SCOTTISH REGULATIONS

In December 2024 the Scottish Government launched the second consultation which closed in Feb 2025, this consultation proposed the following

We propose that private NSCPs should take place in either:

• an independent clinic, or other healthcare setting regulated by Healthcare Improvement Scotland (HIS)
• a premises which is licensed by the local authority

We propose that wherever procedures take place they should be carried out by a suitably trained and qualified practitioner or by an appropriate healthcare professional.

• where procedures take place in a licensed premises we propose that this is ensured by requiring the practitioner to be licensed
• where procedures take place in a HIS regulated setting, this will be ensured through existing HIS processes

Proposals for grouping NSCPs

The Groups proposed are:

Group 1 will contain those procedures which carry the lowest level of risk, are the least invasive, and which we believe can be safely carried out by a trained practitioner who is not a healthcare professional

We propose that Group 1 procedures should be undertaken in either a licensed premises or a HIS regulated setting.

Group 2 will contain procedures which carry a higher level of risk, and are more invasive than those in Group 1.

We propose that Group 2 procedures should only be undertaken in a HIS regulated premises. We propose they could be safely carried out by a trained practitioner who is not a healthcare professional, but that such practitioners should be supervised by an appropriate healthcare professional.

Group 3 will contain the procedures which carry the highest levels of risk and which are more invasive than Group 1 or 2 procedures.

We propose that as well as being undertaken in a HIS regulated premises that these procedures should always be undertaken by an appropriate healthcare professional.

There was a set of specific questions the Scottish Government asked the public to answer, and these can be found at https://consult.gov.scot/healthcare-quality-and-improvement/regulation-of-non-surgical-cosmetic-procedures/ 

The Scottish Government propose that private, non-surgical cosmetic procedures (NSCPs) should only take place either:

• In an independent clinic, or other healthcare setting regulated by Healthcare Improvement Scotland (HIS): or
• In a business premises that is licensed by the local authority.

We further propose that certain procedures should only be carried out in a HIS regulated setting, either by an appropriate healthcare professional or under their supervision.

Under this proposal practitioners in a licensed premises would be able to carry out lower risk, less invasive procedures, with more invasive, higher risk procedures carried out only in a HIS regulated setting. 

Wherever procedures take place we propose to establish standards (unless these are already established by virtue of the existing HIS regime) for:

• Training and qualifications;
• Insurance and indemnity;
• Premises’ hygiene and equipment;
• Materials, for instance disposable needles and consumable products used in procedures.

https://consult.gov.scot/healthcare-quality-and-improvement/regulation-of-non-surgical-cosmetic-procedures/

We propose that group 1 procedures may be undertaken under a licensing scheme as detailed above in section 3.

These procedures are less invasive and lower risk than some of the procedures in the other two groups. They will not require the use of prescription-only medicines, and the potential complications are unlikely to require medical attention. This does not mean that there are no associated risks, but that these risks can be adequately managed by a trained practitioner who is meeting the broader requirements of the licence.

These procedures may involve the use of needles or blades that penetrate the skin, but will not involve the use of any product that is carried by or passes through those needles or blades (note that tattooing, where ink or dyes are used, will remain a licensed procedure as it is currently). Where chemicals, lasers and lights, or heat and cold are used it may only have a penetrating effect into the viable epidermis. 

We propose that laser tattoo removal will also be permissible under licence, as an exception to the general principle relating to depth of penetration, given the established practice in this area. Procedures may not be carried out in intimate areas, with the exception only of laser hair removal. Piercings and electrolysis will also continue to be permitted in intimate areas in line with the current licensing arrangements.

We propose that group 1 procedures include:

• Microneedling
• Chemical peels into the viable epidermis
• Intense pulsed light (IPL) / light emitting diode (LED) therapy
• Use of lasers for tattoo removal
• Non ablative laser hair removal

GROUP 2:  Procedures to be undertaken in a regulated clinic with supervision by a healthcare professional

We propose that Group 2 procedures will be undertaken in a clinic or other setting regulated by Healthcare Improvement Scotland with supervision by a healthcare professional as detailed above in section 3.

These procedures will be more invasive or higher risk than some of the procedures in Group 1. While they can safely be performed by non-healthcare professionals, the level of complexity of the procedures and the risk of complications are such that they should be carried out by a suitably trained practitioner with supervision by a healthcare professional.

Group 2 includes procedures that may require the use of prescription-only medicines (such as botulinum toxin, some painkillers and certain medicines designed to treat complications of dermal fillers), which should be prescribed to an individual after a face-to-face consultation with the prescriber, and as such are not suitable for use outside a regulated setting, or without medical oversight. Where dermal fillers are used the volume should be no greater than 2 millilitres in one site at one time.

These procedures may involve the injection of medicines and products into and under the skin, according to the licenced use of those medicines or products. Procedures may involve the use of chemicals, light and lasers, heat and cold with a penetrating effect of medium depth, but not into the deeper dermis.

We also propose that cryolipolysis may be carried out on the same basis as these other group 2 procedures, even though the penetrating effect of the procedure goes beyond the skin. This is because the risk profile of cryolipolysis is comparable to that of other group 2 procedures.

Any procedure undertaken in an intimate area will not be considered a Group 2 procedure.

We propose that group 2 procedures include

• Mesotherapy
• Injections of toxins or drugs for cosmetic purposes
• Injections of semi-permanent dermal fillers (volume less than 2ml in one site at one time)
• All other subcutaneous injectable products and medicines unless specifically listed as a group 3 procedure (including hyaluronic acid, vitamins and minerals)
• Medium depth peels (full thickness destruction of epidermic into upper dermis)
• Photo rejuvenation
• Radiofrequency treatments
• High frequency Ultrasound (HIFU)
• Cryolipolisis

GROUP 3: Procedures requiring delivery by a healthcare professional

The procedures under this group include some of the most invasive procedures, which require a higher level of medical knowledge to carry out safely. They also carry a higher risk of complications.

For this reason we believe that the appropriate healthcare professional to undertake these procedures will be a doctor or a nurse prescriber, who must be responsible for the decision to progress with treatment, and undertake the procedure personally. The procedure should be undertaken in a HIS-regulated clinic, and the professional should be working within their medical competency for the procedure and area of anatomy involved. This will include following the guidance of professional regulators, including any indication that procedures in this list should be considered surgical and undertaken accordingly.

Due to the increased sensitivity of the skin in intimate areas, and the risk of complications including the potential for impact on sexual function, the majority of procedures undertaken to the genitals, anus or perineum should also be considered a Group 3 procedure (note that laser hair removal may continue to be undertaken as a Group 1 procedure, and intimate piercing, tattoos and electrolysis may continue to be undertaken under licence as presently).

Procedures may involve the use of chemicals, light and lasers, heat and cold which penetrates into the deeper dermis or beyond, or may involve the use of needles or blades acting beyond the skin (e.g. subcutaneous injections, IV infusions).

We note that in the view of some stakeholders some of these procedures are surgical. Nothing in this consultation is intended to imply otherwise, but procedures are included where there has been some doubt expressed or the procedures have been considered non-surgical elsewhere, it is not for this consultation to attempt to define surgical procedures.

We propose that group 3 procedures include:

• Platelet rich plasma, biotherapy or injections of any products derived from the patient’s blood
• Injection Microsclerotherapy
• Injection lipolysis or injections of fat dissolving agents
• Dermal Micro coring
• Hay fever injections
• Any procedure involving intravenous fluids or drawing and processing bloods for cosmetic or lifestyle purposes, for instance provision of IV vitamins and minerals, or IV blook oxygenation
• Use of dermal fillers in excess of 2 ml into one site at one time, e.g. larger volumes used for the augmentation of breasts and buttocks
• Any form of liposuction or use of autologous fat for any cosmetic purpose
• Deeper chemical peels such as phenol peels
• All laser treatments not specified above, including lasers which target the deeper layers of the dermis.
• Carboxytherapy
• Cellulite subcision
• Electrocautery
• Cryotherapy and Cryocautery
• Thread lifting and cogs
• Weight loss injections
• Topical prescription only medicines

All group 1 or 2 procedures where procedures are carried out in an intimate area (except hair removal, and not including procedures already licenced under the Civic Government (Scotland) Act 1982 (Licensing of Skin Piercing and Tattooing) Order 2006)

https://www.gov.scot/publications/consultation-background-paper-regulation-licensing-non-surgical-cosmetic-procedures/pages/6/

Since 2020, the Scottish Government has been engaging with various stakeholders, including medical professionals, to determine the scope and structure of proposed regulations. However, for much of this process, non-medical practitioners have been underrepresented, leaving their perspectives largely unheard. This lack of inclusion has contributed to a biased narrative regarding non-medics, particularly in terms of their standards of practice, knowledge, and training, fueling an increasingly hostile divide between medics and non-medics.

In response, a group of non-medical practitioners came together over several months to challenge this narrative by reaching out to their ministers and directly engaging with the Scottish Government through emails. Their efforts led to the organization of two meetings—one in-person event on February 21st and an upcoming online session at the end of the month.

These meetings provide non-medical practitioners with an opportunity to voice their concerns, clarify key issues, and discuss how the proposed regulatory groupings will impact their businesses. The first in-person meeting took place at the Scottish Government building in Glasgow and lasted for two hours. During this time, practitioners were able to engage directly with government officials, highlighting concerns about the categorization of certain treatments within Group Two. A significant point of contention was the proposed requirement for prescribers to be on-site, which was deemed financially unviable for the majority of practitioners.

Additionally, strong concerns were raised regarding prescribers charging premium rates, with some setting a minimum fee of £500 per day and others demanding £200 or more per hour—practices that, in the bluntest terms, amount to extortion.

Following the online consultation, a recording of the session will be made available.