Botulinum Toxin and Cosmetic Fillers (Children) Bill

Jane Stevenson Excerpts

2nd reading & 2nd reading: House of Commons
Friday 16th October 2020 Commons Chamber

[Jane Stevenson (Wolverhampton North East) (Con)]

It is a pleasure to follow my hon. Friend the Member for South Suffolk (James Cartlidge), who spoke so passionately about children’s mental health, which is at the core of the Bill. I thank my hon. Friend the Member for Sevenoaks (Laura Trott) and congratulate her on bringing this really important Bill to the House.

The use of botulinum toxin and dermal fillers has become big business over recent years. These non-surgical procedures are now a £2.75 billion industry in the UK. They started out as a subtle way to knock a few years off and to look a bit younger, but in recent years they have been used to a much greater extent and to achieve a much more obvious cosmetic effect. They can be used to change the shape of facial features—to disguise a bump on someone’s nose, to redefine their jawline, or to plump up their cheeks or their lips. They are becoming incredibly popular.

We live in an age when everyone has a video camera in their pocket and our daily lives are shared on social media and broadcast on such a wide range of social media channels. Magazines bombard us with airbrushed images of celebrities. I know that my hon. Friend the Member for Bosworth (Dr Evans) seeks to require doctored images to be clearly labelled on social media, but sadly, at the moment, our young people look at very unrealistic images.

[Dr Luke Evans]

Does my hon. Friend agree that the problem with images online, especially if they are doctored in their proportions, is that they create an unrealistic aesthetic that is unachievable in real life? That is the problem with social media versus aesthetics in the real world.

[Jane Stevenson]

I absolutely agree, and I commend my hon. Friend for his work in this area.

I am thankful that in my early teenage years, I did not have to face the kinds of pressures that young people today have to face. I have concern for my two goddaughters, Lily and Eve, who are in their early teens, growing up with these constant pressures to look a certain way that is unrealistic to achieve. Thankfully, my awful 1980s hairstyles in an attempt to look like Bananarama or the latest pop group, and my appalling dress sense of my early teens, are now a dim and distant memory—a very distant memory—but young people today know that images taken of them every day will live online for their whole lives.

Our teenage years are challenging enough as we grow up, and many young people are now turning to these treatments as a way to feel better about themselves or to copy the look of someone they admire. In my work in schools over a decade, I noticed that sixth-form girls were increasingly having eyelash treatments to lengthen their eyelashes, or fillers to make their lips plumper. It is incredibly sad. As my hon. Friend the Member for Sevenoaks said, no child needs botox or fillers. It is completely unrealistic.

Sadly, consumer protections have not kept up with the industry, and we hear some horror stories; my hon. Friend shared one a moment ago. When they are injected by people without medical training, these treatments are extremely dangerous. Many people seeking beauty treatment do not realise that botox is a prescription-only medicine that should be prescribed only after a face-to-face consultation and by a licensed prescriber.

[Anthony Mangnall]

My hon. Friend is making a very good point. She raises the issue that people treat botox as something trivial, and that there needs to be greater sincerity about people going through that procedure, putting aside whether it is necessary or for cosmetic reasons. Does she think that further steps need to be taken to make people more aware? This goes back to the point about education that I made in my intervention on my hon. Friend the Member for South Suffolk (James Cartlidge).

[Jane Stevenson]

Yes, I absolutely agree. People have to go into these treatments with full information so that they are giving informed consent, which, of course, under-18s cannot realistically give on such a serious matter.

The cost of these treatments is certainly not insignificant. A reputable, qualified, experienced practitioner can charge between £300 to £1,000 for botox treatments. Dermal fillers have a similar cost. The effects last about 12 months before they will need to be repeated. For most adults, those are significant amounts of money. For young people, the high cost leaves them seeking cheaper alternatives. They use non-healthcare professionals, sometimes hairdressers or beauticians, many of whom have trained for mere hours rather than several years.

In the wrong hands, these treatments frequently go wrong. The number of cases of botched jobs has doubled in the last year, from 616 cases in 2017-18 to 1,300 last year. There are, as we have heard, potential health risks, including blindness, tissue necrosis, infection and scarring. There can also be a significant psychological impact when a treatment does not give the desired effect, or when it does not deliver the desired boost in self-confidence. I think that that is at the root of the mental health point.

[Dr Luke Evans]

Does my hon. Friend agree that when complications happen, particularly when someone does not feel their aspirations have been achieved, that creates a vicious cycle, because the temptation to go back and have yet another procedure means that they are entwined in associating the procedure with their body image and the negative effect that can have?

[Jane Stevenson]

Absolutely. I completely concur. We see that in the treatments becoming more obvious and lip fillers becoming bigger. We see girls with very unrealistic lip sizes these days, which is worrying.

I agree with my hon. Friend the Member for Sevenoaks that the industry needs more regulation. Certainly, we want the security that one can go to somebody who knows what they are doing, and has the insurance and the skill to correct a procedure that does not go to plan. The NHS should not be picking up cases where an obvious failure of skill has occurred.

[Anthony Mangnall]

My hon. Friend is again making an important point about ensuring that registered practitioners undertake these practices. Could she just add a few more points on whether she thinks a national register needs to be created, so that this cannot be practised by people who do not have the correct skills to be able to perform it?

[Jane Stevenson]

It certainly needs a lot more regulation. The Bill does not seek to impose that, but minimum training levels to inject someone’s face with a filler or with botox is certainly desirable. On insurance, that could be regulated, too. I am sure further legislation will appear.

[Fay Jones (Brecon and Radnorshire) (Con)]

I add my congratulations to my hon. Friend the Member for Sevenoaks (Laura Trott) on bringing the Bill forward. My hon. Friend the Member for Wolverhampton North East (Jane Stevenson) is making suggestions for further areas of regulation that could be looked at. Does she agree on the need for consultation when the process is carried out? I was staggered to read in the research by my hon. Friend the Member for Sevenoaks that almost 40% of the people who made a complaint said they had no consultation whatever. Does my hon. Friend agree that that needs to be addressed?

[Jane Stevenson]

I absolutely agree. As these treatments become more common, it becomes like getting a haircut or having your nails painted. It is something that people can do in their school lunch break or after school. It is really concerning that they are not taken seriously. People do not feel consulted and they certainly have not been made aware of the medical risks of these procedures.

In summing up, I absolutely support the Bill. The age limit of 18 seems entirely reasonable and aligns these treatments with other treatments that carry health risks, such as sunbed use, teeth whitening and tattooing. I commend my hon. Friend the Member for Sevenoaks for this thoughtful, sensible Bill that puts young people’s mental health at the heart of the matter. I am very happy to support the Bill.

[Mr Speaker]

Just a little information for the House. Sir Christopher is stuck in traffic, but he has sent news that he will be here for the next debate.

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[Claire Coutinho]

Well, I thought I would quite like to go to Antarctica. I was told that it would be rather cold, so I said I would wear a very big jumper. It struck me when I was looking at those children that in a couple of years’ time, when they are 13 or 14, the questions might be slightly different. Women in the House will recognise the questioning that we have all experienced, which is sometimes very personal to our looks, our diet, our wardrobe and how we get ready in the morning. That focus on how we look, which seeps into our thinking as we grow older, is unfortunate and sad.

[Jane Stevenson]

Does my hon. Friend agree that many magazines and newspapers perpetuate that by attacking Members in the House as well as other people in the public eye? Young people see that as something important. Does she also agree that building children’s confidence, through a range of methods, about the fact that they are good at several things—it is not all about how they look—is incredibly important?

[Claire Coutinho]

I completely agree with my hon. Friend. It is worrying when our sense of self-worth relies on the way we look, so what she suggests is welcome.

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[Dr Evans]

Thank you, Madam Deputy Speaker.

I absolutely agree with my hon. Friend. The differentiation between medical and aesthetic is really important. This is all about accountability, which is the key part of the Bill. There are the good uses that we have talked about, but there are complications as well. Unfortunately, in my practice I have seen those complications. I have had patients come to me who have had botox, and it has created an asymmetry in the face. Fortunately, it lasts only for six months, but that is a long time to sit with a face that a person is not happy with. More concerningly, I have seen patients who have come in with lip fillers that have gone wrong. The lesser side is the bruising and swelling, which will usually go after the first two weeks, but fillers can also become clumpy, with uneven lumps and bumps within the lips. Worse still, I have seen necrosis, which is dying of the tissue, where the lip filler starts to come out. That is absolutely devastating for the person suffering, and there is no accountability or anything to allow them to find out how to get that corrected.

[Jane Stevenson]

Does my hon. Friend agree that any cosmetic treatment, whether non-surgical or simple beauty treatments such as eyelashes being permanently bonded to the face, carries a medical risk? Does he agree that any procedure with medical risks should involve a detailed consultation and a form of consent?

[Dr Evans]

Absolutely. Yet again, I wholeheartedly agree with my hon. Friend. That is the crux of what we are discussing, and I will get on to that point.

Complications happen. Fortunately, I have seen them only in adults; I have yet to see them in a child.

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[Dr Evans]

I thank my hon. Friend for raising that point. I believe the industry has put in place a voluntary sign-up for standards. The point was made earlier—I am sorry, but I forget who by—that the industry itself is asking for regulation to be put in place, because it understands that good practitioners are very good at doing these procedures safely and wisely. We want to encourage businesses to take responsibility for putting standards in place.

[Jane Stevenson]

Does my hon. Friend agree that another serious concern is that less scrupulous practitioners will not use a light touch and seek a cosmetic improvement, but will seek to upsell and invite people to have more and more procedures in the name of making more money?

[Dr Evans]

Absolutely. My hon. Friend points out something worrying: if someone is vulnerable in the first place when they go for a procedure, unsure about why they are there, and is coerced into taking some further measure, that is a concern. It leads into a vicious cycle of returning again and again for an update on something that may never be achieved.

All that leads on to the idea of consent, which is really important for both patients and practitioners. We need to make sure that when someone goes for a procedure it is fully explained to them what the procedure is, why they are having it and what the consequences are, including the short-term and long-term complications. If someone goes to theatre to have an operation, it is spelled out to them. They have to sign a declaration to say that they understand it, and they and the person carrying out the operation are held accountable to that standard. That is really important. Sadly, that accountability is lacking, particularly in respect of fillers. That is the concern, because it leads to a variation in standards, an unregulated industry and the horrific cases that my hon. Friend the Member for Sevenoaks highlighted.

All that I have described applies to adults, but of course we are talking about under-18s. It is really important to make the point that this is about drawing these procedures into line. We already have statutory regulations that say that a person cannot have a tattoo until they are 18. The Bill would simply bring into line an industry that is burgeoning and blooming. That is the important point.

This is about protection, accountability and, most importantly, choice. We should encourage those who want to go ahead for the right reasons to have the right procedure done in the right way, and held to account in the right way. We need to protect, nurture and educate those under the age of 18 and allow them to make the decision when they become 18.

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[Suzanne Webb]

I thank my hon. Friend for his comments. That is an important point. People put pressure on us to make us feel that there is a way that we are supposed to look. I am afraid that gentleman often make us feel that way as well. We feel that we need to look a certain way to be attractive. We are attractive for who we actually are. We should just be ourselves. That is the most attractive quality in a person that I can think of.

I have seen written work where botox was debated around a “Should they or shouldn’t they?” argument. My simple question is: why would you? Why would you feel the need to do that?

I had not realised when researching this topic that non-surgical cosmetic treatments, such as botox and dermal fillers, generate over £2.75 billion in the UK and account for 75% of all cosmetic enhancements carried out each year. That is great news on the one hand because it is generating income—fantastic—but when we look at it another way, it is a lot of money focused on cosmetic enhancements. It is the word “enhancements” that starts to ring alarm bells, as does the fact that young adults partake of this practice. I thank my hon. Friend the Member for Sevenoaks for taking time to raise awareness of the impact of botox and dermal filler procedures among all age groups, but particularly those under the age of 18.

When I dug a little deeper, I found that, unlike their surgical counterparts, such as breast enlargement and facelift operations, which have clear and defined laws as to who can undertake the procedures, non-surgical cosmetic injections can be administered by anyone. What struck me most was that it is a largely unregulated industry. I support the wish to see the regulation of this practice enforced by a local authority, which will help to keep children safe from these procedures. It will help to ensure that children grow up to be the person they actually are and, as I said before, to age gracefully.

I thank my hon. Friend for raising awareness of the potential health risks of the procedures, including blindness, infection, scarring and psychological impacts. I also want to say again that we do not know the mental health impact of this and what has brought somebody there in the first place. There must be some damage to one’s self-esteem to think that you need to change your appearance. For me, as I mentioned at the start, that is one of my greatest concerns on this and the growing mental health issue within young adults.

[Jane Stevenson]

I thank my hon. Friend for her recollections of ABBA impersonation; mine was Bananarama, but I follow her lines. Does she agree that, as society has shifted and self-confidence is built on what you look like rather than you as a complete person, we are storing up this mental health crisis for future years? People who are now entering into these cosmetic procedures as they get older will be less able to cope with how they look and less happy with themselves. On the “Love Island” point raised a moment ago, we have seen suicides of those contestants, and it concerns me greatly that if one’s confidence is built purely on what one looks like, this is extremely concerning for one’s mental health.

[Suzanne Webb]

My hon. Friend raises a really important point. It is the fact that people feel so self-conscious, but it is also about how, by embracing who you are, you take the consequences of your actions. We all fail at times—we cannot always look beautiful, and we sometimes make disastrous decisions about what we are wearing and how we look—but that is how we grow and learn, and that is how we become strong. We become strong individuals in our life by learning through our mistakes and so forth. It is about turning up with the wrong frock or the wrong jacket on, putting too much lipstick on, or just looking flipping awful some days. Am I allowed to say “flipping” in here? That is what it is about, and it makes you a strong character. Manufacturing who you are does not make you resilient for life, and I think that is a very important point.

The growth in non-surgical treatments increases the need for consumer protection, and I believe it is important to work with stakeholders to strengthen the regulation of cosmetic procedures, so that only regulated health professionals may administer botox or dermal fillers to under-18s, which may be required for medical reasons. It concerned me greatly when I heard about the impact on and damage to that person. The story was quite heartbreaking.

I know that botox is a treatment option for people who suffer from chronic migraines. It is used in the treatment of a range of medical conditions, including the management of bladder dysfunctions, face and eyelid twitching, painful involuntary neck muscle contractions and severe sweating, as my hon. Friend the Member for East Surrey (Claire Coutinho) has already mentioned. I am pleased that it will be used in these cases, with under-18s being able to access that treatment.

I believe it is important that these procedures remain available where there is an assessed medical need. I think that is key—the assessed medical need. It is not needed for beauty; it is needed only for a medical reason and when provided by a registered health professional. At present, practitioners do not need to be medically qualified to perform those procedures, which is a great concern. I did not realise that that was the case until my hon. Friend the Member for Sevenoaks introduced her Bill. There are no mandatory competency or qualification frameworks related to the administration of those procedures, which is incredibly scary. The potential health risks, which she raised, include blindness, tissue necrosis, infection, scarring and psychological impact.

My hon. Friend has made a really powerful case for the need to prevent under-18s from accessing botox or dermal filler procedures for aesthetic reasons, making the administration of botox and cosmetic fillers by injection to under-18s an offence, and I thank her for doing so. She also wants to establish a regulatory framework for local authorities to ensure that businesses have appropriate safeguards in place to prevent under-18s from using their services. She has 100% support from me for her Bill, which will stop dangerous and unnecessary non-medical procedures that can ruin children’s lives. Let us not forget that. We do not yet know the consequences for a young adult of using botox. We still do not know the consequences for adults of using botox as a beauty treatment.

The Bill also ensures that any treatments that are required are performed by a medical practitioner, which I really appreciate. For me, the most important part of the Bill, in conjunction with the private Member’s Bill introduced by my hon. Friend the Member for Bosworth (Dr Evans), which tackles body dysmorphia and unrealistic images in social media, is the fact that it contributes significantly to promoting body positivity, which I have long championed, and I will continue to do so. That begins at home and at school, and we need to educate young adults and children from the age of one, two, three, four and upwards. They are beautiful as they are. We embrace who we are and what we look like, and that is what makes us stronger in life. Any measures that do that have my unquestionable and unwavering support.