Abstract
BACKGROUND: Given rising demand for botulinum toxin (BoNT) treatments and limited data on safety, ethics, and regulation, a national survey explored experiences with cosmetic BoNT in the United Kingdom. OBJECTIVES: To conduct a national observational survey with the aim to capture real-world experiences of cosmetic BoNT in the United Kingdom. METHODS: A cross-sectional online survey gathered data on experiences with cosmetic BoNT injections across the United Kingdom. Participation was open to adults (≥18 years) who had received cosmetic BoNT treatment. RESULTS: A total of 919 participants completed the survey and were predominantly female, white, and had a high household income. Commonly reported acute complications were bruising/swelling (26.1%), and headache (24.7%). Commonly reported long-term complications were BoNT resistance (2.9%), social withdrawal (2.7%), nerve damage (2.5%), and dry eyes/vision problems (2.5%). In total, 66% stated their treatment was administered by a prescriber, 28% said it was not. Among those treated by a non-prescriber, 40% reported that a prescriber was present during the consultation, 42% said no prescriber was present, and 17% were unsure. Surprisingly, a few had not signed a consent form (8%), 11% were not informed of treatment risks, and 18% were not told how to respond to complications. A large majority expressed support for enhanced oversight, with 57.8% favoring significantly stricter regulation, and 31.3% somewhat stricter regulation. CONCLUSIONS: Cosmetic BoNT can offer high satisfaction and a favorable safety profile when administered appropriately. However, findings highlight key vulnerabilities: inconsistent practitioner qualifications, gaps in informed consent, insufficient complication support, and weak regulation.