Assessing the Utility of a National Conference on Non-surgical Facial Aesthetics as an Educational Tool: A Survey-based Pilot Study

J Clin Aesthet Dermatol. 2024;17(12):32–36.

by Rohan Shankarghatta, MBBS, BSc*; Sarika Grover MBBS, BSc*; Julia Bahja, MBBS, MRes; Zeanab Chaer, BDS; Rahim Feddag, BDS; Can Celik, BDS; Felix Karst, MD, BDS, MRCS, AKC, and James Olding, MBBS, BDS, BSc, MRCS

Dr. Shankarghatta is with the Manchester University NHS Foundation Trust in Manchester, United Kingdom. Dr. Grover is with the University Hospitals Coventry and Warwickshire NHS Trust in Coventry, United Kingdom. Dr. Bahja is with the Great Western Hospitals NHS Foundation Trust in Swindon, United Kingdom. Ms. Chaer and Mr. Feddag are with King’s College London, Faculty of Dentistry, Oral and Craniofacial Sciences in London, United Kingdom. Dr. Celik is with Queen Mary Barts and the London School of Medicine and Dentistry in London, United Kingdom. Dr. Karst is with Royal Free London NHS Foundation Trust in London, United Kingdom. Dr. Olding is with the Department of Oral and Maxillofacial Surgery at King’s College Hospital in London, United Kingdom. 

*Drs. Shankarghatta and Grover share co-first authorship of this article.

ABSTRACT: Objective: Non-surgical facial aesthetics (NSFA) is a rapidly growing field involving the use of dermal fillers and botulinum toxin for aesthetic enhancement. The aesthetic injectables market is expanding, attracting interest from individuals seeking NSFA procedures. There has also been marked interest among healthcare professionals (HCPs) aspiring to become aesthetic practitioners. Conferences play a crucial role as educational platforms for HCPs venturing into NSFA. We used a national NSFA conference as an education tool for undergraduate and postgraduate healthcare students, assessing the utility of this conference in imparting knowledge on topics such as training pathways, regulations and complications in NSFA.

Methods: The FACExpo conference, held in November 2022, was organized by both qualified and aspiring aesthetic practitioners. Pre- and post-conference questionnaires were administered to attendees to evaluate their interest in facial aesthetics and their knowledge before and after the conference.

Results: A total of 68 delegates responded to the pre-and post-conference questionnaires. There was a statistically significant improvement in awareness of training pathways, regulations, and complications (p<0.0001). Only 39.71 percent of delegates were aware of the NSFA regulations before the conference, which increased to 91.18 percent in the post-conference survey. Similarly, 38.24 percent of delegates were confident in their understanding of training pathways pre-conference which increased to 97.10 percent post-conference.

Conclusion: This study demonstrates that facial aesthetic conferences can be used as an educational tool for aspiring practitioners and highlights the existing knowledge gap among current practitioners. Further research is needed to assess the overall impact of aesthetic conferences on the education of aspiring practitioners.

Keywords: Non-surgical facial aesthetics, regulation, medical education

Introduction

Non-surgical facial aesthetics encompasses a wide range of procedures, including the use of dermal fillers and botulinum toxin, primarily for aesthetic purposes. The market for aesthetic injectables is experiencing continuous growth, with a rising number of individuals expressing interest in non-surgical facial aesthetic procedures. A 2019 Allergan 360 Report, which surveyed over 14,500 consumers, provided further insights into the surging popularity of medical aesthetic treatments. This trend can be attributed to advances in technology, the influence of social media, and the increasing participation of millennials (ages 21–35) and men in the industry.¹ Notably, the report revealed that 82 percent of consumers aged 21 to 35 consider injectable treatments socially acceptable, and 83 percent are willing to invest in enhancing their appearance.¹ The global medical aesthetics market is expected to reach an estimated value of around $26.53 billion by 2024, a significant increase from $10.12 billion in 2016.² As the demand for these procedures continues to rise, there is a predicted corresponding increase in the need for skilled practitioners to meet this growing demand.

Currently, in the UK, the non-surgical aesthetics field is solely privatized. Despite the intricate anatomical knowledge required to provide these procedures safely, due to lack of regulation in the UK, in the past, these procedures have been commonly carried out by those who are not registered healthcare professionals (HCPs) and by the end of 2023, these regulations are expected to change.³ Large group events, specifically healthcare-oriented conferences, are a useful platform for attendees to learn about the current practice and the future of the specific field.⁴ Conferences, such as the British Society of Aesthetics Annual Conference, have been utilized to educate existing practitioners on the current trends, standards, and innovations in aesthetic practice.

An increasing number of HCPs are venturing into aesthetics without a standardized curriculum or formal educational events. This situation poses a potential risk to patient safety. Many patients experience complications in aesthetic procedures. With no assurance that aesthetic practitioners can adequately manage or even recognize these complications, patients may find themselves in need of emergency or primary care services in the public sector for treatment.⁵

This study aimed to identify the utility of FACExpo, a one-day conference which took place in November 2022, on educating undergraduates, postgraduates, and recently graduated healthcare professionals on non-surgical facial aesthetics.

Methods

On the day of the conference, we distributed pre-conference and post-conference questionnaires. Access to the questionnaires was facilitated through scannable QR codes on delegates’ name badges and displayed on the main stage.

The conference surveys were designed using Google Forms, featuring primarily multiple-choice type as well as five-point Likert scale questions aimed at quantifying delegates’ perceptions. Additionally, to further assess the utility of this conference in providing education, two short-answer questions were included in both the pre- and post-conference questionnaire to understand delegates’ knowledge of complications associated with NSFA procedures before and after the conference. The objective of these questionnaires was to identify any shifts in delegates’ knowledge, as well as their level of interest in the field of aesthetics, both before and after the conference. Responses from delegates were anonymized and aggregated as qualitative data, which was subsequently analysed using Microsoft Excel.

Statistical methods. The Shapiro-Wilk test was used to assess the data collected from the pre and post-conference questionnaires to determine whether the data was normally distributed. The Mann-Whitney U test was used to assess if there was any statistical significance between the non-parametric pre- and post-conference responses.

Ethics. The study participants included both undergraduate and postgraduate students as well as recently qualified HCPs. No patients were involved in this study. All participants provided their consent for their anonymized data to be used towards this research study.

Results

To assess the utility of a national conference on NSFA, an analysis of survey responses from both the pre- and post-conference questionnaire was carried out. From a total attendance of 127, 68 delegates responded to both the pre- and post-conference questionnaires. 

Demographics. Our survey captured responses from a diverse cohort of participants. Dental students formed the predominant group, representing 27 delegates (39.71%) of respondents, followed by qualified dentists representing 15 delegates (22.06%), and medical students making up 11 of the delegates (16.18%) (Table 1). Of these participants, 86.76 percent either strongly agreed or agreed that they intended to pursue a career in non-surgical facial aesthetics before the conference. 

Before the conference, a significant 38 delegates (57.35%) indicated having no prior teaching or exposure to non-surgical facial aesthetics.

Within the scope of the survey, respondents were asked about their knowledge and familiarity with NSFA regulations and their consequential potential effects on their prospective professional careers. Twenty-seven out of the initial 68 participants (constituting 39.71% of the sample) either expressed agreement or strong agreement concerning their awareness of NSFA regulations before the conference. In the subsequent post-conference survey, this ratio witnessed a significant escalation, with 62 out of the same 68 delegates (equating to 91.18% of the cohort) reporting increased awareness of regulations (Figure 1).

Delegates were also asked whether they were aware of the training pathways required to pursue a career in NSFA. Only 26 delegates (38.24%) in the pre-conference survey agreed that they were aware of the next steps to progress through training in NSFA, which increased to 66 delegates (97.06%) in the post-conference survey (Figure 2).

Understanding of the potential complications of NSFA in practice was also examined in this survey; Before the conference, only 10 delegates (14.71%) strongly claimed awareness of the complications associated with both dermal fillers and botulinum toxin. In the post-conference survey, the overall degree of confidence increased once again throughout, with 63 delegates (92.65%) agreeing or strongly agreeing that they were aware of complications involved with delivering dermal fillers and 53 delegates (77.94%) for botulinum toxin (Figure 3).

In the context of specific knowledge evaluation, it was observed that 37 (54.41%) of participants correctly identified the active ingredient in the dermal filler JUVEDERM (Allergan Aesthetics) in the pre-conference survey. Following the conference, this percentage demonstrated a notable increase, reaching 55 delegates (80.88%) (Figure 4). Moreover, in the pre-conference survey, 53 delegates (77.94%) demonstrated the ability to state an appropriate complication associated with dermal filler procedures, and this proportion increased to 63 delegates (92.65%) after the conference.

The statistical significance and effect size of the impact of this conference are detailed in the Table 2.

Discussion

The study aimed to evaluate the impact of a national conference on NSFA on the knowledge and awareness of its attendees, The findings provided valuable insights into the effectiveness of such conferences in disseminating knowledge and enhancing awareness among participants.

A significant portion of respondents had no prior experience in NSFA, emphasising the limited availability of standardized educational resources in this field.⁶ This is concerning as it suggests that interested individuals lack sufficient opportunities for formal training and understanding of the training pathways required for safe practice. It also raises concerns about HCPs who may encounter complications from non-surgical aesthetic procedures in the public sector, even if they are not aesthetic practitioners themselves.

One key aspect examined in our study focused on participants’ knowledge of NSFA regulations. The landscape of NSFA regulations is evolving, and it’s crucial to stay informed about these changes. Current regulations still allow practitioners without certified clinical qualifications to perform procedures, and dermal fillers are not yet prescription-only.⁷ However, a proposed government plan is under review, where practitioners and their operating premises will need licenses to perform specific non-surgical cosmetic procedures.³ Licensing aims to establish consistent standards and protect individuals from physical, emotional, and psychological harm resulting from poorly executed procedures.

The initial pre-conference survey revealed that only a limited fraction of attendees were aware of the current regulations. However, post-conference results showed an increase in awareness. HCPs must be aware of providers delivering these procedures because, whether they actively practice in this field or not, they may encounter patients with complications in emergency healthcare settings. Without proper regulation, patients are left poorly informed and lack protection against unregulated suppliers and practitioners, leaving them vulnerable if complications arise. 

Without regulation, aesthetic providers, especially those without certified clinical backgrounds, may be unable to prescribe, provide treatment, or manage complications. Consequently, patients may turn to the National Health Service (NHS) when complications arise. This situation can pose complex ethical and resource challenges for the NHS when addressing the aftermath of such complications. The pre-conference survey found limited awareness, particularly regarding dermal fillers, but post-conference, there was a notable increase. This heightened awareness is essential for patient safety, considering potential side effects associated with treatments like botulinum toxins, including erythema, oedema, pain, ptosis of the eyelid or brow, and ecchymosis. One study, focusing on reported complications of aesthetic botulinum toxin A (BoNT-A) treatments in the UK, suggested that the Medicines and Healthcare Products Regulatory Agency (MHRA) may underestimate the adverse events associated with BoNT-A treatment.⁸ A case study from Chelsea and Westminster Hospital further illustrated the dangers of unregulated practices, demonstrating the ease of patients accessing “dermal fillers” online and self-injecting, emphasizing the need for robust regulations.⁹ Beyond the United States, the industry producing tools and applications for “non-surgical” aesthetic procedures lacks adequate regulation, with approval often relying solely on CE certification. A survey among UK plastic surgeons by the British Association of Aesthetic Plastic Surgeons found that approximately 40 percent of surgeons were encountering 1 to 3 patients per year with permanent filler complications,¹⁰ underscoring the need for increased regulation and awareness.

Furthermore, this study revealed that the current understanding of training pathways in NSFA remains limited, lacking formal curriculum-based teaching and standardized training for undergraduate students. Unlike other public-sector-based specialities, there is no formal curriculum-based teaching available. Similarly, there is a lack of standardized, formal training for undergraduate students seeking to advance in NSFA. Individuals interested in NSFA can often enroll in unregulated courses as short as one day. Despite ‘Guidance for Doctors Who Offer Cosmetic Interventions, GMC, 2016’ emphasizing the importance of safety through training and supervised practice before independently performing interventions, insurance companies often accept one-day course certificates as sufficient evidence for independent practice.¹¹ A prior study surveying final-year medical students pursuing NSFA careers revealed that the majority believed that completing an accredited teaching course was enough for delivering non-surgical rhinoplasty, Botox injections, and dermal fillers.¹² However, the lack of regulation means there is no clear definition for an “accredited teaching course,” leading to variations in length, content, and cost. Therefore, it is essential to educate students about suitable options to prioritize patient safety as they embark on their careers.

The significant increase in awareness of training pathways in non-surgical aesthetics observed after the conference underscores the conference’s role in clarifying the educational and training requirements for those interested in NSFA. This positive shift holds promise for enhancing the professionalism and competence of future practitioners in this field.

Limitations. The limitations of this study include potential response bias within our cohort, as conference attendees were likely predominantly interested in aesthetics and may have possessed prior knowledge about topics like complications and regulations before attending. Additionally, our sample size was relatively small and did not fully represent the desired cohort. Lastly, we did not conduct a comparison between conferences and other forms of education to determine which offered the most utility.

Future research endeavors should focus on assessing the effectiveness and impact of conferences like the one studied here. This includes evaluating the value these conferences bring to participants, potentially through post-conference follow-ups to trace their educational and career pathways. Furthermore, conducting repeat conferences can help gauge sustained engagement and interest in these educational events over time. Additionally, it would be beneficial for future studies to delve deeper into understanding the substantial interest in NSFA among healthcare students, as existing literature indicates that this is an underexplored area. Investigating the utility of conferences as valuable networking tools within the NSFA community is another avenue worth exploring to provide a comprehensive assessment of their benefits.

Conclusion

This study highlights the beneficial role of national conferences in NSFA education. The improvements in knowledge and awareness underscore the potential of such events to bridge educational gaps and raise practice standards. As NSFA’s popularity continues to grow in healthcare, conferences play a significant role in educating future practitioners.

References 

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