Rise of UK aesthetic botulinum toxin industry outpacing regulation

The study, published in Aesthetic Surgery Journal Open Forum, provides the most comprehensive research to date of the UK’s botulinum toxin sector (which includes Botox and other anti-wrinkle injection brands).

Researchers identified 19,701 practitioners working across 5,589 clinics. This compares with 3,667 practitioners identified in a 2023 national study, with the authors noting that the differences may reflect both rapid market expansion and more comprehensive mapping of online and social media-based providers.

The findings come as the Government prepares major reforms to regulate non-surgical cosmetic procedures amid growing safety concerns.

A previously estimated 900,000 botulinum toxin injections are carried out in the UK each year, and in this new study, the UCL researchers found that the proportion of practitioners without a medical background doubled from 12% to nearly 25% between 2023 and 2025, whilst medical doctors accounted for under a third of practitioners.

The researchers say that the differential access across socioeconomic groups highlights a “trade-off between accessibility and potential safety oversight” which forthcoming reforms must “address directly”.

They acknowledge that botulinum toxin, which works by relaxing specific muscles and blocking certain nerve signals, has revolutionised aesthetic and medical treatment options but are calling for urgent action. Whilst reforms across the UK are imminent with plans for a practitioners licensing scheme announced by the Government, the precise shape of new regulations remains to be seen.

The problem is particularly acute in poorer areas, where treatments are more likely to be provided by non-medical practitioners and cost less.

Lead author Dr Alexander Zargaran (UCL Surgery & Interventional Science) said: “The proliferation of botulinum toxin providers who do not have professional healthcare backgrounds raises questions regarding the adequacy of training standards and highlights challenges for the impending government reforms.

“Our findings show that while more than 90% of those treatments are given in hospitals or clinics, there are a range of non-clinical settings where botulinum toxin – a prescription-only medication – is being administered, including beauty salons, spas, and even mobile setups which might lack the adequate safety infrastructure.”

The researchers analysed practitioner data to calculate how many aesthetic botulinum toxin clinics and practitioners there were in the UK.

The study is also the first to examine socioeconomic differences in access to botulinum toxin injections across the UK.

The researchers found that the treatment is more readily available in deprived areas. However, this increased access is largely driven by a growing presence of non-medical practitioners – and with significantly lower access to specialist doctors and clinical settings, this highlights a potential inequality in safety oversight.

Dr Alexander Zargaran said deregulated markets create an abundant supply in deprived areas, but with reduced clinical oversight, because those markets allow non-medical practitioners to compete directly with medical providers, signalling differentiation through lower pricing.

Co-author Dr David Zargaran (UCL Surgery & Interventional Science) said: “Practitioner background was the strongest determinant of pricing in this market. Doctors charged around 30% to 40% more than non-medical practitioners, with dermatologists and plastic surgeons consistently occupying the highest price tier.

“These differences were larger than those explained by geography or premises type, suggesting that market competition is structured primarily around practitioner qualification rather than location.”

Hospitals charged the highest median prices (£170.64 per treatment area), followed closely by clinics and spas. Beauty salons operated at modest discounts, while mobile providers charged the lowest prices.

Senior author Professor Ash Mosahebi (UCL Surgery & Interventional Science) said: “Our findings highlight the need for regulation that balances accessibility with consistent safety standards for prescription-only aesthetic procedures.”

Links

• Research paper in Aesthetic Surgery Journal Open Forum
• Alexander Zargaran's academic profile
• Dr David Zargaran's academic profile
• Professor Ash Mosahebi's academic profile
• UCL Faculty of Medical Sciences
• UCL Division of Surgery & Interventional Science

Image

• iStock - Credit: anatoliycherkas

Media contact 

Nadine Palmer

E: nadine.palmer@ucl.ac.uk