‘Stop and ask the question’ campaign regarding beauty and lifestyle injectable/invasive treatments
FINAL
If you are thinking about having an injectable beauty or lifestyle treatment please remember to stop and think about:
- WHO? Who is giving you the treatment and what are their qualifications and experience. Are they registered to practice in Gibraltar? Do they need to be?
- WHAT? What is it that you are being injected with?
- HOW? Look and watch what the person is doing. Contaminated or re-used needles can spread HIV or hepatitis B infection. Contaminated infusions can result in septicemia otherwise known as blood poisoning.
The following ‘frequently asked questions’ have been developed in partnership between:
Director of Public Health, Gibraltar Medical and Nursing Registration Boards, Gibraltar Health Authority Chief Pharmacist, Office of Fair Trading, Press Office and HM Customs.
We are unable to provide specific advice regarding treatment suitability or advise upon which companies, clinics or individuals you can use. The intention of these frequently asked questions is to empower you as the consumer to ask questions about the treatment that you are receiving.
Frequently asked questions
- What do you mean when you talk about injectable beauty or lifestyle treatments?
We mean anything that breaks through the protective barrier of the skin.
This could be an injection like Botox or dermal fillers. Or when a needle or cannula is placed in your arm to give you a vitamin infusion or fluid into your veins.
Procedures like microblading/permanent make up tattoos cause small cuts to the skin and break through the protective barrier of the skin. These are invasive procedures.
Dermaplaning can cause small cuts to the skin and could also potentially be considered invasive.
New beauty treatments will develop all the time and if they break the skin they can be classified as invasive.
- I’m thinking about having an injectable beauty treatment or vitamin infusion. Where can I find out more information?
Do your homework and research the treatment that you are considering using trusted websites. Do not only rely upon recommendations and advice from friends and family although this can be helpful in finding someone you trust to give you a treatment.
Find out about potential side effects and risks. The person giving you the treatment should advise you of the complications: this forms part of you giving informed consent to the treatment you are paying for and receiving.
Here are some links to resources that may help you research treatments that you are considering:
- https://www.nhs.uk/conditions/cosmetic-procedures/advice/choosing-who-will-do-your-procedure/
- https://www.bapras.org.uk/public/patient-information/cosmetic-surgery/considering-cosmetic-surgery
- https://www.rcn.org.uk/Get-Help/RCN-advice/aesthetic-practice
- http://www.cosmeticstandards.org.uk/
- Tattoos, Temporary Tattoos & Permanent Makeup | FDA
- Do intravenous vitamin infusions give you health benefits?
Intravenous vitamin infusions are becoming more popular. There is no current scientific evidence of their effectiveness in healthy people.
If the infusions are not manufactured or stored correctly there is an increased risk of bacteria contaminating the infusion fluid. This can lead to septicemia which can be life threatening if not promptly recognised and treated.
If there is re-usage of needles or cross contamination there is the risk of HIV or hepatitis B infection.
- https://www.ncbi.nlm.nih.gov/books/NBK567072/
- https://www.bmj.com/company/newsroom/iv-nutrition-risks-becoming-the-norm-for-athletes-despite-no-evidence-it-works/
- https://www.nhs.uk/conditions/sepsis/
- How do I know that the person is qualified to give me the treatment and the standard of the course or training that they say they have done?
There is no register of approved courses. We appreciate that it is then difficult for the public to understand whether the person is qualified and experienced enough to give you the treatment that they are giving you.
Here are some suggested questions to help you try and determine if the person is suitably qualified:
- Ask the person giving you the treatment what training they have done and how long the course lasted
- Ask them whether they are registered in Gibraltar by either the Nurses, Midwives & Health Visitors’ Registration Board or the Gibraltar Medical Registration Board and, if they say they are, ask them for proof
- Find out who provided the training course and search for the company on the internet to check if there are any complaints or concerns about the training provider.
- Search for information about where they took their course and what it actually covered
- Ask to see their certificate and check this is in date
- Ask about how long they have been doing this treatment and how many people they have given it to
- Ask if they have had anyone develop complications from the treatment they are offering
- Some complications cannot be anticipated or prevented such as an allergic reaction. This does not mean that the person giving you the treatment is unsafe.
- The person giving you the treatment should always ask you if you have had any previous reactions or if you have any known allergies as part of their assessment prior to giving you a treatment.
- They should also ask you if you have any known illnesses such as bleeding disorders and what medication you are taking as some medications may react with injectable treatments
- Ask about the level of insurance cover they have
If you are not sure about their responses or if they have not asked YOU questions then STOP and re-consider the treatment or find an alternative person providing the treatment.
Your health is more important.
- Do beauticians or non-health professionals have to be registered in Gibraltar to give injectable beauty treatments or infusions?
Doctors, dentists, pharmacists and allied health professionals from named professions have to be registered with the Gibraltar Medical Registration Board (GMRB) to work in Gibraltar. If they are not registered, what they are doing may be illegal
Qualified nurses have to be registered with the Gibraltar Nurses, Midwives and Health Visitors’ Registration Board (GNRB) to work in Gibraltar. If they are not registered, what they are doing may be illegal.
There are no equivalent registers for non-health professionals or beauticians.
Anyone who is carrying on business offering injectable beauty treatments or infusions, or any other beauty treatments for that matter, must be in possession of a business licence issued by the Office of Fair Trading (OFT). You can check a business’s licence and what it is granted for on the OFT’s website: [URL to be provided once the system goes live]
Being a registered health professional provides you with the reassurance that the person has had their health qualifications checked to enable them to be on the register. It does not necessarily mean that they have undertaken further training in the procedure that they are offering so it is always advisable to still ask what training they have undertaken for this specific procedure.
There are some very experienced individuals who provide invasive beauty and lifestyle treatments who are not registered health professionals. Do your homework, ask questions and ensure the person you are using is trained, using safe products and adhering to good infection control practices.
- How do businesses, clinics and individuals obtain licences for injectable beauty and lifestyle treatments?
The Office of Fair Trading (OFT) issues business licences to allow businesses to offer injectable beauty and lifestyle treatments. As part of the application process the OFT seeks the guidance of the Gibraltar Medical Registration Board. Applicants for a licence must provide evidence of things such as the clinical governance policy and level of insurance. If the clinic is offering Botox injections, which is a prescription only medication, the GMRB will ask information regarding who the named doctor providing the prescriptions is and whether the doctor is registered in Gibraltar and has an agreed scope of practice to do this. Neither the OFT nor the GMRB inspect clinics.
- Can Botox be given by a non-health professional?
Yes, providing that it has been prescribed by a doctor or dentist who is registered with the Gibraltar Medical Registration Board.
A small number of Gibraltar Health Authority (GHA) employed nurses have undertaken additional specialist training and had approval through the GHA Drugs and Therapeutics Committee to enable them to prescribe a limited range of drugs whilst working for the GHA. For allied health professionals even if they have a qualification to enable them to prescribe in other countries this is not legal in Gibraltar yet.
Botox is classified, in law, as a prescription only medication. A prescription has to be issued by a doctor or dentist who is currently registered with the Gibraltar Medical Registration Board. This does not mean that you have to physically collect the prescription from a pharmacist but a prescription has to be issued to the beautician for them to then give you the Botox.
Botox cannot be brought into Gibraltar without a licence issued by the Director of Public Health, followed by an import permit issued by the Collector of Customs. An unlicensed importation is illegal and liable to the goods being confiscated by HM Customs together with a fine being issued or the matter taken to Court.
You are entitled to ask the person giving you the Botox who the doctor or dentist is who has issued you with a prescription and check that they are registered on the GMRB website.
- Is filler a prescription only medication?
This is under active discussion. In the UK it is not a Prescription only Medicine currently but classified as a ‘medical device’.
- Where can I find out if the doctor, dentist, pharmacist or named allied health professional is registered?
You can check this online through the GMRB website.
- Where do I find out if a nurse is registered?
There is not an online nurse register yet but you can come into St Bernard’s Hospital and check the physical paper register: opening hours 9am-3pm
- What do I need to do if I want to make a complaint?
If the person who gave you the treatment was:
- a registered nurse you can contact the GNRB: +(350) 20007313
- a registered health professional GMRB: https://www.gmrb.gi/ +(350) 20007313
- not a registered health professional the OFT: https://www.oft.gov.gi/
In addition:
- Depending upon the level of harm experienced you may be advised to contact the Royal Gibraltar Police
- If you suspect an illegal import of a prescription only medication such as Botox contact HM Customs: hmc.investigation@hmcustoms.gov.gi or +(350) 20078879
- I’m worried that I have had a treatment, or someone I am with has had a treatment, and is having a bad reaction what do I do?
Depending upon how severe the reaction is the options are:
- contact the clinic or individual who gave you the treatment and seek their advice
- call 111
- call an ambulance if you think it is immediately life threatening such as a severe allergic reaction or blood poisoning. Symptoms that may indicate these serious complications are if you are having difficulty breathing, dizziness, losing consciousness or swelling of the throat.
If in doubt seek advice.
- How do I know if the insurance that the person has is adequate?
Ask the person what level of insurance cover they have and if they personally have insurance and/or are they covered by the clinic or business they are working from.
Registered health professionals should also have professional medical indemnity cover and ask to check this covers the procedure that you are considering.
Be mindful that if you consent to treatment in Gibraltar and the treatment is undertaken outside of Gibraltar the insurance cover may not be valid. Ask and check.
- Why are you raising awareness of this issue now in August 2023 when some of these procedures have been around for years?
Globally, beauty and lifestyle treatments are evolving, expanding and developing rapidly. Awareness, affordability, acceptability and popularity are increasing.
Some treatments are not subject to regulation. Legislation will not keep pace with advancements in the beauty and lifestyle industry.
The reason for us commencing this awareness campaign now is because an individual was admitted to hospital very ill as a result of a lifestyle/beauty treatment. We cannot comment upon the specifics of individual patient’s details.
This is why we are trying to raise awareness amongst you, as the consumer of these services, of the risks to support and empower you to ask questions and access treatments that are not going to harm you.
We are asking you to report concerns to the relevant authority so that appropriate action can be taken to protect the public.
If poor practice is not reported then future harm to the public cannot be prevented.
Remember STOP and ask the questions WHO? WHAT? HOW?
- Where can I send a question to that it not covered here?
Please send questions to Health.Promotion@gha.gi and we will do our best to include these in future updates of the FAQs.
