Botox and cosmetic fillers

This guidance is for England

In order to safeguard children from potential health risks, the Botulinum Toxin and Cosmetic Fillers (Children) Act 2021 has been introduced to prohibit persons and business owners from administering botulinum toxins (generally referred to as Botox) and cosmetic fillers to children under the age of 18. The Act only applies to England.

Business owners are also prohibited from making arrangements to administer, or arranging for another person to administer, botulinum toxins and cosmetic fillers to children under the age of 18.

If you are a business owner, you should have effective systems in place to avoid committing an offence under the Act.

The law

If you are a person who administers botulinum toxin and cosmetic filler, or if you own a business offering services to administer these products, the Botulinum Toxin and Cosmetic Fillers (Children) Act 2021 applies to you.

As a business owner, you must ensure that a person working in the business (other than an 'approved person' - see below) does not administer either of the following to a child under the age of 18:

• botulinum toxin
• cosmetic filler

A filler is a subcutaneous, submucous or intradermal injection of a filler for a cosmetic purpose (whether or not it was designed to be so used) where the likely effect of the injection is, or would be, to alter the appearance of the person injected.

You must also ensure that you, or anyone acting on your behalf (such as an employee), do not make arrangements to administer these products to a child under the age of 18. Agreeing to perform a procedure on someone underage, making an appointment and confirming the appointment can be considered to be 'making arrangements'.

This is because you commit an offence if a person (other than an 'approved person') administers one of these products or if you, or anyone acting on your behalf, makes arrangements to administer one of these products to a child under the age of 18.

A registered medical practitioner (a doctor) is an 'approved person'. A regulated health professional (a nurse, dentist and pharmacist) is also an 'approved person' when acting under the direction of a registered medical practitioner.

Defences

If you, as a business owner, are charged with an offence, you have the 'due diligence' defence available to you. This means that you need to prove that you took all reasonable precautions and exercised all due diligence to avoid committing the offence.

A person charged with an offence of administering one of the products has a defence that they were either a registered medical practitioner or a regulated health professional (acting under direction) at the time of the offence, or that they had taken reasonable steps to establish the person's age and reasonably believed that the person was 18 or over.

Keeping within the law

As a business owner, in order to keep within the law and therefore satisfy the legal 'due diligence' defence, you are advised to introduce an age verification policy and have effective systems to prevent the administering of (or making arrangements to administer) botulinum toxin or cosmetic filler to a child under the age of 18. To ensure these systems stay effective, they need to be regularly monitored and updated (where necessary) to identify and put right any problems or weaknesses, and to keep pace with any advances in technology.

Key best practice features of an effective system include the following.

Age verification checks

Always ask young people to produce proof of their age. The Chartered Trading Standards Institute, the Home Office and the National Police Chiefs' Council support the UK's national Proof of Age Standards Scheme (PASS), which includes a number of card issuers. You can be confident that a card issued under the scheme and bearing the PASS hologram is an acceptable proof of age.

A passport or a UK photocard driving licence is also acceptable, but make sure that the card matches the person using it and the date of birth shows they are 18 or over. Military identification cards can be used as proof of age, but (as with other forms of identification) make sure the photo matches the person presenting the card and check the date of birth. Be aware that military identification cards can be held by 16 and 17-year-old service people.

You do not have to accept all of the above forms of identification and it may be best to exclude any type of document that your staff are not familiar with.

Some young people may present false identification cards so it is advisable to also check the look and feel of a card. For example, the PASS hologram must be an integral part of a PASS card and not an add-on.

If the person cannot prove that they are at least the minimum legal age - or if you are in any doubt - do not make an appointment for a procedure.

Please see the Home Office False ID Guidance for more information.

Operate a Challenge 21 or Challenge 25 policy

This means that if the person appears to be under 21 or 25, they will be asked to verify that they are 18 or over by providing valid proof of age before making an appointment (whether online, by phone or face-to-face) and again before the procedure is actually carried out.

Staff training

Make sure your staff are properly trained. They need to know which procedures are age restricted and the action they must take if they believe a child under 18 is attempting to book an appointment. It is important that you can prove your staff have understood what is required of them under the legislation.

This can be done by keeping a record of the training and asking members of staff to sign to say that they have understood it. These records can then be checked and signed on a regular basis by management or the owner.

Maintain a refusals log

It is best practice to record all refusals (date, time, incident, description of potential buyer). Maintaining a refusals log will help to demonstrate that you actively refuse sales and have an effective system in place. It is advisable that the manager / owner checks the log to ensure that all members of staff are using it.

A specimen refusals log is attached.

Some tills have a refusals system built in. If you use a till-based system, ensure that refusals can be retrieved at a later date. Be aware that some refusals are made before a product is scanned.

Till prompts

If you possess an EPoS system, it may be possible to use it to remind staff of the age restriction via a prompt.

Signage

Display posters showing the age limit for these procedures and a statement regarding the refusal of appointments for them. This may deter potential purchasers and act as a reminder to staff.

Closed circuit television (CCTV)

A CCTV system may act as a deterrent and reduce the number of incidents of underage appointments.

Online appointments

If you take online appointments, you should set up an effective system capable of verifying the age of potential purchasers. Please see 'Online sales of age-restricted products' for more information.

Further information

The Department of Health and Social Care has produced guidance on how to comply with the law, which can be found on the GOV.UK website.

Visit the Advertising Standards Authority website for guidance on the marketing of surgical and non-surgical cosmetic procedures, which includes a prohibition on the advertising of cosmetic interventions aimed at children under the age of 18.

Trading Standards

For more information on the work of trading standards services - and the possible consequences of not abiding by the law - please see 'Trading Standards: powers, enforcement and penalties'.

In this update

Link added to ASA guidance.

Last reviewed / updated: November 2023