Regulation and licensing of non-surgical cosmetic procedures: consultation background paper

Annex B – Glossary of terms

In describing these procedures, the Scottish Government is not endorsing any claims made about their cosmetic or other effect. Descriptions of the intended, or advertised, effect are included only as an aid to understanding the procedures under consideration. The evidence base for these and other procedures is varied and should be discussed with a practitioner before any procedure is undertaken. There has been no assessment made on the evidence base for any of the procedures listed here.

Procedures may be described in different terms by different practitioners. This consultation has sought to adopt widely used terms, and avoid using proprietary terms except where these are likely to be more commonly understood.

Autologous fat treatment: This treatment uses the patient’s own fat, harvested from the patient’s body and reinjected in another area, with the intention of smoothing or augmenting the skin or body.

Biotherapy: A treatment that uses substances made from living organisms, which may include substances which can occur naturally in the body or substances made in a laboratory.

Botox^®: Botox^® is a brand of botulinum toxin, which paralyses or relaxes muscles under the skin and has a range of uses. It is used in non-surgical cosmetic procedures with the intention of reducing or preventing lines and wrinkles on the skin, mainly on the face.

Carboxytherapy: A treatment in which carbon dioxide gas is injected under the skin. With the intention of causing fat cells to die and stimulating blood flow. This is undertaken with the intention of improving the elasticity of the skin, and reducing the appearance of cellulite.

Cellulite subcision: Cellulite is caused when the connective cords which tether the skin to the muscle beneath it are stretched as fat cells accumulate. Subcision uses a needle to cut through the cords, with the intention of allowing the muscle beneath to be smoothed out and reducing the appearance of cellulite.

Chemical peel: A treatment which removes skin on the face, hands or neck. Levels of peel range from gentle exfoliation of the outer layer to full penetration of the middle layer, with the intention of removing skin cells, and improving the appearance of the skin.

Cogs / Thread Lifting: A treatment in which permanent or dissolvable threads are inserted underneath the skin of the face or neck and manually positioned to stretch the skin. Barbs on the threads latch onto the skin and underlying tissue so that the threads can be pulled tight. Cogs and threads are applied with the intention of tightening skin or plumping the skin by inducing the production of collagen.

Cryocautery: A treatment which uses compressed gas at low temperatures with the intention of removing or reducing skin blemishes such as skin tags, age spots and warts.

Cryolipolysis: A treatment also known as ‘fat freezing’, this treatment cools fat cells with the intention of breaking them down.

Cryotherapy: A treatment which is intended to enhance the appearance of the skin using ultra-cooled nitrogen gas.

Dermal filler: Dermal fillers are substances that are injected under the skin with the intention of reducing lines and wrinkles and providing volume to the face or other body areas. Dermal fillers can be synthetic or substances that occur naturally in the body. Common products include hyaluronic acid and poly-L-lactic acid. A semi-permanent treatment, dermal fillers are most commonly used on the face and neck but can also be used on the breasts, buttocks and genital areas.

Dermal micro coring: This treatment is also known as fractional tissue extraction or micro-excisional skin removal, and it uses a small needle device to punch holes, less than half a millimetre in diameter, in the skin. The holes are placed in a pattern with the intention of stimulating collagen production and tightening the skin.

Dermis: the dermis is the layer of skin between the epidermis, or uppermost layer, and the deeper tissue beneath. The dermis contains sweat glands, hair follicles, nerves and blood vessels, as well as collagen and elastic fibres that provide structure.

Devolved matter: Following the establishment of the Scottish Parliament under the Scotland Act 1998, responsibility for a number of policy areas was passed to Scotland from the UK. These include health and social services, but the regulation of health professions and aspects of the regulation of medicines and medical devices is in the main reserved to the UK Government.

Electrocautery: A treatment which uses heat generated by a light electrical current to remove skin lesions. A heated coil is used to burn off the lesion.

Epidermis: This is the uppermost, visible, layer of the skin, above the dermis.

Exceptional referral protocol: Previously known as the Adult Exceptional Aesthetic Referral Protocol, this protocol outlines those aesthetic procedures which are not available routinely as part of NHS services as they do not treat an underlying disease, but can be offered in exceptional circumstances where there is clear evidence of benefit to the patient. The protocol is set out in Chief Medical Officer Letter 5 of 2019 (CMO(2019)5).

High frequency ultrasound (HIFU): Also known as high intensity focused ultrasound, this treatment uses ultrasound energy with the intention of stimulating production of collagen and tightening skin to reduce the appearance of scars, smooth wrinkles and improve elasticity of the skin. HIFU is sometimes undertaken with the intention of tightening the vagina, where it is often described as ‘intimate HIFU’.

Injection lipolysis: Also known as lipolytic or fat dissolving injections, this treatment injects substances, sometimes prescription-only medicines and sometimes other substances, with the intention of breaking down fat cells in targeted areas.

Injection Microsclerotherapy: A treatment for spider or thread veins, which uses ultra fine needles to inject a substance into the veins which causes the vein walls to become inflamed, with the intention of reducing the visibility of the vein(s).

Intense pulsed light (IPL) therapy: IPL treatments, also known as photo facials, use high intensity pulses of visible light with the intention of improving the appearance of rosacea, birthmarks and other skin lesions. IPL can also be used for hair removal.

Laser treatments: High energy beams of laser light can be used for a variety of purposes, including hair removal, tattoo removal, acne scarring, sun damage and treatment of other skin lesions. Lasers can be set to different wavelengths of light so that the strength and depth of penetration can vary. The laser beam heats cells causing localised damage or vaporising affected cells. Non-ablative laser treatments cause controlled tissue injury in the dermis but leave the epidermis intact. Fully ablative lasers completely remove the epidermis and some of the dermis by vaporising skin cells.

Light emitting diode (LED) therapy: LED therapy uses masks, lamps or handheld devices to shine light directly on to photoreceptors in the skin. It is used for treatment of acne, psoriasis, fine lines and other conditions.

Liposuction: This treatment uses a narrow tube or canula to suck fat from areas of the body. One or more incisions are made to insert a thin hollow tube which is moved around to loosen the fat and suck it out. The procedure may be accompanied with the use of ultrasound, lasers or water jets. Local or general anaesthetic may be required, depending on the location and scale of the procedure.

Mesotherapy: Very fine needles are used to inject substances into the dermis. These substances can include hyaluronic acid, minerals and amino acids. The intention of the treatment is to smooth the skin, improve the appearance of blemishes and stimulate the production of collagen.

Microneedling: Also know as collagen-induction therapy, is a treatment that punctures the skin with a series of tiny needles to stimulate the skin to heal, with the aim of producing collagen to smooth and firm the skin.

Non-ablative laser hair removal: See laser treatments.

Phenol peel: This is an intense chemical peel that penetrates through the top layer of skin into the dermis, removing tissue. The intention of the treatment is to help with deep wrinkles, scarring and sun damage.

Photorejuvenation: A treatment that uses lasers or intense pulsed light to create controlled wounds to the skin, prompting regrowth and new skin cells, with the intention of improving skin condition, including sun damage, wrinkles and discolouration.

Platelet-rich plasma treatment: In this treatment plasma and platelets are extracted from a sample of the client’s own blood. This protein-rich solution is then spread across the skin; microneedling is intended to allow the proteins to be absorbed into the skin, or the solution can be injected in the same way as a dermal filler. These procedures are sometimes known as ‘Vampire facials’ but can also be applied elsewhere on the body.

Radiofrequency treatments: A treatment that uses heat to create small ‘injuries’ to the skin that promote repair of tissue with the intention of reducing the appearance of scarring and wrinkles, or tightening the skin.

Regulated healthcare professional: Healthcare professionals including doctors, nurses, dentists, pharmacists, and optometrists are regulated in law by their respective professional bodies, which include but are not limited to:

• the General Medical Council;
• the General Dental Council;
• the General Optical Council;
• the Health and Care Professions Council;
• the General Pharmaceutical Council; and
• the Nursing and Midwifery Council.

Regulation ensures that healthcare professionals are properly trained and qualified, and keep to codes of practice and ethics. Regulatory bodies have the power to investigate a professional’s fitness to practice and can remove them from the relevant professional register if they are found to be unfit.

Reserved matter: Reserved matters are those for which responsibility was not passed to Scotland following the establishment of the Scottish Parliament and are listed at schedule 5 of the Scotland Act 1998. For the purposes of this consultation these include, in the main, the regulation of the health professions, which is undertaken by bodies such as the General Medical Council and the Nursing and Midwifery Council, and aspects of the regulation of medicines and medical devices. Health and social care in general is a devolved matter.

Subcutaneous: This means ‘under the skin’. A subcutaneous injection delivers medicine or cosmetic product to the area between the skin and muscle.

Thread lifting: see Cogs / Thread lifting.

Topical: Topical products are products which are applied to the skin, such as gels and creams.

Viable epidermis: This is the layer immediately underneath the outermost layer of skin, and is effectively the barrier layer of skin.