On 24 April last year, Anne Towlson went to Turkey. A 58-year-old mother, she’d booked into the Green Park Hospital in Istanbul for a pre-planned tummy tuck and liposuction procedure. But then, she made a “last-minute decision” to have “bingo wings” surgery, aimed at removing sagging skin from beneath her arms. Things quickly went wrong. Just after the procedure, Towlson’s right hand swelled up, seeping a yellowy liquid that stained her hotel pillows. To start with, the clinic was communicative, even as Towlson took antibiotics and painkillers to fight her symptoms.
But then, once Towlson was back in the UK, Green Park seemed less willing to offer aftercare support: with disastrous consequences. By 11 May, Towlson was dead, found decomposing in her home. Her tragic story is far from unique. Since 2019, some 28 Britons have died after cosmetic procedures carried out in Turkey. In truth, though, fatalities represent only the most extreme outcomes. For every death, hundreds more patients return to the UK with complications requiring urgent NHS treatment — treatment which the British Association of Aesthetic and Plastic Surgeons (BAAPS) estimates costs the NHS £15,000 per patient.
Combined with a rise in dangerous off-the-books procedures in Britain itself, and the beauty industry is having a profound impact on our health service. Part of the solution involves tightening up regulations, and clamping down on dodgy practitioners. But the problem ultimately stems from deeper societal issues — around beauty standards, mental health, and the immense power of imported US culture. Without addressing these root causes, the NHS will continue to bear the physical, psychological, and financial burden of beauty gone wrong.
Medical tourism is booming, with Turkey especially emerging as a primary destination for dental work and cosmetic procedures. Yet if BAAPS figures show the country is comfortably the most popular destination for Britons opting for cosmetic surgery abroad, everywhere from the Dominican Republic to Tunisia are represented too. All told, the ONS has found that the number of British residents leaving the country for medical treatment increased by over 100,000 from 2021-2.
Yet as the Towlson case so vividly shows, these expeditions can end in disaster. In a sense, this is unsurprising. Investigating Towlson’s death, the coroner expressed concern about the lack of coordination between international medical authorities, and the absence of clear warning systems for British patients considering procedures abroad.
Even when patients don’t die, they can still suffer, with symptoms ranging from post-operative wound infections to full-blown sepsis and pulmonary emboli. I see similar basket cases in A&E, from red raw peeling scalps that have been butchered by backstreet hair replacement clinics to faces so swollen by cheap collagen implants that the patient’s head takes on an eerie alien look.
Yet far from crowing about the state of foreign cosmetics practitioners, cases like Susan McGowan’s highlight the deadly potential of procedures inside Britain itself. An NHS Scotland nurse, McGowan died on 4 September 2024, after receiving injections of tirzepatide (more commonly known as Mounjaro) from an unqualified practitioner here in the UK. McGowan’s colleagues at University Hospital Monklands in Airdrie fought to save her life, after she presented at A&E with severe stomach pain — but to no avail.
As with Anne Towlson, McGowan’s case is the sharp end of a far wider wedge. Weight loss drugs like Ozempic and Mounjaro may be celebrated on social media as miracle cures, and even trumpeted by Health Secretary Wes Streeting. But the numbers are worrying. Data submitted to the UK drugs regulator show that, as of January this year, dozens of deaths have been linked to these medications.
The side effects of these medications — primarily nausea and suppressed appetite — are often misunderstood or downplayed. As treatments go, indeed, this is Wizard of Oz stuff: pull back the curtain and you’ll lose weight not because of the wonders of modern medicine but simply because you feel sick all the time. I had a patient who thought her persistent stomach issues were simply side effects of Mounjaro. Actually, the drug was masking symptoms of potentially life-threatening bowel cancer.
At the same time, patients seem increasingly unwilling to accept clinical guidance. A dentist friend told me of a patient who wanted a dental bridge. My friend advised against it: the risk of complications and infections was far too high. The patient ignored my friend’s advice, went to Turkey, had the procedure — and the predicted complications duly appeared. My friend refused to fix the problem, advising the patient to return to Turkey for additional treatment. This may seem harsh, but a dentist or clinician who’s advised a patient against a risky procedure isn’t obliged to clean up another practitioner’s mess.
Yet when complications do arise, patients often find themselves in NHS emergency departments, creating a perverse system where private profit is internationalised while the costs of complications are socialised through the NHS. In other words, British taxpayers end up subsidising both shoddy domestic and foreign cosmetic practices, and patients who haven’t thought carefully about the procedure they’re embarking on — all because they want to save a few quid and be “Instagram ready”.
Telling, too, is how many people now arrive at A&E expecting comprehensive corrective procedures to their cosmetic nightmares, misunderstanding the fundamental mission of emergency medicine. Essentially, me and my colleagues are there to maximise a patient’s utility, not magically turn them into Scarlett Johansson. But, today, everyone has a bit of Gen Z about them. No one will wait for anything. Everyone thinks it’s their right to look young, attractive and desirable. When I try to give my oozing, bleeding, weeping patients a “teachable moment”, they don’t want the reality lecture. They want the fantasy outcome.
Nor is the problem going away. If anything, it’s getting worse, with untrained practitioners proliferating right across the country. It’s astounding how many and what sort of invasive procedures can be carried out by someone with zero clinical expertise. As researchers at UCL found, 68% of cosmetic practitioners administering injections such as Botox and dermal fillers are not qualified medical doctors. That’s even as the UK injectables market is predicted to reach a value of £11.7 billion by 2026.
NHS departments regularly treat patients suffering from infections after receiving dermal fillers from beauticians who may have only watched a handful of instructional YouTube videos. Many hairdressers branch out into doing cosmetics after doing a perfunctory online course, thinking they can go from hair extensions or pedicures to collagen implants and butt fillers that breach the skin and enter the body. Ironically, 16th-century barbers who combined cutting hair and trimming beards with pseudoscientific leeching are the progenitors of today’s NHS surgeons. To that extent, then, rogue beauticians are simply reclaiming their birthright.
“Many hairdressers think they can go from hair extensions to collagen implants and butt fillers”
And like in the Renaissance, unregulated procedures today flourish in a regulatory wild west. The legal specifics differ significantly between countries. In the US, for instance, the industry is considerably more controlled. Start pumping patients up with Polyfilla and not only will you wind up with a massive lawsuit, you’re also going to jail.
The UK, however, has developed a reputation for what one friend calls a distinctive “British style” of cosmetic surgery — one characterised by poor technique and overfilling thanks to looser regulations around who can perform procedures. The landscape is further complicated by dubious online marketplaces. Performance-enhancing steroids and supplements that would send the IOC into a spasm can be bought at the click of a button, from the same sources selling bootlegged weight-loss medicines, corrosive teeth whiteners, or self-administered collagen implants.
Given the shocking deaths of Towlson, McGowan and others, renewed and growing calls for stricter regulation of the beauty industry, from both the Royal College of Surgeons and the British Medical Association, represent the concerns of myself and colleagues who find the unabated rise of cosmetic quackery deeply worrying. But if the Government is incapable of legislating against backstreet practices here in the UK, what hope is there for people who find themselves ill-treated abroad? My advice to anyone contemplating cut-price cosmetic surgery, anywhere, is to take a good, hard look at yourself in the mirror — literally — and ask yourself: is it really worth the risk?
Anyway, even in well-regulated environments, financial incentives can distort clinical judgment. Some practitioners provide prescriptions with minimal oversight, driven by profit rather than patient welfare. There are plenty of unethical private doctors happy to leave a private prescription under the plant pot. These people, though highly trained, are not thinking about patient complications. They’re thinking about being able to buy a new tack for their daughter’s pony.
In the end, though, I think tightening up the rules is only half the answer. Behind every botched procedure lies a deeper psychological narrative. Body dysmorphia, unrealistic expectations, and a profound disconnect between self-perception and reality drive many towards the surgeon’s knife. Talking to my own patients, it’s clear there are vast mental health problems washing about in less-regulated corners of the cosmetics industry. The subtext: I don’t like who I am, I want to be someone else.
Unsurprisingly, social media is central here, revolutionising how beauty standards are created, communicated and commodified. The “Instagram face” — characterised by inflated lips, sculpted cheekbones, and contoured features — has become a globalised aesthetic. That’s even as rapid cycling between extreme body types, from heroin chic (remember that one?) to Kardashian curves and back again, makes it impossible for punters to keep pace either physically or financially.
Perhaps all that’s an inevitable consequence of a culture that’s preoccupied with difference, individuality, identity politics and celebrity. Once upon a time, if you were some random person out of the limelight, you wouldn’t need to care about what you looked like. But today, if you’ve picked up a couple of thousand followers online, you feel like you have to look a certain way to keep up appearances.
All the while, platforms like TikTok accelerate these trends through filters that shrink noses and enlarge lips, creating a distorted self-image that patients then seek to make permanent through cosmetic procedures. This phenomenon drives people to show plastic surgeons their filtered face as their desired result — an inherently unattainable standard. And though traditionally associated with women, cosmetic enhancements have increasingly attracted male patients, particularly for hair transplants and dental work.
Some men also pursue more extreme interventions like bicep implants and chest enhancements, reflecting changing expectations around male physique. Class matters here too. We’re often talking about people who can’t afford treatments in the first place, then can’t afford to take time off work when something goes wrong. At the other end of the spectrum are people with too much money and not enough sense, who pursue extreme procedures without thinking them through.
I’d ultimately argue that whoever’s taking Mounjaro or having their teeth done is falling prey to an insidious form of American cultural imperialism, at odds with British self-perception. We like to think of ourselves as European, modern and sophisticated. The truth, though, is that we’ve got an obscene obsession with what’s happening over the Atlantic. This influence extends to the commercialisation of procedures, with practitioners styled after American influencers, promoting not just beauty but a luxury lifestyle complete with private jets and pool parties in Dubai.
Rather than obsessing over miracle drugs, then, perhaps Streeting should encourage society to address the underlying factors driving such procedures. This includes media literacy education, particularly for young people, and more nuanced conversations about body image and self-worth. And it’s worth repeating: this is about more than patient safety. Just as eating disorders, self-harm and substance addiction drive the weak and the vulnerable toward A&E, the dark side of the cosmetics industry will invariably do the same, even if it seduces you with a smile on its face.
