospital Management Committee [1957] 1 WLR 582, the principle was established:

"A man is not negligent, if he is acting in accordance with such a practice, merely because there is a body of opinion who would take a contrary view."

In Chester v. Afshar [2004] UKHL 41, the House of Lords stated:

"The law imposes a duty on a medical practitioner to warn a patient of a small but well-established risk of serious injury inherent in the proposed treatment."

These principles provide the legal framework within which aesthetic claims are assessed and reinforce the importance of detailed consent and professional standards.

The Role of the Expert Witness

In aesthetic litigation, the expert witness has a crucial role in assessing whether the standard of care met legal and clinical expectations.

This includes:
▪ Evaluating the consent process and treatment rationale
▪ Reviewing treatment records, photographs, and training evidence
▪ Offering impartial, experience-based opinion on causation and breach
▪ Assisting the court in understanding technical clinical issues

Expert opinion must be independent, based on current guidance, and within the individual's area of expertise. For instance, an aesthetic nurse with years of hands-on experience in administering dermal fillers would be well-placed to assess a filler-related injury claim.

A Call for Reform

The UK Government has recognised the need for tighter regulation. The Health and Care Act 2022 included provisions for a licensing regime for aesthetic practitioners and premises in England. Although this is a step forward, implementation has been slow, and there is an ongoing need for:
▪ Clear definitions of high-risk procedures
▪ National training and accreditation standards
▪ A public register of approved practitioners
▪ Consistent enforcement mechanisms

Until such reforms are enacted, personal injury claims will continue to highlight the dangers of a fragmented system. In the meantime, robust training, consent, and documentation remain the most effective risk mitigation tools for practitioners.

Conclusion

Personal injury in aesthetic medicine is a growing area of concern, particularly within non-surgical practice. These procedures, though widely perceived as minor, carry real risks. Where harm results from inadequate care, the legal consequences can be severe—for both patient and practitioner.

Practitioners must adhere to best practice standards, respect the principles of informed consent, and exercise sound clinical judgement. For legal professionals handling aesthetic injury claims, expert witnesses remain a vital asset in helping courts understand whether a duty was breached, and if so, whether that breach led to avoidable harm.

Only through greater professional accountability, regulatory reform, and patient-centred care can the aesthetic sector truly balance innovation with safety.