Cosmetic Treatments

The term cosmetic treatments covers a wide range of activities and procedures. It is generally taken to mean any procedure which is designed to change the appearance, colour, texture or structure of bodily features. Cosmetic treatments include so called ‘beauty treatments’ undertaken purely as enhancements to an individual’s appearance, and also remedial and camouflage treatments following surgical procedures or major trauma.

Nearly all cosmetic treatments can be performed safely and hygienically but where this does not happen action needs to be taken to protect the public.

In England and Wales there is a range of legislation available to deal with these procedures. Some of this is specific to particular procedures, for example the Local Government Miscellaneous Provisions Act 1982  which covers certain types of skin piercing procedures or, in London, the London Local Authorities Act 1991 which applies to businesses carrying out procedures known as special treatments. Other legislation such as the Health and Safety at Work Act 1974 or the Health Protection Regulations 2010 has a more general application.

Over the past 20 or so years the range of novel treatments has increased significantly and now includes many highly invasive procedures which might more appropriately be described as medical, dental and even surgical procedures although they have no therapeutic purpose.

Some of these pose potential serious risks to the health of those who choose to undergo them. In some cases these treatments may also pose risks to those who undertake them, as well as risks of permanent disfigurement or even disablement if carried out incorrectly or in an unhygienic manner.

There are areas of practice where the application and enforcement of any law is uncertain or absent. The CIEH is campaigning for all cosmetic treatments to be appropriately regulated to protect the health of the public. We believe the regulatory controls should include:

  • Identifying who may lawfully administer the procedure
  • Specifying the training that person should have
  • The conditions in which the procedure should be carried out
  • The safeguards and restrictions that need to be in place, and
  • The information and advice that must be given to the participant.

In the absence of comprehensive legislation and guidance, we are working with health protection and other experts to produce a series of Health Protection Advice Bulletins (see below) to assist local authorities in controlling those treatments for which there is uncertainty over the appropriate legal controls.

▼ Health Protection Advice Bulletins 

These bulletins have been produced by the CIEH, in conjunction with health protection and other experts to assist local authorities in controlling certain types of cosmetic treatment.

2013 - No. 3 Adobe PDF iconMarketing authorisation for medicinal products  October 2013
2013 - No. 2 Adobe PDF icon Application of Leeches  October 2013
2013 - No. 1 Adobe PDF iconDerma roller products  October 2013
▼ Skin piercing 

Current controls on skin piercing

Under the Local Government (Miscellaneous Provisions) Act 19821, as amended, local authorities in England and Wales are responsible for regulating and monitoring businesses offering the following services:

  • Acupuncture
  • Ear-piercing
  • Electrolysis
  • Tattooing
  • Cosmetic piercing
  • Semi-permanent skin colouring

All of these procedures involve some degree of skin piercing and therefore carry potential health risks to those undergoing them. These can include

  • Skin infections
  • Allergic or toxic reactions to the substances used
  • The transmission of blood borne viruses such as hepatitis or HIV

Businesses wanting to offer these services must register with their local authority. Both the person undertaking the activity and the premises must be registered. It is a criminal offence to trade without registration or to be in breach of the relevant byelaws. Model byelaws which local authorities can adopt have been developed by the Department of Health.

In dealing with businesses offering the above procedures, local authorities can also use enforcement powers under the Health and Safety at Work etc Act 1974.

Additional legislation, the Tattooing of Minors Act 1969, makes it an offence to permanently tattoo persons under the age of 18. No such statutory restrictions apply to cosmetic piercing or skin colouring.

The CIEH believes that there should be minimum ages of consent for all forms of skin piercing.


At present there are no nationally approved training courses available for UK body piercers, although a number of commercially run courses are available. The CIEH would like to see approved training courses become developed for all skin piercing practitioners and for such courses to be made compulsory for all new practitioners. Practitioners should also be required to demonstrate continuing competence in their work activities. The HSE recommends that basic first aid training and infection control guidance be provided as part of any cosmetic piercing training course.

Review of the Regulation of Cosmetic Interventions  

Guidance and advice

The best place to start if you are looking for information and guidance on skin piercing is your local council website. Many councils offer advice and information to both businesses and to members of the public.

Following concerns raised by tattoo and body piercing practitioners, as well as health protection and environmental health specialists, about the lack of robust and consistent guidance on standards of hygiene and safety in the industry, the CIEH convened a multi-agency steering group working group to develop guidance. Comprising representatives from the CIEH, the Health and Safety Laboratory, Public Health England (formerly Health Protection Agency), the Tattoo and Piercing Industry Union and also individuals with practical experience of working in this area, the Group produced the following guidance in July 2013.

Adobe PDF icon Tattooing and body piercing guidance: Toolkit  

Tattoo Hygiene Rating Scheme (THRS) 

The Tattoo Hygiene Rating Scheme which has recently been piloted in Wales and is now being taken up by local authorities around the country is designed to drive up standards in tattoo studios by advising members of the public through a rating scheme rising from 1 to 4 the standard of hygiene and safety practices in the studio. It follows research showing that 93% of customers considering having a tattoo would be influenced by a rating scheme and 80% of tattoo studio operators interviewed considered it would be good for businesses. You can follow the progress of the scheme on its twitter account - @TattooHygiene. 

'Before you Ink Think’ 

To assist those thinking of having a tattoo, Cardiff Council’s Communicable Disease team has produced a DVD called 'Before you Ink Think.' The DVD, which is sponsored by CIEH Wales, lasts about 15 minutes and highlights all those things that potential purchasers of tattoos should consider before they take the plunge. The DVD, which costs £8.00, can be obtained from CIEH Wales. 

1 Local authorities in London have additional powers to control skin piercing activities under the London Local Authorities Act 1991 and the Greater London Council (General Powers) Act 1981. 

▼ Review of the Regulation of Cosmetic Interventions 

In August 2012 the Department of Health launched a Review of the Regulation of Cosmetic Interventions, carried out by Professor Sir Bruce Keogh, NHS Medical Director.

A call for evidence was issued seeking views on the following:

  • the regulation and safety of products used in cosmetic interventions
  • how best to ensure that the people who carry out procedures have the necessary skills and qualifications
  • how to ensure that organisations have the systems in place to look after their patients both during their treatment and afterwards
  • how to ensure that people considering cosmetic surgery and procedures are given the information, advice and time for reflection to make an informed choice
  • what improvements are needed in dealing with complaints so they are listened to and acted upon

The CIEH made a detailed submission to the review, supported by extensive published literature and evidence from CIEH members working with regulatory controls. Our submission outlined our concerns over the regulation of the cosmetic interventions sector and emphasised the need for the inclusion of tattooing and body piercing in the Government’s Review.

The final report of the Keogh review was published in April 2013 and in February 2014 the Government published its response. The CIEH was disappointed to see that the review would not be widened to include tattooing and body piercing as we had recommended.

At a meeting of the Associate Parliamentary Group for Environmental Health on 4th March 2014 we made a presentation and circulated a briefing paper outlining professional and public concerns over the public health risks of tattooing and body piercing.

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