2021 marks the 25th anniversary of the Hamilton Fraser family. Created as a niche insurance broker in 1996 the fledgling company’s clutch of commercial clients included a few medical practitioners, mainly nurses, who were practising in a new health and beauty sector, aesthetic medicine.
Back in 1996, the burgeoning aesthetics industry in the UK was being stifled by red tape, with unaffordable insurance premiums making entry into the market and sustainability, almost impossible. Hamilton Fraser relentlessly ‘knocked on doors’ until they found and forged relationships with other forward-thinking professionals; those that believed in the potential of the sector as much as they did.
The dominance Hamilton Fraser has enjoyed within the aesthetic sector is irrefutable. Since 1996, the business has innovated, educated and ultimately led the sector and, in many ways helped create elements of the aesthetics industry the UK enjoys today. Hamilton Fraser took a niche industry, recognised the opportunity it represented and helped turn it into a thriving sector worth £2.75 billion in the UK.
Together with its private rented sector business, Hamilton Fraser now employs more than 200 staff who look after more than 500,000 individual customers. In celebration of these milestones, the following chronicles the part the company has played in the inception and the seemingly unstoppable rise of the aesthetic and cosmetic industry.
War. (What is it good for?)
Throughout history civilisations and individuals have always taken an interest in their appearance. Cosmetic improvements and aesthetic enhancements of people’s bodies can be traced back to antiquity, with references to procedures taking place during the height of both the Egyptian and Roman empires, and plastic surgery dating back to 800 B.C. in Ancient India.
Almost every civilisation has documented reconstructive techniques for numerous facial defects, be it noses, ears, lips or eyes. But it is American surgeon John Peter Mettauer who is often recognised as the pioneer of cosmetic surgery, carrying out a cleft palate operation in 1827 with self-designed instruments.
Necessity is often called the ‘mother of invention’ and very often the catalysts for essential innovation have been wars. As conflicts became increasingly industrialised from the 19th century, the unprecedented number of disfiguring injuries sustained brought about the rapid development of reconstructive surgery techniques, anaesthesia and more hygienic processes.
Surgeon Harold Gillies’ work developing facial reconstructive surgery following the huge rise in the number of drastic facial injuries in the first world war (1914-18) marked the dawn of cosmetic surgery as we know it today.
The decades that followed the second world war (1939-45) saw plastic surgery become increasingly popular and more respectable in the medical community. Silicone initially used for breast implants for the first time in 1962 was swiftly adapted for other surgical procedures. With increased prosperity surgeries moved into the mainstream.
Dermal filler procedures were first carried out in the 1970s when various animal collagens had been researched and tested enough to use on humans and collagen injections and implants were introduced.
In the late 1980s, an alternative to cosmetic surgery was offered in the form of non-surgical procedures. Also referred to as ‘non-invasive’, these procedures include anti-wrinkle treatment, lip enhancement and cheek and chin augmentation. The original injectable wrinkle relaxer botulinum toxin type A (Botox) was first introduced onto the market in 1989.
Initially the sole preserve of celebrities and the wealthy, increased media coverage and general acceptance, combined with greater affordability and the non-permanence of the treatment, saw non-invasive procedures move quickly increase their popularity.
From wrinkle relaxing injections to dermal fillers, laser hair removal, chemical peels and non-surgical fat removal, the non-invasive cosmetic sector shows no sign of abating in the UK, not least due to their ready adoption by millennials.
But how did the aesthetic and cosmetic industry initially take off in the UK? How was a start-up insurance broker, with a handful of clients, so vital in its early adoption? And how did that insurance broker come to lead the industry for 25 years?
In 1996, Hamilton Fraser opened its doors for business in a small office in High Barnet, North London. In the same year a small but growing aesthetic medical market in the UK was dominated by wrinkle-busting collagen injections supplied by manufacturers such as Q-Med, Allergan and Collagen Aesthetics.
The aesthetics industry was being held back by the lack of relevant and affordable malpractice insurance cover. Medical practitioners needed to obtain a form of insurance from medical membership bodies and the pricing was based on the area of medicine that was practised.
So new was the branch of medicine that the membership bodies classed the risks – and the premiums – based on those for invasive reconstructive plastic surgery.
After much searching a small Lloyds underwriting business that specialised purely in medical malpractice in the UK and emerging territories called Marketform was found.
They were an innovative insurer looking for new opportunities, a perfect match for Hamilton Fraser. Insurance for collagen injections set at £1,000 a year ensured this insurance was an instant hit.
With an affordable and relevant insurance product now available, in the late 1990s Hamilton Fraser went about cementing their position with an ever-expanding customer base.
To do this the company needed to better understand the new aesthetic products and procedures finding their way onto the market.
So ensued numerous meetings with both manufacturers and the practitioners.
A regular monthly slot in the training department of Collagen Aesthetics was therefore secured. Speaking to newly trained nurses about insurance helped the Hamilton Fraser name to gain traction within the industry and this created a knock-on effect of recommendations and further networking invitations.
Eventually, this escalated to speaking engagements at the Royal College of Physicians in London and the International University of Monaco.
In 1999, Hamilton Fraser was introduced to Ron Myers, a young sales and marketing executive who specialised in the pharmaceutical industry. Ron was employed by Wigmore Medical who were the main distributers of ‘Botox’ in the UK.
Botox was a botulinum A toxin product that caused temporary paralysis of nerve endings and could be injected to smooth the wrinkles on the face. Unlicensed across the world but successfully being used ‘off-label’ in the US, practitioners would not risk using the product without relevant insurance, so Ron sought out Hamilton Fraser to solve the problem.
Ron had identified the dental market as a good opportunity and felt that if dentists embraced the technology Wigmore could dominate this market. Around the same time a cosmetic dentist named Bob Khanna entered the picture. He wanted to train in the administration of the drug and then train other interested dentists.
Hamilton Fraser hatched a plan to form an exclusive arrangement with the two for the training and distribution of ‘Botox’.
The Bob Khanna Training Institute was set up with Wigmore Medical providing exclusive distribution rights to Bob for the dental sector, and Hamilton Fraser as the exclusive insurance provider. The plan worked, with scores of dentists soon lining up to be trained in the new treatment.
In 2002 the US Food and Drug Administration (FDA), followed by the UK Medicines and Healthcare Products Regulatory Agency (MHRA), announced regulatory approval of botulinum toxin type A to temporarily improve the appearance of moderate-to-severe frown lines between the eyebrows and the ‘Botox’ boom began.
Until the early 2000s, when the FDA approved the use of hyaluronic acid fillers, both bovine collagen, as well as some human collagen fillers, were used for dermal fillers. A natural substance that is already found in our bodies, hyaluronic acid products lasted much longer than collagen fillers and had far fewer side effects, which contributed to their instant success.
Hamilton Fraser had helped create the market for ‘Botox’ in the UK and successfully laid the foundations for the cosmetic sector that was to follow.
In 2013, a review by Sir Bruce Keogh, the NHS medical director for England, said non-surgical procedures such as fillers to tackle wrinkles, botulinum toxin and laser hair removal were “almost entirely unregulated”. He therefore recommended a register of anyone that performs surgical or non-surgical cosmetic interventions.
The Department of Health said it was exploring additional safeguards relating to the supply and administration of dermal fillers and other injectable cosmetic procedures to safeguard vulnerable groups.
With an increasing number of practitioners operating in the cosmetic treatment sector and the media highlighting problematic results, in 2013 the Advertising Standards Authority (ASA) published specific advertising guidance on the marketing of both surgical and non-surgical ‘cosmetic interventions’.
It covered the use of misleading issues such as making exaggerated or unrealistic claims, the trivialisation of some procedures and highlighted the prohibition on advertising prescription-only medicines, such as botulinum toxin.
It also outlined the circumstances under which it is acceptable for doctors to refer to themselves as ‘surgeons’ and ‘cosmetic surgeons’, as well as the use of other terms, including ‘qualified or ‘specialist’ and, comparative claims such as ‘leading’.
The guidance was further updated in 2016 as the sector continued to expand and evolve.
During an episode of ‘Keeping up with the Kardashians’ in 2015, Kylie Jenner revealed that she’d had lip fillers. This created a massive spike in demand, with one London clinic revealing a 70 per cent rise in enquiries within 24 hours of the show airing.
The ‘selfie era’ soon gained momentum, with social media having a significant impact on those seeking out cosmetic treatments.
In fact, a survey conducted by the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) in 2017, found that 55 per cent of facial plastic surgeons reported that patients wanted to look better in selfies, a 13 per cent increase from 2016.
Some practitioners referred to this request to undergo procedures to resemble their digital image as “snapchat dysmorphia”.
A report by Health Education England (HEE) entitled ‘Qualifications in the non-surgical sector’ was published in 2016.
The report was one of several with the aim of improving and standardising the training available to practitioners who carry out non-surgical cosmetic procedures.
In 2016, and following the report’s publication, the Joint Council for Cosmetic Practitioners (JCCP) was formed. A not-for-profit organisation, the JCCP is a self-regulating body for the non-surgical aesthetics market in England.
Its primary aim is to enable the public to easily identify safe practitioners across non-surgical aesthetic treatments and provide information to the public seeking non-surgical treatments.
A survey in 2019 by Chinese smartphone firm Honor indicated that the average person in the UK now takes 884 photos each year, 468 of which are selfies. The continued rise of the ‘selfie’ fueled the desire for cosmetic surgery and non-invasive procedures, with the average age of both men and women undergoing both for the first time, reducing.
In the same year, the Department of Health and Social Care (DHSC) launched their ‘Clued up on cosmetic procedures’ campaign. Hosted on the ‘Health A-Z’ section of the NHS website, its primary aim was to make those considering a cosmetic procedure consider the physical and mental consequences of the treatment.
Ethically aesthetic treatment plays on many people’s insecurities, but equally choice is part of life so it is society’s responsibility to ensure that people are informed and made aware of the potential consequences of their actions.
In 2019, the Advertising Standards Authority (ASA) banned three Instagram adverts for cosmetic fillers, stating that they misled consumers, by suggesting that celebrities had used the promoted treatments. This highlighted the ethical implications associated with marketing cosmetic procedures and reminded practitioners of their duty to protect the emotional and physical safety of their clients above profit.
In 2014, there were 150,000 vegans in the UK. By 2019, this had quadrupled to 600,000 – 1.16 per cent of population*. As most fillers are made from non-animal origin hyaluronic acid, they are considered vegan.
However, since many treatments, such as ‘botox’, are classified as a medical product by law, many of them are tested on animals. Lots of companies, however, are dedicated to reducing or eliminating the need for animal testing and this fuels a growing market for identifying more sustainable treatment methods and products for the future of the sector. *Ipsos Mori survey
In January 2020, the Public Health Minister for Scotland said that Scotland will be the first part of the UK to introduce a licensing scheme for any healthcare professionals that carry out cosmetic procedures for treatments such as dermal fillers or lip enhancements.
Like every other sector, the COVID-19 pandemic has required practitioners to change and adapt how they operate, the procedures they offer and how they deal with patients.
With successive lockdowns requiring clinics to close for months at a time, many practitioners have kept their businesses afloat and maintained relationships with patients through video consultations. A new and daunting experience for many, whether it’s Zoom, Skype, Teams or WhatsApp video, virtual consulting has evolved from a necessity to part of the ‘new normal’ for many practitioners and patients alike.
Practitioners have reported an increase in enquiries for ‘lockdown’ procedures including those for skin conditions caused by mask wearing and due to the ‘Zoom effect’, with people becoming much more aware of how others see them and, how they see themselves.
This has also changed how practitioners view their patients, with a more holistic approach being taken, with the wellbeing of patients and their suitability for treatment being taken into consideration.
Whether the pandemic results in long-term sizeable changes to the sector remains to be seen, but it is clear that a change from purely practical clinical procedures to a more patient focused approach in order to provide a well-rounded service, has already begun.
Hamilton Fraser continually seeks to improve the sectors in which it operates. In 2017, the company launched the Aesthetics Business Conference (ABC) to provide business advice and support to new and existing customers. It is now a regular annual event, with over 100 delegates attending, and their ‘ABC Cutdown’ tours regionally to reach and help as many practitioners as possible.
The company continues to influence the market, including creating a more structured cosmetic sector via its involvement with the Joint Council of Cosmetic Practitioners (JCCP) to further improve standards for consumers and training excellence for practitioners.
The success of Hamilton Fraser Cosmetic Insurance is their relentless pursuit of understanding the market and the customers in it at every level, creating lifetime partnerships with many through long term support.
The company provides malpractice insurance to more than 65 per cent of the aesthetic sector, with a customer base of more than 10,000 individual practitioners and small businesses. Plans are in place for further penetration of the traditional beauty sector and branching out into new healthcare areas.
With new and innovative technologies and techniques being developed and the increased potential for personalised treatments, demand for cosmetic treatments is showing no signs of waning.
Non-surgical treatments are expected to increase in popularity during the next few years, with the worldwide aesthetics industry estimated to be worth 22 billion dollars by 2025. With an abundance of opportunities for practitioners, the future looks bright for the industry and, Hamilton Fraser Cosmetic Insurance.