Change in law on botulinum toxin and cosmetic fillers for under 18s

Fillers and Botox cannot be administered to under 18s for cosmetic reasons in England.

A change in the law means that it is a criminal offence to administer botulinum toxin or a subcutaneous, submucous or intradermal injection or filler for cosmetic reasons to a person under the age of 18 in England.

However, these treatments can be provided or approved by a registered medical practitioner where there is a clinical need.

Regulation and indemnity

Non-surgical, aesthetic treatments have become increasingly popular over the last few years and are easily accessible. There is no regulatory framework in the UK as to who can administer the injections and no requirement for the provider to have insurance. Medical practitioners, dentists, nurses and pharmacists need to comply with the guidance set out by their own professional regulators.

The GMC has specific guidance on cosmetic interventions and doctors also need to have adequate and appropriate indemnity arrangements in place covering the full scope of their medical practice.

Safeguarding children

The Botulinum Toxin and Cosmetic Fillers (Children) Act came into force on 1 October 2021. It aims to safeguard children from the potential health risks associated with botulinum toxin (commonly known as Botox) and cosmetic fillers. The law applies not only to businesses but also to providers of clinical healthcare services and regulated medical practitioners.

  • It is a criminal offence to administer cosmetic fillers to those under the age of 18
  • Permission to go ahead with treatment cannot be provided by someone with parental responsibility for the child.
  • It is also an offence to book appointments or make arrangements to provide treatment to anyone under the age of 18 in England.

Definitions and exceptions

The definitions of cosmetic purposes are set out in the Act and include any substances inserted into the body with the intention of producing a filling effect to change appearance.

An exception to the law is where treatment is provided to under 18s to meet a named clinical need when administered by a registered doctor, nurse, dentist or pharmacist, having been approved by a registered medical practitioner.

The only other exception providing a defence is where the provider takes reasonable steps to establish the patient's age, and reasonably believed they were 18 or over.

MDU advice

When providing cosmetic interventions, ensure you are familiar with the GMC's advice (linked above) and can demonstrate compliance with the standards outlined.

We recommend doctors document very clearly their communications with patients and, where relevant, medical colleagues. Keep us informed about the type of work you are doing so we can ensure you are appropriately indemnified.

For more information, see our related guide on cosmetic procedures.

This page was correct at publication on 14/10/2021. Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.

Dr Kathryn Leask 2023

by Dr Kathryn Leask Medico-legal adviser


Kathryn has been a medico-legal adviser with the MDU since 2007 and is a team leader, trainer and mentor in the medical advisory department. Before joining the MDU, she worked in paediatrics gaining her MRCPCH in 2002 and holds a CCT in clinical genetics. She has an MA in Healthcare Ethics and Law, a Bachelor of Law and a Professional Doctorate in Medical Ethics. She is also a fellow of the Faculty of Forensic and Legal Medicine and has previously been an examiner and deputy chief examiner for the faculty. Kathryn is currently a member of the faculty’s training and education subcommittee and a member of the Royal College of Pathologists (medical examiner).