'Cut-throat' cosmetics 'not a nice industry to be in'

But as illustrated by the sudden collapse in July of high street chain SK:N, this booming sector is also a highly competitive industry where business success is far from guaranteed.

Gill Baird opened Cosmedicare's Glasgow hospital in 2022 (Image: Contributed)

Gill Baird set up weight loss and plastic surgery specialist Cosmedicare in 2016 and now runs overnight hospitals in Livingston and Glasgow operating on more than 100 patients each month. She says there is currently more uncertainty than there has ever been within the sector.

“This industry is cut-throat and I don’t just mean the non-surgical,” she said. “We often talk about [the non-medics and injecting], but when you move up a level and you go into surgical hospital services in Scotland, it’s not a nice industry to be in, and it’s such a shame because it didn’t used to be that way.

“There was a healthy competitiveness before but as more entrants have come into the market, I think a lot of people are fearful of losing their market share and they start doing things that are a wee bit underhanded – playing patients off against providers, causing issues on social media, and undercutting on price.”

The phrase “Wild West” is most often used in connection with injectables such as Botox and dermal fillers, which in Scotland can currently be administered by people with no medical qualifications. Rare Consulting, which compiles data and research on the private healthcare market, estimates that for every regulated provider in Scotland there are at least 12 unregulated providers offering dermal fillers, Botulinum toxin, polynucleotides, or skin boosters.

“The range of innovation in the aesthetics industry is just fascinating to see and I suppose with that you get a lot of entrepreneurship and activity, but there is a big question mark on patient safety and it would seem that governments just haven’t gotten up to speed with that,” says Ben Pask, founder and managing director of Rare.

READ MORE: Scottish entrepreneur steps into the skincare breach

Fiona Ross of The Aesthetics Club said her segment of the industry “definitely” needs more regulation as the popularity of non-surgical treatments continues to grow amid the proliferation in new types of treatments.

“We have had patients who have had terrible experiences elsewhere with people who have done a weekend course and have no medical background,” she said.

“You would never have anybody else other than a GP performing a GP consultation…nothing like that would ever happen. It’s bizarre that in this industry it happens so it would be great if more legislation and guidelines were to come into place to avoid that happening.”

Ms Ross opened her third clinic last month in Newton Mearns, adding to existing sites in Bearsden and London’s Notting Hill, and is due to open a fourth in another Scottish city by the end of this year. Along with an array of other treatments, the new clinic is the first in Scotland to offer Oxylight and Moxi Laser Treatment.

Fiona Ross (Image: Contributed)

“Our Bearsden clinic was extremely busy – we had wait lists of over three months for patients to be seen,” she said of the decision to open in Newton Mearns. “We do a huge amount of brides who are getting ready for their wedding in terms of skin preparation and injectable treatments [so] to be able to accommodate the demand we decided it would be a good idea to divide and conquer.”

Ms Ross said the cost-of-living crisis has had no appreciable impact on demand from clients as The Aesthetics Club is “busier than ever”.

Surgical specialist Signature Clinic, winner in the brand expansion category at this year’s Scottish Aesthetics Awards, has since 2022 seen an increase in patients not going ahead with treatment due to cost. However, co-founder and chief executive Christian Gotti said the business is still carrying out approximately 750 procedures per month across its five locations thanks to the quality of service delivered at a reasonable price.

Mr Gotti describes Signature as a “market disruptor” as it offers all of its procedures only under local anaesthesia. This was unusual when the group opened its first clinic in Glasgow in March 2019, but has become an increasingly popular business model.

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“We have always been a local anaesthesia clinic,” he said. “Everything we do is under complete wide-awake anaesthesia and I really feel that how we disrupted the market and became so successful in the UK is because we were saving money on anaesthetist costs, which means we could make the procedure very much affordable for the patient.”

Some in the field say they would never consider doing certain procedures such as breast augmentation or liposuction under local anaesthetic – even though it can be done – because of the discomfort to patients. Mr Gotti contends there is “no need” to put patients under total sedation and points out that local anaesthesia in such procedures is common practice in other countries such as the US, Egypt and Iraq.

“The surgeons we recruit are experts on local anaesthesia,” he said. “They have that exposure and that overseas training, whereas lots of surgeons in the UK with the NHS are reliant on anaesthetists and the feel more comfortable with [general] anaesthesia because of course it’s much easier when the patient is asleep and you’re not worrying about if they are in pain, or if they jerk, or anything like that.”

Neither Signature nor Cosmedicare actively compete in what has become a saturated market for non-surgical treatments, opting to only offer Botox and the like to existing patients hoping to further enhance the results of their surgical treatment.

READ MORE: Threats, pain, regret: Why is it so hard to sue when cosmetic treatment goes wrong?

While Ms Baird at Cosmedicare would welcome the introduction of tighter legislation, she says the industry has a responsibility to put its own house in order.

“The medics are being quite aggressive in their campaign against the non-medics injecting, however, they have problems within their own camp with medics being compliant with the rules and regulations, particularly in relation to prescribers being present when treatments are conducted,” she said.

Botox is a prescription medication and while fillers are not, the Hyalase that is required if there is an emergency issue with a filler treatment is a prescription drug. Non-medics and nurses who are not licensed to prescribe must pay a prescriber for these scripts, which Ms Baird said were being widely issued remotely until a recent crackdown on the requirement for face-to-face prescription consultations.

“It makes it more difficult for non-prescribers to manage their clinics because they can only do the clinics when the prescriber is available to be there physically,” she said. “It also makes it less attractive for the prescriber because if they have to be there physically they may as well take a higher margin by doing the procedure themselves rather than prescribing for someone else.”