Crackdown on cosmetic cowboys will require underwriting and risk cover to ‘evolve’

In August 2025, the UK government announced it was finally cracking down on so-called cowboy cosmetic procedures – high-risk treatments such as breast or even genital fillers that have left patients in need of urgent medical care.

The aesthetics industry has long been self-regulated, with horror stories of botched cosmetic procedures capturing headlines in the media and leaving an influx of medical negligence claims in their wake.

Poorly executed cosmetic procedures, such as non-surgical Brazilian butt lifts, where dermal filler is injected into the buttocks to increase size, have been recorded to lead to adverse effects like filler migrations, infections, disfigurations and, in some rare cases, death.

Unsafe procedures have also taken place in unsafe environments – including homes, hotel rooms and pop-up clinics.

And, as calls for reform to this Wild West grew, the Department of Health and Social Care introduced a series of measures to provide much-needed regulation for the aesthetics market.

Crucially, this new mandate includes a requirement that practitioners must purchase indemnity insurance, as well as rules that only qualified and specialised healthcare professionals registered with the Care Quality Commission (CQC) would be authorised to perform high-risk or ‘red category’ procedures.

Additionally, lower risk procedures still deemed dangerous, such as Botox, lip fillers and facial dermal fillers, will now also come under stricter oversight via local authority licensing systems, with practitioners required to meet strict safety and training before operating legally. 

According to Save Face, the register of accredited practitioners, almost 3,000 complaints were received in 2022, with over two-thirds of those relating to dermal fillers and nearly a quarter relating to Botox.

For broker Hamilton Fraser’s chief executive Eddie Hooker, the proposed licensing regime “should help bring much-needed clarity to a sector that has, until now, operated across a broad spectrum of risk”.

However, Hooker noted that this shift has significant implications for brokers, especially since parts of the sector have historically lacked consistency around how risk is presented, assessed and managed.

He continued: “As licensing and inspection regimes develop, clinics and practitioners are also likely to encounter new and emerging exposures.

“These may include the risk of non‑compliance with licence conditions, the use of inadequately trained staff, procedures being carried out in unsuitable environments or shortcomings in areas such as record‑keeping consent and safeguarding.

”Brokers will play a key role in helping clients understand where these risks sit and how they can be managed.”

Evolving risk

The proposed shift from an unregulated Wild West system to one that structured around regulators and requirements will “pose hurdles” for current aesthetics providers.

That was according to Jonathon Enston, partner and specialist in business crime and regulation at JMW Solicitors, who told Insurance Times that the government’s proposed tiered system “will help to mitigate risk”.

With each tier categorising a different risk, Enston explained that clinics will have to ensure that they are only advertising procedures that are within the remit of their tier.

He added that clinics will also have to ensure that all practitioners possess up-to-date licences that are within the government requirements, including holding indemnity insurance within their own practice area.

This also addresses a “key challenge” for UK insurers when assessing clinical negligence claims, in terms of defining whether a practitioner fell below the expected standard of care and that this directly caused harm, he continued.

The introduction of a regulated system, he added, will help to “determine the level of care” that is expected in individual instances of negligence and eventually “standardise” expectations.

When incidents do occur, Hooker noted that claims may extend beyond physical injury to include psychological harm, loss of earnings and legal costs, which can influence insurer appetite, pricing, capacity and minimum indemnity expectations – particularly for higher‑risk procedures.

As a result, he stressed that “insurance arrangements themselves may need to evolve”.

This includes reviewing malpractice limits, checking that premises and public liability cover remain appropriate and confirming that governance, supervision and training arrangements are robust enough to support the risk being presented.

He continued: “More broadly, stronger regulatory standards, better training and clearer operating frameworks should help reduce incidents and improve outcomes when claims do arise.

“For brokers, the focus will increasingly be on supporting clients through regulatory change, identifying gaps in risk management and ensuring insurance programmes remain fit for purpose in a more tightly controlled market.”

Worth the red tape?

The government’s decision to impose stringent regulations with criminal sanctions, however, is also likely to take a toll on which treatments clinics can afford to carry out.

Bethan Parry, healthcare partner at law firm Browne Jacobson, noted that some providers may consider that it is “not worth the red tape” to offer all types of treatment and may limit their practice to the tiers with the lowest risk.

She explained that this will be influenced by “additional red tape”, with expectations of rising costs and the requirement to have the appropriate indemnity insurance in place.

Commercial broker Miller and Partner’s director John Miller agreed, adding that he expects premiums to increase to mitigate the impact of tighter regulations.

The issue for clinics and the insurance market is that most aesthetic practitioners are not medically qualified, he explained.

Most of the business his firm covers are newly formed businesses, which can be “tricky to place for any normal industry” without such strict regulations.

Indeed, an analysis of the UK’s cosmetic injectables industry by UCL researchers, published in July 2023, revealed that 68% of cosmetic practitioners administering injections were not medical doctors.

Speaking to Insurance Times, Dianne Lewis, head of healthcare, beauty and wellbeing at Hiscox UK, explained that the industry may see “a temporary contraction in the number of practitioners able to comply immediately”.

She clarified that this would not be expected to be permanent as it is likely that there will be a “transitional period” to allow practitioners time to meet new requirements.

In the longer term, she predicted capacity to stabilise as the market adjusts and practitioners are supported to be upskilled in line with the required qualifications.

With insurer focus on higher underwriting standards and tighter risk management, Diane Caplehorn, head of partnerships at Everywhen, expected that there would be greater vetting of practitioner qualifications.

She explained that it was also part of the broker’s role to encourage practitioners to maintain strict audit records focusing on mandatory face-to-face consultations, as well as obtaining informed consent for every treatment.

Lewis added: “As long as practitioners are willing and able to meet the new standards, we do not envisage them becoming harder to place.

“The focus is less on excluding practitioners and more on ensuring appropriate training and competence for the procedures being offered.”

‘Tightening’ market

Miller told Insurance Times that he had already seen the insurance market “tightening” for high-risk policies.

While insurers currently operating in the space are not leaving altogether, he noted that they were “definitely being more selective in their criteria”.

He added that there are “definitely less MGAs operating in this space than there used to be, but there will always be the main players to reach out to”.

For Miller, “staying close to specialist insurers” and “monitoring regulatory developments” will be key to protecting client insurability.

In turn, Parry added that, because there will be greater regulation, insurance should be “more readily available” and may well be “more cost effective” because of the reassurance of the framework.

Lewis concluded: “The industry has been calling for regulatory reform for many years, particularly to address inconsistencies in standards and oversight.

“Over time, this should help improve standards, provide greater clarity around who can carry out higher‑risk procedures – and ultimately enhance patient safety, which benefits practitioners, insurers and, most importantly, end customers.”