News & Blog
07/05/2025 • by The RAM Institute
The UK and Ireland Aesthetics Research Collaborative (ARC):
A Multi-Centre Observational Study of Practitioner Demographics, Complication Rates, and Treatment Trends in Aesthetic Medicine
McCabe-Robinson O¹, Monteith-Ross K2, Haworth N², on behalf of the UK and Ireland Aesthetics Research Collaborative (ARC)
¹Etherow Health, Glossop, UK, ²The Clinic by La Ross, Kent, UK, ³The Doctor & Company, Whalley,UK
Abstract
Background
Aesthetic medicine is expanding rapidly across the UK and Ireland. Despite this growth, large-scale real-world data describing practitioner demographics, complication rates and emerging treatment trends remain scarce. Much of the existing evidence base is derived from single centre studies or industry sponsored research, which may not accurately represent routine clinical practice.
Objectives
This study aimed to characterise the professional background and working patterns of aesthetic practitioners, to evaluate self-reported incidence of vascular occlusion and delayed onset nodules and to describe emerging trends in regenerative and biostimulatory treatment demand.
Methods
A multi-centre observational survey was distributed electronically to aesthetic clinics across the UK and Ireland. A standardised questionnaire captured data on practitioner demographics, clinic structure, complication experience, emergency preparedness, referral patterns, treatment trends and outcome data collection practices. Responses were anonymised prior to descriptive analysis.
Results
One hundred and seventy-three medical practitioners responded. Doctors comprised 32.9% of respondents (n=57), and independent nurse prescribers comprised 31.5% (n=54). Solo clinic working predominated at 58.9%. Vascular occlusion events were infrequently reported: 79.4% of respondents reported no events in 2023/2024 and 85.3% reported no events in 2024/2025. Emergency preparedness was high, with 97.1% stocking hyaluronidase and 94.1% operating under a defined complication protocol. Demand for regenerative treatments was reported to have increased by 96.9% of respondents. Polynucleotides were identified as highly requested by 100% of respondents within this group. In spite of this treatment evolution, only 13.3% of clinics collected standardised outcome measures.
Conclusion
This study identifies low self-reported complication rates alongside high filler emergency preparedness within UK and Ireland aesthetic practice. A pronounced shift toward regenerative medicine is underway. The near absence of standardised outcome data collection represents a critical evidence gap that collaborative research infrastructure is well placed to address.
Introduction
Aesthetic medicine in the UK and Ireland has undergone substantial change over the past decade. The range of available treatment modalities has expanded considerably, with growing patient demand for regenerative and biostimulatory interventions alongside established injectable and energy-based approaches. Despite this expansion, the evidence base informing everyday clinical practice remains limited. The preponderance of existing literature originates from single centre case series or manufacturer sponsored studies, neither of which may accurately reflect the diversity of real-world practice across independent aesthetic clinics.
A particular deficit exists in multisite practitioner level data. Information describing the professional composition of the aesthetic workforce, real world complication rates normalised to treatment volumes, and objective trends in treatment demand is largely absent from peer reviewed literature. This gap limits the capacity for meaningful benchmarking, informed regulatory development and evidence-based guideline creation.
The UK and Ireland Aesthetics Research Collaborative (ARC) was established with the explicit objective of addressing this structural deficit through coordinated multicentre data collection. This paper reports the initial findings of ARC’s inaugural observational study, providing a cross-sectional snapshot of practitioner demographics, complication experience, emergency preparedness and treatment trends across participating clinics.
Methods
Study design
This was a multicentre observational survey study. A standardised electronic questionnaire was distributed to aesthetic practitioners across the UK and Ireland via surveying software. Participation was voluntary and responses were fully anonymised prior to analysis. No interventional procedures were performed and no patient identifiable data were collected.
Questionnaire structure
The questionnaire was structured to capture the following domains: practitioner professional background and qualification type; practice setting and working patterns; patient age demographics; incidence of vascular occlusion and delayed onset nodules across two discrete reporting periods (2023/2024 and 2024/2025); complication preparedness and referral behaviour; trends in regenerative and biostimulatory treatment demand; factors influencing brand selection; and use of standardised patient reported outcome measures.
Data analysis
Data were analysed descriptively. Frequencies and percentages were calculated for all categorical variables. No inferential statistical testing was performed at this stage of analysis. Where response rates varied between questionnaire sections, the relevant denominators are reported alongside the corresponding percentages.
Results
Practitioner and practice characteristics
A total of 173 practitioners completed the survey. The professional backgrounds of respondents are summarised in Table 1. Doctors formed the largest single group at 32.9% (n=57), followed closely by independent nurse prescribers at 31.5% (n=54). Non-prescribing nurses represented 11.0% (n=19) and dentists 12.3% (n=21). Pharmacists accounted for 2.7% (n=5) and all remaining professional groups were captured within an “other” category at 9.6% (n=17).
Professional Background | n | Percentage |
Doctors | 57 | 32.9% |
Independent Nurse Prescribers | 54 | 31.5% |
Dentists | 21 | 12.3% |
Non-Prescribing Nurses | 19 | 11.0% |
Other | 17 | 9.6% |
Pharmacists | 5 | 2.7% |
Total | 173 | 100% |
Table 1. Professional background of survey respondents (n=173).
With respect to practice setting, solo clinics were most prevalent at 58.9% of respondents, followed by home clinics at 17.8% and group clinics at 16.4%. A near equal split was observed between full time aesthetic practice (46.6%) and part time practice (53.4%). The most commonly treated patient age groups were 35 to 44 years (65.7% of respondents) and 45 to 54 years (60.0% of respondents).
Vascular Occlusion: Reported Incidence
Vascular occlusion data were reported across two time periods. Table 2 presents the frequency distribution for both years. In 2023/2024, 79.4% of respondents reported zero vascular occlusion events and 11.8% reported a single event. In 2024/2025, the proportion reporting zero events increased to 85.3%. Single event reports accounted for 8.8% of respondents in 2024/2025.
Notably, 2.9% of respondents in 2024/2025 reported more than ten vascular occlusion events within the reporting period. This figure, came with addition information – that these occlusions were referred into clinic by other injectors.
Reported Events | 2023/2024 (%) | 2024/2025 (%) |
No events | 79.4% | 85.3% |
One event | 11.8% | 8.8% |
More than ten events | Not reported | 2.9% |
Table 2. Self-reported vascular occlusion events by reporting period.
Delayed Onset Nodules: Reported Incidence
Delayed onset nodules were similarly infrequent. In 2023/2024, 73.5% of respondents reported
no cases. In 2024/2025, this increased to 76.5%. The progressive reduction across both complication categories from one reporting period to the next may reflect genuine improvement in practice but may equally reflect underreporting or reduced treatment volume. Without denominator data referenced to treatment numbers this comparison remains descriptive.
Emergency Preparedness
Emergency preparedness indicators were reported, with 97.1% of respondents stocking hyaluronidase on site. Of these, 47.1% held more than ten 1500 IU vials in stock at any given time. A defined complication management protocol was in use by 94.1% of respondents. Referral to secondary care or emergency departments had occurred in 14.7% of responding clinics within the preceding two years. The complete preparedness data are presented in Table 3.
Preparedness Indicator | Respondents (%) |
Hyaluronidase stocked on site | 97.1% |
More than ten 1500 IU vials held in stock | 47.1% |
Defined complication protocol in use | 94.1% |
Referral to secondary care in preceding two years | 14.7% |
Table 3. Emergency preparedness indicators (subset, n=173).
Regenerative and Biostimulatory Treatment Trends
Demand trends in regenerative medicine were captured within the respondents. An increase in patient demand for regenerative and biostimulatory treatments was reported by 96.9% of this group. Polynucleotides were identified as highly requested by all respondents (100%), representing universal demand recognition within this cohort. Biostimulators were reported as highly requested by 46.9% of respondents and exosomes by 40.6%. Energy-based devices were noted by 28.1%. The treatment demand distribution is shown in Table 4.
Treatment Category |
Reported as Highly Requested (%) |
Polynucleotides | 100.0% |
Biostimulators | 46.9% |
Exosomes | 40.6% |
Energy-based devices | 28.1% |
Table 4. Practitioner reported demand for regenerative and biostimulatory treatments (subset, n=173).
Brand Selection Influences
Respondents within the treatment trends subset were asked to identify factors influencing their brand selection decisions. Clinical efficacy was the most frequently cited factor at 93.8%, followed by safety profile at 90.6% and availability of robust research data at 78.1%. Marketing considerations and patient preference were both reported by 18.8% of respondents. These
findings suggest that this cohort prioritises evidence-based criteria over commercial or patient preference drivers when making product selection decisions.
Outcome Measurement Practices
Despite the complexity of treatments being offered and the reported shift toward regenerative approaches, only 13.3% of clinics reported routinely collecting standardised outcome measures.
Validated instruments cited included the Global Aesthetic Improvement Scale and FACE-Q. The large majority of respondents (86.7%) did not use any standardised outcome tool, representing a significant gap in objective clinical data generation within routine aesthetic practice.
Discussion
This multicentre survey provides an early empirical characterisation of aesthetic practice across the UK and Ireland, drawing on self-reported data from 173 practitioners across a range of clinical backgrounds and practice settings. The findings are discussed below against their key domains.
Workforce composition
The near equal distribution between doctors (32.9%) and independent nurse prescribers (31.5%) reflects the pluralistic and largely unregulated nature of the UK aesthetic workforce. Dentists (12.3%) and non-prescribing nurses (11.0%) together represent a further substantial proportion of practitioners.
The significance of non-prescribing nurses in the workforce deserves specific attention: this group cannot independently prescribe prescription-only medicines including botulinum toxin and emergency medications such has hyaluronidase and must work alongside a prescriber. The extent to which robust prescribing governance is in place across these arrangements is not captured by the current dataset and represents an area meriting further investigation.
The predominance of solo clinic working (58.9%) has implications for peer oversight, continuing professional development access and the capacity to implement consistent complication management protocols. Solo working reduces the availability of second opinion in complex clinical scenarios and may increase the isolation of practitioners from broader quality governance structures.
Complication rates and preparedness
The self-reported rates of vascular occlusion are low. A reduction was observed between reporting periods, with the proportion reporting no events rising from 79.4% in 2023/2024 to 85.3% in 2024/2025. This trend is broadly consistent with a growing awareness of injection safety technique and the wider availability of hyaluronidase complication / dermal filler reversal training across the sector.
The preparedness data are reassuring in aggregate. Stocking of hyaluronidase was reported by 97.1% of respondents and the adoption of defined complication protocols by 94.1%. These figures compare favourably to earlier survey data from the UK aesthetic sector and suggest meaningful improvement in emergency readiness. The Health Education England guidance and recommendations from the Joint Council for Cosmetic Practitioners (JCCP) have
advocated consistently for mandatory emergency kit requirements and these data appear to reflect some degree of uptake.
The outlier finding of one respondent reporting more than ten vascular occlusion events in 2024/2025 merits comment. This figure represents a single high volume practitioner working as a referral site for complication management.
Secondary care referral having occurred in 14.7% of clinics over a two-year period indicates that complications of sufficient severity to require escalation are not rare events within this cohort. This underscores the importance of established referral pathways and sustained engagement with secondary care colleagues, particularly vascular surgery and ophthalmology.
Regenerative treatment trends
The reported increase in demand for regenerative and biostimulatory treatments by 96.9% of the treatment trends subset reflects a broader observable shift in aesthetic medicine philosophy. Polynucleotide injectables have seen rapid commercial expansion in the UK market over the preceding three years and their recognition as highly requested by all respondents in this subgroup is consistent with this trajectory.
The emergence of exosomes as a highly requested treatment category (40.6%) is notable given the current regulatory ambiguity surrounding these products in the UK. The Medicines and Healthcare products Regulatory Agency (MHRA) has not yet issued definitive classification guidance for exosome-based aesthetic products. Practitioners identifying patient demand for exosomes should be aware of the evolving regulatory landscape and the limited peer-reviewed clinical trial data available to support their use in aesthetic indications at this time.
Brand selection being driven primarily by clinical efficacy (93.8%) and safety profile (90.6%) rather than marketing (18.8%) is an encouraging finding. It suggests that product adoption decisions are grounded in evidence appraisal. The weight given to availability of robust research data (78.1%) further supports this interpretation. Whether this translates to systematic critical appraisal in practice or reflects a socially desirable response pattern cannot be determined from survey data alone.
Outcome measurement: a critical gap
The most significant concern arising from this dataset is the low rate of standardised outcome data collection. With only 13.3% of clinics using validated instruments such as GAIS or FACE-Q, the aesthetic sector in the UK and Ireland is operating largely without the infrastructure necessary to generate meaningful efficacy and safety evidence in routine practice. This is not a peripheral issue. The absence of patient-reported outcome data at the clinical level severely limits the capacity for the field to self regulate, demonstrate value to commissioners or develop evidence-based treatment guidelines.
The rapid adoption of regenerative treatments documented in this survey sits in direct tension with this outcome data deficit. New treatment modalities are being absorbed into practice at scale without the systematic collection of data that would allow practitioners or regulatory bodies to assess their real-world effects. This represents a structural vulnerability in the sector that collaborative research infrastructure is well positioned to address.
Limitations
Several limitations of this study require explicit acknowledgement.First, all data are self-reported and subject to recall bias, reporting software limitations and social desirability effects. Complication rates in particular may be underestimated if practitioners are disinclined to report adverse events. Second, complication incidence was not normalised to treatment volume. Without denominator data, the absolute significance of reported rates cannot be determined and
comparison between respondents or against published benchmarks is not possible.
Third, the sampling methodology is not described in sufficient detail to assess representativeness. It is not known whether the 173 respondents accurately reflect the broader UK and Ireland aesthetic practitioner population with respect to geography, seniority, treatment volume or practice model.
Conclusion
The UK and Ireland Aesthetics Research Collaborative (ARC) has demonstrated both the feasibility and the value of structured multicentre data collection in aesthetic medicine. This inaugural dataset establishes a quantitative baseline for practitioner demographics, complication preparedness and treatment trends across the sector.
The key findings are that vascular occlusion events are infrequently self-reported with rates improving between the two documented periods. Emergency preparedness is high within the respondent cohort. There is a pronounced and near universal shift toward regenerative treatment demand. The critical outstanding issue is that standardised outcome measurement is adopted by fewer than one in seven clinics despite this expanding treatment complexity.
Addressing the outcome data deficit must be a priority for future collaborative activity. Without systematic collection of patient-reported and clinician-assessed outcomes, the field will continue to operate without the evidence base required to support confident claims about treatment efficacy or safety at population level. ARC is well placed to lead this work and subsequent iterations of this study should incorporate volume normalised complication data and validated outcome instruments as core data collection requirements.
Declarations
Conflicts of interest: None
Funding: No external funding was received for this study.
Ethics: This study involved voluntary anonymous survey data from healthcare practitioners and did not involve patient data or clinical intervention. Formal ethics committee review was not required under applicable guidelines.
Dr Olivia McCabe-Robinson is known for her academic excellence, surgical background, and commitment to ethical, patient-focused care. After graduating in 2016, she pursued surgery, achieving her MRCS with the Royal College of Surgeons of Edinburgh. She is a PhD candidate in advanced materials and tissue engineering at the University of Manchester, supporting her evidence-based approach. A Key Opinion Leader, trainer, and international speaker, Dr Olivia contributes widely to the industry and received multiple awards recognising her expertise and innovation.
Kate Monteith-Ross is an experienced nurse practitioner, specialist in wound care and independent prescriber. She is the owner of The Clinic by La Ross, an award winning, CQC registered clinic in the south of England, specialising in bringing a wide range of aesthetic treatments, energy based devices and medical services supporting her patients with a global approach. Kate is an international key opinion leader for Dermalux, Neogen and Jalupro and is the Director of The Clinic, Urban Training Academy, The Patient Recovery Network and co-founder and director of The Nurses Network and The Aesthetic Pages.
Kate is a dedicated teacher and has written many case studies and papers on the subject of complication mitigation, surgical care, infection control, regenerative medicine and combination therapies and has been honored to present these topics globally: Turkey, Spain, Greece, Asia, UAE, Italy and is working hard to raise the international profile of the nursing community. Kate had been featured in national press for her work with botched surgery patients and has been featured in Vogue and Platinum magazine.
Dr Natalie Haworth (MBChB), qualified as a medical doctor at the University of Manchester before specialising in aesthetic medicine. She is currently completing a Master’s degree in Skin Ageing and Aesthetic Medicine, ensuring her approach remains at the cutting edge of science, research, and innovation.
Alongside her clinical work, she is a nationally recognised advocate for aesthetic regulation and patient safety, having contributed to parliamentary discussions on the risks of poorly regulated treatments.
“The UK aesthetic sector is largely safe and well-prepared for emergencies, with most practitioners stocking hyaluronidase and having protocols in place. Serious complications like vascular occlusion are uncommon and appear to be getting rarer.
The workforce is diverse – doctors and nurse prescribers in roughly equal numbers – and most work alone, which carries some risk from a governance and oversight perspective.
Regenerative treatments, particularly polynucleotides, have essentially taken over as the dominant patient demand. Almost every practitioner surveyed is seeing this shift.
Despite all this progress and complexity, fewer than 1 in 7 clinics actually measures outcomes in any standardised way. That means the sector is expanding rapidly with very little hard evidence about whether treatments are working or how patients are faring long-term. That’s the central problem the paper is raising.”
Dr Lee Walker, Scientific Committee member
