Guidance issued for Brazilian Butt Lift and body contouring practitioners following UK’s first BBL death

Following the UK’s first death from an improperly administered buttock augmentation, the Joint Council for Cosmetic Practitioners (JCCP) issued guidance in October 2024 to assist Local Authority Environmental Health Officers (EHOs) in managing the risks associated with so-called ‘BBLs’ and other body contouring procedures and ensure public safety.

The regulators are now increasing scrutiny on health and safety in non-surgical cosmetic procedures — meaning that organisations offering these services should be alert to the risks they face if a regulator finds any breaches of health and safety law. 

Here, Thorrun Govind, Solicitor in our regulatory and professional conduct team and practising pharmacist, and Hannah Fawcett, Partner and lead of our beauty and fashion team — outline how aesthetic practitioners can ensure that they stay compliant.

Risks of non-surgical cosmetic procedures

Non-surgical cosmetic procedures have become increasingly common and normalised, driven by social media, accessibility, affordability and advancements in technology and products. However, all procedures carry risks, which can lead to serious complications if they aren’t performed correctly. 

These risks are heightened when the practitioner lacks sufficient knowledge or training, uses unregulated products or operates in unsuitable premises. This trend is evident in the rising number of hospitalisations linked to poorly performed surgical fat transfer procedures (otherwise known as ‘Brazilian Butt Lifts’ or ‘BBLs’).

Lack of regulation for unlicensed practitioners

The aesthetics industry has a lack of regulation for unlicensed medical practitioners. This places people’s health at serious risk — while specialist surgeons follow safety guidelines, untrained individuals can inject unsafe, bulk-purchased products in unregulated settings.

Non-surgical BBLs involve the use of hyaluronic acid fillers to enhance the size and shape of the buttocks. Though often promoted as a safer, cheaper alternative to the surgical BBL, experts warn that the risks are still high.

While some local authorities — including Wolverhampton and parts of Essex — have banned specific companies from offering such treatments due to safety concerns, there’s no nationwide licensing framework. This has led to unqualified practitioners performing the high-risk procedure, often without sufficient medical training.

The importance of qualified professionals

Developed alongside the Chartered Institute of Environmental Health (CIEH) and British Beauty Council, the guidance addresses the increasing dangers of unregulated procedures. It outlines the powers that local authorities have under the Health and Safety at Work Act 1974 to issue Prohibition Notices to risky businesses or practitioners.

The document classifies buttock, breast and genital augmentations as surgical procedures that require qualified medical professionals. It also provides advice on identifying non-compliant practitioners and ensuring consistent enforcement. The JCCP emphasises that only trained specialist surgeons and fully qualified, General Medical Council-registered doctors should perform these procedures. 

What are the risks of a health and safety breach?

Health and safety breaches have serious consequences — and fines are increasing every year. It has never been more important to ensure that you have a robust health and safety management system in place for your business.

If a regulator investigates your organisation and finds any breaches of health and safety law, it may decide to take enforcement action.

This may include:

• Informal advice.
• Improvement notices (requiring specific actions by a certain date).
• Prohibition notices (prohibiting certain activities).
• Thorough investigations.
• Prosecutions.

Health and safety offences are criminal, leading to criminal records and potentially unlimited fines. For organisations with a turnover between £2m and £10m, fines are calculated by reference to turnover, culpability, seriousness of harm risked and other mitigating and aggravating features.

Any failure to comply with a notice will be treated as a separate offence.

Individuals convicted of health and safety offences could face custodial sentences and/or fines. Serious offences can result in up to two years in prison. Fines for individuals are based on the seriousness of the offence and weekly income.

While organisations may have insurance for investigating breaches and defending prosecutions, fines from successful convictions won’t be covered by insurance and must be paid in full. Regulators can also recover costs for investigating and enforcing health and safety law, which can be significant for complex cases.

How to stay compliant 

It isn’t only unlicensed practitioners who should worry about regulatory action. Organisations that legitimately perform non-surgical cosmetic procedures should also look to safeguard themselves against enforcement action while EHOs get familiar with the new guidance. 

While the EHO compliance checklist (Appendix 4 of the guidance) is a helpful start for organisations, this isn’t exhaustive. It’s critical that all serious risks — no matter how remote — are identified as part of the consenting process and organisations should be prepared to demonstrate this.

Organisations should also be able to show how they identify and summon emergency support and escalate medical issues in-line with monitoring until emergency services attend. At a minimum, monitoring should include oxygen saturation, blood pressure and patient presentation/symptoms.

Evidence of thorough aftercare arrangements should also be available. This includes timely access to a prescribing healthcare professional, competent in the diagnosis of infection and sepsis, as well as the ability to coordinate treatment with other expert medical professionals and resources. Practitioners must be familiar with NICE and resuscitation guidance relating to anaphylaxis and keep evidence of continued professional development.

If an incident does occur — or the HSE believes that it has identified a material breach of health and safety law during a site visit — being able to demonstrate a robust approach to health and safety management will go a long way to help defend or mitigate any enforcement action. This can also have a significant impact on reducing any fines issued following a successful conviction. 

Talk to us

While we’ll always be by your side when the unexpected happens, prevention is better than cure — and proactively managing risk through Brabners Protect will significantly reduce the likelihood of serious incidents occurring in your business. 

Tailored to the needs of your business and competitively priced, you only pay for the support that your business needs — nothing more.

If you’d like more information about your health and safety obligations, please get in touch.

Talk to us by giving us a call on 0333 004 4488, sending us an email at hello@brabners.com or completing our contact form below.