Under-18s and over-18s: crossing regulatory tipping points for cosmetic procedures

Birthday milestones can seem like arbitrary affairs. There’s the ‘life begins’ birthday milestone of 40, or the ‘key to the door’ at 21. Two little ducks even make an appearance – although I might be getting milestones muddled up with my Top Ten Favourite Bingo Calls.

These milestones aside, the one which really holds weight for law and policy is when a person reaches the age of 18, when they are no longer considered to be a minor (a provision outlined in law in 1969). On turning 18 in England, a person can buy alcohol, join the armed forces – or get married – without parental consent, vote, buy fireworks, and get a tattoo. The 18-year-old who does all those things on their birthday would have quite the day.

But in this flippancy lies an important – if obvious – point. Legal provisions that apply to a person are there one day, and gone as soon as the clock strikes midnight to usher in their 18^th birthday.

Turning 18 has recently had other consequences added to it, in the form of two developments which aim to afford under-18s stronger protections in the context of cosmetic procedures. This is a topic we’ve thought about a lot at the Nuffield Council, following our report four years ago on the ethical issues raised by cosmetic procedures, and both developments are ones which prompted me think about what they mean for the sector more broadly – including those who are over-18.

But first things first: what are these developments?

A ban for under-18s’ access to botox or fillers

On 1 October 2021, a new law came into force in England which made it a criminal offence to make arrangements for, or administer, botox or fillers to under-18s. Here at the Nuffield Council, we particularly welcomed this development, as it echoed closely a recommendation we made in our report, which stated that under 18s shouldn’t be able to access cosmetic procedures apart from in the context of multidisciplinary healthcare.

Since the announcement of the law change in England, the Welsh Government has said it is looking into the regulations in Wales, which still allow under-18s to have botox or fillers. The Northern Ireland Government has stated that it has no plans to legislate on this. No update has been given by the Scottish Government.

Restrictions on advertisers directing ads for cosmetic interventions at under-18s

The second development was announced at end of November 2021, when the Advertising Standards Authority (ASA) revealed that, from May 2022, adverts for cosmetic interventions will be prohibited from being directed at under-18s. Specifically, according to the ASA, the new rules will mean:

• Ads for cosmetic interventions must not appear in non-broadcast media directed at under-18s;
• Ads for cosmetic interventions must not appear in other non-broadcast media where under-18s make up over 25% of the audience; and
• Broadcast ads for cosmetic interventions must not appear during or adjacent to programmes commissioned for, principally directed at or likely to appeal particularly to under-18s.

What should be next? Regulation as a form of priority-setting

These changes are absolutely to be celebrated, not least because young people may be particularly sensitive to conform to prevailing peer and social pressures, especially as they develop their sense of identity – meaning that their access to cosmetic procedures raises particular ethical concerns.

Therefore if we look at the regulation of the cosmetic procedures sector as a priority-setting exercise, then a strong argument can be made for addressing under-18s’ access to these procedures, and the content which advertises them, first. But – as we argue throughout our report – the ethical buck shouldn’t stop there.

As we saw when we tackled this project over the course of two years, the cosmetic procedures sector is a juggernaut – and a complex one at that: it spans an ever-expanding range of procedures, practices, and products provided by practitioners operating in premises that range from high-street beauty salons to hospitals. The sector, and the treatments it offers, are predominantly accessed by adults, and it is to these adults which regulation might consider as the next step in its priority-setting exercise. We made a number of recommendations for what might be done to improve the integrity of the sector in this respect.

These included a focus on the role of social media. We recommended, for example, that social media companies should collaborate to establish and fund a work programme to understand better how social media contributes to appearance anxiety. The use of social media affects a wide age-range – not just the under-18s – so any efforts in this respect should span all age groups. No such efforts in collaboration have been made, despite calls we made in response to the online harms white paper in 2019.

In a similar vein of collaboration, we also urged major providers of cosmetic procedures to work together to develop a code of best practice for each provider to adhere to. This code should include a commitment to a two-part consent process for anyone considering having a procedure – and a guarantee that there would be no financial commitments asked of clients before the consent process was complete. Here the news is slightly better: a code of practice has been drawn up by the UK’s Joint Council for Cosmetic Practitioners (JCCP). But adhering to this code is not mandatory – nor is registering with the JCCP.

I’ve chosen to highlight these two recommendations for a reason (there are 25 others in our report). This is because they emphasise that, if other regulations outside the realm of cosmetic procedures take precedence in the priority-setting exercise, it doesn’t mean that the sector has a Get Out of Jail Free Card. That is, it should absolutely not be the case that the aspiration of a more ethical cosmetic procedures sector for everyone who is having, or thinking about having, a cosmetic procedure, should be abandoned if regulation is not forthcoming. There are other things that the sector itself can do for all its potential clients – regardless of whether they’re old enough to vote.

The Nuffield Council on Bioethics’ report on cosmetic procedures: ethical issues is available to download.