Unregulated cosmetology clinics in India

Esthetic, derma, skin, and cosmetology clinics have mushroomed across India, offering services such as chemical peels, skin lightening therapies, hair removal and hair transplant, peels, fillers, and Botox injections for anti-aging therapies. With the wellness sector booming in India, experts are pressing for the regulation of this sector to safeguard patients. Such mushrooming of unregulated clinics poses serious risks to patient safety, the association members of the Indian Association of Dermatologists, Venereologists and Leprologists (IADVL) cited at least five deaths and numerous cases of disfigurement and psychological trauma nationwide. The IADVL has called for immediate government intervention and public clarification to prevent further misuse and ensure patient safety in the domain of esthetic medicine.

The wellness clinic is now a big business. Investing in one’s appearance is becoming increasingly common and further fuelled by social media and appearance-related pressures. This is exacerbated by the widespread mistaken perception that cosmetic procedures are easy and safe. The problem with these “clinics” is two-pronged: they are run by practitioners who are not qualified to perform particular procedures, and they are unlicensed or unregistered and lacking tie-ups with full-fledged medical centers. Vulnerable patients, especially women, are being preyed on by unqualified individuals offering procedures without medical training. Low awareness among patients and a burgeoning demand for services contribute to the problem. This is compounded by the rise of social media marketing and online platforms, allowing unscrupulous advertising by clinics to reach vast audiences. In many cities, for instance, advertisements of such clinics dot every wall and lamp post across offering: “Gain back hair in 7 days” or “Skin whitening and tightening in 10 days” with a nameless phone number given below.

Dermatology is a medical specialty that covers diseases and cosmetic concerns related to the skin, hair, and nails. However, the term “cosmetologist” is often misused to mislead the public. Cosmetology is not a medical field; it involves haircuts, makeup, and manicures in layman’s interpretation. It has no clinical or therapeutic component. Precisely, cosmetology is the study of chemistry, pharmacology, biology, and business economics of cosmeceutical ingredients to be useful in the cosmetic industry. Medicine is not a part of it. A dermatologist, however, should have basic knowledge in the field of cosmetology to better understand ingredients, composition, and application of cosmetics or cosmeceuticals.

Three broad categories of unqualified practitioners are driving the surge in unauthorized dermatology and cosmetology procedures. The first are dentists, BDS and MDS graduates, who branch into esthetics after completing short online fellowships or weekend certification courses. These courses barely scratch the surface, yet many start offering complex procedures such as Botox, fillers, or hair transplants. The second group includes practitioners from AYUSH systems who are not legally permitted to practise modern medicine but still administer allopathic dermatological treatments, often without any formal training. The third category is completely unqualified individuals, some with no medical background whatsoever. A fourth, less discussed group includes MBBS or other specialty doctors offering dermatological services despite not being trained in the field. Thus, this is a systemic issue that is putting thousands of unsuspecting patients at risk every day. Several short-term “courses” are offered by fake institutions, where certificates are available for a fee ranging from 1 lakh to 2 lakhs. Quacks then perform the procedures at exorbitant costs, sometimes ten times more than what qualified dermatologists charge.

All clinics performing cosmetic procedures are supposed to follow the National Medical Commission’s (NMC) Guideline on Aesthetic Surgery and Hair Transplant Procedures, which emphasizes that only registered medical practitioners with adequate training may perform cosmetic surgeries. The main problem is that the lines are blurred now. The NMC and the Dental Council are also at odds over the issue. Most of these cosmetic procedures can be performed as simple day surgeries, which makes this branch a lucrative and “safe” business that everyone wants to have a share of. Another issue is clinics performing procedures that they are not licensed for, displaying the names of qualified doctors who may not be present at the clinic, as well as many esthetic centers not having tie-ups with secondary or tertiary healthcare facilities where patients can be referred to in case of emergencies. Experts say that action by the central and state governments has been inadequate for these unregistered clinics: there are police investigations in some cases, and a few clinics have had their licenses cancelled, but this barely scratches the surface of the problem and does little to deter unscrupulous practitioners.

The lack of regulatory oversight has created a fertile ground for malpractice. There are no dedicated bodies regularly inspecting these centers, and enforcement is virtually nonexistent.

Regulation is the need of the hour to safeguard patients. To ensure that no practitioner is offering or performing procedures for which they are not qualified, clinics are licensed and have facilities in place, and that misleading claims and exaggerated advertisements are curtailed. To achieve this, both the central and state governments must take action. We need stricter regulation through a dedicated law in India. Patients, in the meantime, must exercise caution.