Anyone can currently inject Botox or dermal filler in England without a licence, without proof of training and without the premises being inspected. That gap has been debated since the Keogh Review in 2013, and it is now, finally, being closed. On 7 August 2025 the Government published its response to a 2023 consultation and confirmed it will bring non-surgical cosmetic procedures under a tiered licensing scheme for the first time.
In short: Section 180 of the Health and Care Act 2022 already allows the Government to license non-surgical cosmetic procedures, it has simply never been switched on. Following its 2023 consultation, the Government confirmed on 7 August 2025 that procedures will be split into three risk tiers, green, amber and red, with the highest-risk treatments restricted to regulated healthcare professionals working in CQC-registered premises. The highest-risk tier is being prioritised for legislation first. No commencement date has been set, and a further public consultation on the scheme’s detail was expected in early 2026.
Why Non-Surgical Cosmetic Procedures Have Been a Regulatory Gap
Surgical cosmetic procedures are carried out by registered doctors in regulated premises. Most non-surgical procedures, dermal fillers, non-prescription treatments, microneedling, chemical peels and more, have no equivalent legal floor.
There is no statutory definition of a non-surgical cosmetic procedure, no minimum training requirement, and no central register of who is performing them. Voluntary registers such as the Joint Council for Cosmetic Practitioners and Save Face set standards, but joining them is optional, not mandatory. Botulinum toxin is a prescription-only medicine, so a prescriber has to be involved, but the House of Commons Library briefing on this gap notes ongoing concern about the quality of the consultation that precedes that prescription.
Reviews going back to the Keogh Review in 2013, the Nuffield Council in 2017, an All-Party Parliamentary Group in 2021 and the Health and Social Care Committee in 2022 all called for licensing, and none of their recommendations had been implemented in full before this response.
The Legal Basis, Section 180 of the Health and Care Act 2022
The power to create this scheme has existed since July 2022. Section 180 of the Health and Care Act 2022 lets the Secretary of State make regulations requiring individuals to hold a licence to carry out specified cosmetic procedures, and requiring the premises they work from to be licensed too, with local authorities issuing the licences and Schedule 19 covering fees, offences and financial penalties. What has taken three years is deciding how to use that power, not whether to have it.
What the 2023 Consultation Asked, and What Came Back
The Department of Health and Social Care consulted between 2 September and 28 October 2023 and received 11,848 responses, 55 per cent from professionals and 41 per cent from members of the public sharing personal views. Respondents broadly supported regulation. The Government’s own response describes the current landscape as “fragmented” and says it “does not offer a robust system to protect the public from harm”, language that explains why the scheme has been designed around risk tiers rather than a single blanket licence.
The Three Risk Tiers, Green, Amber and Red
The scheme sorts procedures by risk rather than treating them all the same. Green tier procedures are the lowest risk, treatments such as micropigmentation, IPL and LED light therapies, which any practitioner meeting agreed standards can perform once licensed by their local authority.
Amber tier procedures carry medium risk, including botulinum toxin and semi-permanent facial dermal fillers, where a non-healthcare practitioner would need a licence and supervision from a named, regulated healthcare professional holding an accredited qualification, while a regulated healthcare professional could work independently if they meet the standards. Red tier procedures carry the highest risk, among them hair restoration surgery and procedures that augment the body using fat or dermal fillers, including breast, buttock and genital augmentation.
These are restricted to regulated healthcare professionals, brought under Care Quality Commission regulation, and can only be delivered from CQC-registered premises, taking them outside local authority licensing altogether.
Why the Highest-Risk Procedures Are Being Prioritised First
The Government has said it will prioritise legislation for red tier procedures, so that the highest-risk treatments can only be performed by regulated healthcare professionals working for CQC-registered providers. Oversight requirements for the amber tier, including exactly what supervision will look like and how it applies to procedures needing prescription-only medicines, are still being worked out rather than legislated for immediately.
That sequencing matters for anyone trying to track where the scheme currently stands, red tier detail is furthest along, amber tier detail is still being developed, and green tier procedures have attracted the least additional comment.
What Licensing Will Actually Require
Beyond the tiering, the scheme’s stated aims are to set national education, training and qualification standards, to ensure premises meet hygiene standards, and to require practitioners to hold appropriate indemnity and insurance cover. The detailed conditions, what qualifications count, what premises inspections will involve, what fees will apply, have not yet been published and are expected to form part of the further public consultation on the scheme’s design.
How Age Restrictions Fit Into the Wider Scheme
England already restricts some of this ground. The Botulinum Toxin and Cosmetic Fillers (Children) Act 2021 makes it an offence to administer botulinum toxin or dermal fillers to someone under 18, except where there is a genuine medical need.
The new licensing scheme proposes to go further for licensed procedures generally, prohibiting a practitioner from carrying one out on an under-18 unless a GMC-registered doctor approves it and a specified healthcare professional performs it, aligning cosmetic procedures with the existing rules for Botox, fillers, tattoos, teeth whitening and sunbeds.
Most consultation respondents supported this, though some argued for a higher age threshold, and others raised the practical concern that an approval requirement could delay treatment for conditions such as acne scarring. Patient expectations around cosmetic treatment, and how realistically they have been set before a procedure, are already a recurring theme in claims involving younger patients.
What Stays Outside the New Scheme
Not every cosmetic treatment is moving into this framework. Tattooing, cosmetic piercing, electrolysis, semi-permanent skin colouring and acupuncture remain regulated separately under the Local Government (Miscellaneous Provisions) Act 1982, with additional rules for London under the London Local Authorities Act 1991, and are not being folded into the new licensing scheme.
Cosmetic dentistry, including teeth whitening, stays governed by the Dentists Act 1984 and remains restricted to dental professionals. The Government has said it is not currently adding or removing any procedures from the categories already proposed.
When the Scheme Will Actually Take Effect
No commencement date has been announced. The Government’s response says a further public consultation on the detailed scheme design was expected in early 2026, and any regulations made under section 180 will need to be debated in Parliament before they take effect.
Anyone relying on the scheme for a current standard-of-care assessment needs to check the live position rather than assume it is already in force, as of this writing it is not.
Why This Matters for the Standard of Care in a Claim
Until the scheme is in force, the standard a non-surgical practitioner should have met is assessed against the training, guidance and professional body standards that existed at the time of the procedure, not against a licensing regime that did not yet exist.
That is the same backward-looking exercise that runs through any informed consent or standard-of-care dispute in a cosmetic procedure claim, what would a reasonably competent practitioner, with the qualifications this one actually held, have done.
Once licensing is in force, it is likely to become one of the reference points an expert uses when giving that opinion, but it will not retrospectively change the standard that applied to a procedure carried out beforehand.
| Tier | Risk Level | Example Procedures | Who Can Perform It, and Where |
|---|---|---|---|
| Green | Lowest | Micropigmentation, IPL and LED light therapies | Any practitioner meeting agreed standards, licensed by the local authority |
| Amber | Medium | Botulinum toxin, semi-permanent facial dermal fillers | Non-healthcare practitioners need a licence and supervision by a named regulated healthcare professional; regulated healthcare professionals may work independently if they meet the standards |
| Red | Highest | Hair restoration surgery, body augmentation with fat or dermal fillers including breast, buttock and genital augmentation | Regulated healthcare professionals only, regulated by the CQC, delivered only from CQC-registered premises |
Common Misconceptions About the New Scheme
A frequent assumption is that the licensing scheme is already in force. It is not, only the enabling power in section 180 exists so far, the scheme itself still needs further consultation and secondary legislation. Another common misunderstanding is that the scheme will cover every cosmetic treatment, when tattooing, piercing, electrolysis and cosmetic dentistry are expressly staying outside it under their existing separate regimes.
A third misconception is that Botox and dermal fillers will become restricted to doctors only, in fact the amber tier allows non-healthcare practitioners to continue performing these procedures under supervision, rather than banning them outright.
Frequently Asked Questions
Is the licensing scheme for non-surgical cosmetic procedures already in force in England? No. The Government published its consultation response on 7 August 2025 confirming the approach it will take, but a further consultation on detailed scheme design was expected in early 2026, and no commencement date has been set.
What are the three risk tiers? Green (lowest risk, such as micropigmentation and IPL), amber (medium risk, including Botox and semi-permanent facial dermal fillers, requiring supervision for non-healthcare practitioners), and red (highest risk, including body augmentation with fat or fillers, restricted to regulated healthcare professionals in CQC-registered premises).
Will Botox and filler practitioners need a medical qualification? Not necessarily. Amber tier procedures can still be performed by a non-healthcare practitioner, provided they hold a licence and work under the supervision of a named, regulated healthcare professional with an accredited qualification.
Does the scheme change the age restriction on Botox and fillers for under-18s? The existing ban under the Botulinum Toxin and Cosmetic Fillers (Children) Act 2021 already applies. The new scheme proposes extending a similar restriction across all licensed procedures, permitting an exception only where a GMC-registered doctor approves it and a specified healthcare professional carries it out.
Which procedures are being left out of the scheme entirely? Tattooing, cosmetic piercing, electrolysis, semi-permanent skin colouring and acupuncture remain under the separate Local Government (Miscellaneous Provisions) Act 1982 regime, and cosmetic dentistry stays governed by the Dentists Act 1984.
Whether a case involves a non-surgical procedure that went wrong before this scheme existed, or a question about what standard applied at the time, an independent plastic surgery expert opinion can help establish what a reasonably competent practitioner should have done. Instruct Professor Hindocha to discuss how an expert report can address the clinical questions behind a cosmetic procedure claim.
Related Reading
- Bolam to Montgomery, how the test for clinical negligence changed
- Plastic surgery negligence explained
- Medicolegal challenges in paediatric plastic surgery
- Breast Implant Litigation, BIA-ALCL Claims and Reconstructive Surgery
This article is for general information only and does not constitute legal or medical advice. The licensing scheme described is still in development and its detail may change before it takes effect. Anyone considering a claim should take advice from a solicitor and, where appropriate, an independent medical expert.