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For more than 30 years, I’ve had a front row seat as the medical aesthetics market has grown and taken shape. When Hamilton Fraser first began supporting practitioners in 1996, the sector looked very different. Treatment menus were smaller, patient expectations were lower, the number of practitioners in the space was far fewer and risk was largely defined by what happened inside the treatment room.
Today, practitioner risk is broader, more complex, and often far less visible. It extends beyond injectables to regenerative medicine, devices, digital systems, and AI-enabled tools. And while innovation has brought exciting opportunities, it has also transformed the risk landscape in ways many practitioners underestimate.
This shift in practitioner risk in aesthetics has significant implications for aesthetic practitioner insurance and for how aesthetics insurance in the UK is structured and reviewed.
At Hamilton Fraser, we have seen first hand how practitioner exposure has evolved as treatments, technologies and patient expectations have changed.
In the early years of aesthetics, risk was relatively straightforward. Most practitioners offered a limited number of treatments, peels, laser and dermal fillers, initially collagen and then hyaluronic acid (although permanent fillers were a thing back then). Although lasers were more ablative than they are today, their use for skin was much more refined for the dermatology market and injectables were being performed by plastic surgeons, doctors and nurses.
Claims tended to relate to technique, infection, adverse reactions, or products. Regulation was minimal, oversight was light, and insurance often treated aesthetics as a bolt-on to another medical or beauty based policy rather than a specialty in its own right.
At that stage, the main concern for practitioners was clinical competence. Early groups like the RCN Nurses forum created guidelines for best practice for their members. If you kept your medical training at the forefront and maintained good hygiene, risk felt manageable.
But even then, we recognised that aesthetics required specialist understanding and that generic insurance solutions were not fit for purpose.
In 2006, we saw the introduction of botulinum toxin into the UK with the approval of Allergan’s Botox and that was when the market really began to explode.
As the market expanded, so did practitioner exposure. Dermal fillers and injectable choices diversified, toxin use increased, and energy-based devices, skin rejuvenation treatments, and combination protocols became more mainstream. Clinics began treating more patients, more frequently, and often with higher commercial pressure. The sector also saw a rapid influx of practitioners from diverse backgrounds, including lay practitioners, many entering with limited training and little oversight.
With that came a shift in risk. Claims were no longer just about injections gone wrong, although 2002 saw one of the most famous examples hitting the headlines when actress Lesley Ash had lip enhancement with silicone.
We saw increasing issues around consultation quality, informed consent, aftercare, and patient expectations. The rise of online reviews and a more consumer-driven complaints culture meant dissatisfaction alone could escalate into formal complaints or claims.
Risk had started to move beyond the procedure itself and into the entire patient journey.
This expansion of largely unregulated practice raised serious patient-safety concerns and triggered calls for reform, most notably through the Keogh Review, published in 2013 and led by Sir Bruce Keogh.
The review starkly highlighted that people seeking aesthetic treatments had fewer protections than consumers buying everyday products, exposing significant regulatory gaps.
In response, Health Education England developed formal training and qualification frameworks, introducing risk-based standards that, for the first time, set clear expectations for competence in higher risk procedures such as injectables.
However, because these standards were voluntary, uptake across the industry remained inconsistent. This led to the establishment of the Joint Council for Cosmetic Practitioners in 2017, which took ownership of the framework and created a voluntary register to recognise practitioners meeting higher standards, while continuing to push for stronger regulation and greater public protection across the aesthetics sector. I have been a trustee since those early days and Hamilton Fraser has been proud to be part of this journey.
More recently, regenerative approaches, including PRP, polynucleotides, exosomes, and other biologically active treatments, have added a new layer of complexity. These innovations sit at the intersection of aesthetics, wellness, and medicine, often in regulatory grey areas.
From an insurance and risk perspective, this matters enormously and raises important questions around insurance for regenerative aesthetics treatments, particularly where evidence bases and regulatory frameworks are still developing. Practitioners may assume that because a treatment is popular or widely discussed, it is automatically covered. In reality, coverage depends on training, scope of practice, regulatory status, and policy wording.
We’ve seen increased scrutiny from both insurers and regulators as these treatments grow. Understanding what is permitted, what is evidence-based, and what your insurance actually covers has never been more important.
Technology is now reshaping aesthetics at pace. AI-assisted consultations, automated skin analysis, treatment planning software, CRM systems, and digital marketing tools are becoming embedded in everyday practice.
While these technologies can enhance efficiency and patient engagement, they also introduce new risks.
A question we are increasingly asked is: Do I need new insurance for AI aesthetics? The answer depends on how these tools are being used, how decisions are made, and where accountability ultimately sits.
Over-reliance on automated recommendations without appropriate clinical judgement can expose practitioners to liability. At the same time, the growing volume of patient data brings cyber risk, data protection obligations, and the potential for serious reputational damage if systems are compromised.
These are risks that didn’t exist in the early days of aesthetics – but they are now very real.
One of the most common issues we see is not reckless practice, but gradual “scope creep”. Clinics add new services, delegate treatments to staff, or adopt new technologies without fully reassessing their risk profile. This can lead to underinsurance.
Marketing and social media claims are another blind spot. Promotional language that strays into guarantees or exaggerated outcomes can quickly undermine consent and defensibility if something goes wrong.
Perhaps most concerning is when insurance is not updated as a practice evolves. A policy that was appropriate two years ago may no longer reflect what a clinic actually does today.
These often-overlooked issues represent some of the most significant risks of advanced aesthetics treatments, particularly as clinics expand faster than their governance frameworks.
Risk management in aesthetics can no longer be passive. Effective risk management in aesthetics now requires proactive insurance reviews, clear documentation, and open conversations with specialist insurers.
Practitioners should be reviewing their insurance regularly, understanding exclusions and limitations, and asking direct questions about new treatments, technologies, and business models.
Choosing a specialist provider who truly understands aesthetics is critical. Insurance should evolve alongside your practice, not lag behind it.
Most importantly, risk management should be seen as part of professional responsibility, not an administrative afterthought.
There is no doubt that aesthetics will continue to innovate. Regenerative medicine, longevity-focused treatments, and AI-enabled tools will play an increasingly central role in how clinics operate.
With that innovation comes changing risk. As a specialist provider of aesthetics insurance in the UK, Hamilton Fraser, our role has always been to anticipate those changes, adapt our solutions, and support practitioners with protection that reflects the realities of modern practice.
Risk will never stand still and neither should the way we manage it.
Hamilton Fraser's experienced team is always on hand to give you advice and make sure your coverage is tailored to you and your individual practice needs. Get in touch today and speak to one of our team or get a quote online.
Eddie Hooker
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