Regulation of non-surgical procedures: child rights and wellbeing impact assessment

Child Rights and Wellbeing Impact Assessment Template

1. Brief Summary

Type of proposal (Please delete as necessary):

• Bill
• Scottish Statutory Instrument

Name the proposal, and describe its overall aims and intended purpose.

Legislation (primary and secondary) to introduce a scheme for the licensing and regulation of non-surgical procedures. Regulation is required to address the potential for harm to clients arising from procedures carried out by individuals who do not have suitable training and qualifications, in unsafe environments with unregulated products. The proposed secondary legislation will bring in a local authority licensing scheme for lower risk procedures, and primary legislation will ensure that higher risk, more invasive procedures are carried out in clinics regulated by Healthcare Improvement Scotland. All procedures must be carried out in safe and clean settings by appropriately trained staff – in the case of the higher risk procedures, they must be performed or supervised by certain healthcare professionals.

The proposal will also introduce minimum age limits for procedures.

Note that the provision of non-surgical procedures for healthcare purposes is not within the scope of this policy work and will continue to be made available through established NHS or independent healthcare pathways.

Start date of proposal’s development: 2023

Start date of CRWIA process: February 2025

2. With reference given to the requirements of the UNCRC (Incorporation) (Scotland) Act 2024, which aspects of the proposal are relevant to/impact upon children’s rights?

Article 2: Non discrimination – The legislation creates an offence of providing non-surgical procedures to children under the age of 18. The age limit will apply to all children under 18, unless the procedure is required for a healthcare purpose.

Article 3: Best interests of the child – the creation of the offence of providing a non-surgical procedure to children under the age of 18 is intended to protect them from the potential for lasting harm, and/or detrimental impact, which could be amplified in people of a young age. Many of these procedures are designed for the treatment of the effects of ageing and use products which are not designed for use on young skin.

Article 5: Parental guidance and a child’s evolving capacities – the proposals attempt to balance children and young people’s right to have their voices heard and their views considered against the overall need to protect them from harm, as they are still developing, physically and emotionally. Responses to the Scottish Government’s recent public consultation on the regulation of non-surgical cosmetic procedures (see more below) demonstrated a concern that some children and young people are heavily influenced by social media and peer pressure and have not yet developed the capacity to make decisions that could affect them in the long term.

Article 12: Respect for the views of the child – the proposals reflect the evidence demonstrated below that many of the non-surgical procedures considered here are not appropriate for children and young people and the views of a child require to be balanced with the need to be protected from the risk of lasting harm.

Article 24: Health and health services – the policy aim is to protect the health of all people who have non-surgical procedures performed on them by reducing access to unsafe procedures.

Article 36: Protection from exploitation – children and young people should be protected from individuals who may exploit their lack of understanding of the potential harmful effects of these procedures.

3. Please provide a summary of the evidence gathered which will be used to inform your decision-making and the content of the proposal

Evidence from existing research/reports/policy expertise

The Plastic, Reconstructive and Aesthetic Surgeons Indemnity Scheme (PRASIS) website cites guidance from the General Medical Council (GMC) on the provision of cosmetic surgery to children, which includes:

• the setting should be appropriate for paediatric care;
• practitioners should work with multi-disciplinary teams which include specialists in the care of children and young people;
• only procedures which are in the best interests of the child should be performed;
• while the child should be encouraged to involve parents in their decision and parents can consent to their child receiving a procedure, if it is clear the child does not want the procedure it must not be performed.

PRASIS also cites British Association of Aesthetic Plastic Surgeons (BAAPS) advice that “Aesthetic procedures on patients under the age of 18 years should be exceptional and only undertaken after a full assessment of the risks and benefits, including the health and psychosocial consequences. It is recommended that the patient include their parents or guardians in the consent process”.

The Nuffield Council on Bioethics’ 2017 report on Cosmetic-procedures: ethical issues referred to the Oxford Handbook of the Psychology of Appearance, which said that “[a]dolescents are particularly susceptible to pressures to conform to prevailing peer and social pressures; and are at a vulnerable stage of development with respect to their sense of their own identity. Moreover, appearance dissatisfaction in adolescence has consistently been identified as a risk factor for a variety of practices used to manage appearance and that are associated with long-term consequences, including eating disorders, depression, and low self-esteem”. The report recognises the need to balance protection of young people against their capacity to make decisions for themselves, but stressed the importance of looking out for their best interests at all times. The report goes on to say: “[w]hile the law increasingly recognises the ability of children and young people to make decisions for themselves … this recognition is accompanied until adulthood by an ongoing protective role both on the part of parents and on the part of the state”, and it cites the restrictions on tattoos and use of sunbeds to those aged 18 and over, which do not allow for parental consent. It questions the ethics “of carrying out invasive cosmetic procedures on a child or young person, without expectation of therapeutic gain”.

In 2024 the Cosmetic Surgery Solicitors (CSS) group conducted a consumer survey on: Non-Surgical Cosmetic Procedure Legislation for Under-18s which found that 83% of respondents felt that individuals under the age of 18 should not have a legal right to procedures involving Botox® and fillers without the consent of their parents. CSS concluded that this majority view likely reflects concern about the risks of these procedures, lack of regulation and pressure from social media and other influences on young people to conform to certain standards of beauty. 86% of respondents supported the establishment of a regulated professional body for non-surgical cosmetic procedures in the UK.

From October 2021 the UK Government made it a criminal offence in England to administer botulinum toxin (commonly known as Botox®) or fillers by injection for cosmetic purposes (ie to insert a substance into the body with the intention of producing a filling effect to change appearance) to anyone under the age of 18, or to make arrangements or book an appointment for anyone under the age of 18 to receive these treatments. There is an exemption where a doctor has approved the procedure, but in such cases the procedure may only be carried out by a registered doctor, nurse, pharmacist or dentist.

This offence was created in recognition of the risks posed by these cosmetics treatments, including possible infection and blindness, and the psychological harms arising from a change in appearance: The Explanatory Notes to the Botulinum Toxin and Cosmetic Fillers (Children) Bill state: “there are ethical considerations about the extent to which U18s have the emotional and mental maturity to give their informed consent to these invasive procedures, given the health impacts and limited standards framework which apply to their provision … A targeted policy restricting access to treatments by U18s as a particularly vulnerable group in society is considered a justifiable and proportionate response to the potential health risks”.

In their 2022 public consultation on the licensing of non-surgical cosmetic procedures in England the UK Government proposed a minimum age limit of 18 years on all procedures unless approved by a GMC-regulated doctor and performed by a specified healthcare professional.

Evidence from consultation/feedback from stakeholders

The Scottish Government carried out a public consultation on the regulation of non-surgical cosmetic procedures (which form the majority of the procedures considered here), which ran from 20 December 2024 to 14 February 2025. The consultation asked some questions about a proposed age limit for procedures and about the impacts that the proposals for licensing and regulation, including possible age restrictions, might have on respecting, protecting and fulfilling the rights of children and young people. The consultation included reference to procedures undertaken for lifestyle or other purposes, and thus covered the range of procedures now referred to in this impact assessment as non surgical procedures.

62% of the 2,207 respondents felt that there should be a minimum age limit for non-surgical cosmetic procedures, while 27% thought that there should not be a minimum age limit, but all procedures carried out on under-18s should be carried out by an appropriate healthcare professional in premises regulated by Healthcare Improvement Scotland (HIS).

When asked for each group of procedures (see pages 40-43 of our response to the public consultation for an explanation of groupings) what the age limit should be:

• for group 1 procedures 51% of respondents thought the age limit should be 18 and over, 9% thought it should be 16 and over, 16% thought it should be 18 and over and that 16 and 17 year olds should have parental consent, and 2% thought there should be no age limit;
• for group 2 procedures 66% of respondents thought the age limit should be 18 and over, 3% thought it should be 16 and over, 8% thought it should be 18 and over and that 16 and 17 year olds should have parental consent, and 1% thought there should be no age limit;
• for group 3 procedures 69% of respondents thought the age limit should be 18 and over, 2% thought it should be 16 and over, 6% thought it should be 18 and over and that 16 and 17 year olds should have parental consent, and 2% thought there should be no age limit.

87% of respondents agreed that procedures on intimate areas (genitals, anus, breast, buttocks) should only be available to those aged 18 and over, with 5% disagreeing.

Respondents were also asked how they thought the proposed licencing and regulation scheme and associated age restrictions might impact on the rights of children and young people. 20% of people who answered this question believed an age limit of 18 and above for all cosmetic procedures would be appropriate, with some suggesting that younger people could receive some treatments if necessary for medical purposes or with parental consent.

Respondents felt that the proposals would help to protect children and young people’s rights to health, safety and wellbeing, prevent exploitation and act in their best interests. Although some respondents suggested that it was important to balance this with their right to have their voices heard and their views considered, this was not as important as the overall need to protect them from harm, as they are still developing physically and emotionally. In addition it was recognised that some children and young people are heavily influenced by social media and peer pressure and have not yet developed the capacity to make decisions that could affect them in the long term.

Many respondents pointed to the need to ensure that children and young people still had the right to access treatments for medical or psychological reasons if required, regardless of age. Others suggested that education and awareness campaigns would allow children and young people to make better informed decisions.

Evidence from consultation/feedback directly from children and young people

We have no evidence that any children and/or young people responded directly to our public consultation.

We ran a mini procurement competition using the Children and Young People’s Participation Framework, to seek to identify a (paid) supplier who could lead an engagement exercise with children and young people to gather their views on our proposal to restrict non-surgical procedures to people aged 18 and over. Unfortunately no suppliers responded, and so we have been unable to engage directly with children and young people themselves.

In 2024 GirlGuiding published Girls' Attitudes Survey 2024, which found that “Girls feel under pressure to alter their appearance both online and in real life”. In response to questions from us on the impact of our proposals on children and young people they told us:

“We know that girls as young as 11 tell us they’re considering using anti-aging creams in the next 5 years. Just over a quarter (28%) of girls aged 11-16 said they would consider cosmetic changes to their appearance at some point in the next 20 years, rising to nearly half (48%) for girls aged 17-21. Nearly 1 in 5 young women aged 17-21 say they’d consider cosmetic procedures, like botox [sic] or fillers, in the next 5 years. And 12% say they’d consider undergoing cosmetic surgery.”

4. Further to the evidence described at ‘3’ have you identified any 'gaps' in evidence which may prevent determination of impact? If yes, please provide an explanation of how they will be addressed

Our inability to procure the services of a third party organisation to lead an engagement with children and young people to seek their views directly means that we have a gap in our evidence gathering. We consider that a discussion of the risks of non-surgical procedures may be distressing for some children and young people and members of the policy team do not have experience of engaging directly with children and young people, therefore we do not feel it would be appropriate for us to run an engagement activity ourselves.

We consider, however, that as the nature of the majority of non-surgical procedures makes them unsuitable to be carried out on children and young people, the protection offered to children and young people by our policy proposal to restrict non-surgical procedures to people aged 18 and over outweighs the lack of direct evidence we have been able to gather.

5. Analysis of Evidence

Evidence from existing research/reports/policy expertise

We have seen that the GMC suggests that for cosmetic surgery specialists in the care of children and young people should be involved, and that only procedures which are in the best interests of the child should be performed. We understand that there is a general understanding among non-surgical procedure trainers that the minimum age for undertaking any procedure would be 18, and so it is not likely that training would include anything on the care of children. So, although these procedures are not surgical, this specialist area of knowledge will be lacking for most, if not all, trained practitioners.

We also note BAAPS’ advice that aesthetic procedures should only be carried out on those under the age of 18 in exceptional circumstances. We have made clear that any non-surgical procedures which are required for medical reasons are not covered by our proposals, but again this would suggest that our restriction on non-medical procedures to those aged 18 and over is appropriate.

We have also taken into account the Nuffield Council on Bioethics’ Report detailed above, which stresses a need to look out for the best interests of children and young people, and notes the ethical question around performing invasive procedures on them without any therapeutic gain. We have also seen that in outlawing the provision of Botox® and fillers to people under the age of 18 the UK Government have also questioned the ethics around children and young people’s emotional and mental capacity to give informed consent to these procedures.

Evidence from consultation/feedback from stakeholders

There was strong support for a minimum age restriction for non-surgical procedures in responses to the public consultation carried out in December 2024-February 2025, with the majority of respondents agreeing that for all these procedures the minimum age should be 18. While there was recognition of the importance of children and young people’s voices being heard, respondents felt that the need to protect them from harm was greater.

Evidence/feedback directly from children and young people

It has not been possible to engage directly with children and young people on this issue within the timescale available for publication of this impact assessment. However the findings of GirlGuiding’s Girls’ Attitudes Survey, referenced above, tell us that young women feel pressure to change their appearance, with some saying they would consider cosmetic procedures in future. Engagement with business owners in the aesthetic sector has shown that many would not consider it appropriate to perform these procedures on people under het age of 18.

6. What changes (if any) have been made to the proposal as a result of this assessment?

Prior to running the public consultation we did consider that, alongside an age restriction of 18 years and over, we could include 16-17 year olds with parental consent. However the low rate of agreement with the parental consent option demonstrated in responses to the consultation, as detailed above in our response to Question 3, coupled with other evidence and feedback we received, led us to discount this option. We consider that a restriction on non-surgical procedures to people aged 18 and over, with an exception for medical purposes, is appropriate.