What the field now covers
Aesthetic medicine sits between dermatology, plastic surgery and cosmetic practice, and its boundaries are commercial rather than scientific. In practice the term now covers non-surgical interventions intended to change the appearance of skin, facial proportion or body contour, delivered in a clinic setting, usually without general anaesthesia and usually without a period of recovery that stops a person working.
Four families account for most of what is delivered. Neuromodulators reduce the activity of specific muscles. Injectable fillers, most commonly hyaluronic acid, replace or redistribute volume. Energy-based devices, including laser, radiofrequency and microneedling systems, provoke a controlled injury that the skin repairs. Prescription topicals and, less often, oral agents alter skin biology over a period of months.
Around those four sit a growing number of adjuncts: polynucleotides, skin boosters, biostimulatory injectables, platelet preparations and regenerative products of various descriptions. Several are genuinely interesting. Almost all of them are supported by shorter, smaller and more surrogate-heavy evidence than their marketing implies, which is a distinction this journal treats as central rather than pedantic.
Neuromodulators, the best characterised family
Botulinum toxin type A works by blocking the release of acetylcholine at the neuromuscular junction, which reduces the contraction of the injected muscle for a period of months while the nerve terminal recovers. The mechanism is well understood, the pharmacology is well characterised, and the products are licensed medicines with a substantial safety record across both therapeutic and cosmetic indications.
The evidence for reduction of dynamic lines in the upper face is the strongest in aesthetic medicine, which is a statement about that specific claim rather than about every use the product is put to. Off-label facial and body uses vary enormously in how well they are supported, and a patient is entitled to ask which category a proposed treatment falls into.
Two practical points matter more than product choice. The first is that the result depends on where and how much, which is an anatomical judgement rather than a purchasing decision. The second is that these are prescription-only medicines in the United Kingdom, so a prescriber must assess the individual patient before supply. A remote or retrospective prescription is a governance failure regardless of how the treatment turns out.
Fillers, where technique dominates
Hyaluronic acid fillers are gels of a naturally occurring polysaccharide, cross-linked to varying degrees to control how firm, how cohesive and how long-lasting the material is. They are regulated in the United Kingdom as medical devices rather than as medicines, which is a lower evidential bar than many patients assume and one of the more important facts in this field.
The immediate effect is mechanical and therefore reliable in a way that few aesthetic treatments are. The risks are also more serious than in any other injectable family. Vascular occlusion, in which filler obstructs a blood vessel, is uncommon but can cause tissue loss and, rarely, visual impairment. It is a time-critical emergency, and the material difference between a bad outcome and a recoverable one is whether the injector recognises it early and has the means to respond.
That is why the questions worth asking are about the practitioner rather than the gel. Which vessels are at risk in the area being treated, what the early signs of occlusion are, whether hyaluronidase is stocked on the premises, and who answers the telephone at nine in the evening. Practices working under doctor-led protocols make those answers easy to obtain, and in west London Dr Harry Clinic is among the practices structured that way, with a prescriber on site and consultation treated as a separate step from treatment. That structure, rather than any brand of product, is the standard worth looking for wherever you are.
Energy-based devices and the surrogate problem
Laser, intense pulsed light, radiofrequency, microfocused ultrasound and microneedling systems all work on a common principle. They deliver energy that creates controlled damage, and the skin's repair response produces the change. Ablative and fractional lasers have the deepest evidential base, particularly for resurfacing and for specific pigmentary and vascular targets.
The difficulty across the category is that a large proportion of the published work reports surrogate outcomes: collagen density on biopsy, elasticity measured by a device, or a rater's score on a photograph at three months. These tell you the skin responded. They do not establish how much visible change a person will see, how long it lasts, or how it compares with a cheaper alternative. Our explainer on surrogate endpoints sets out why that gap is not a technicality.
Device outcomes are also more operator-dependent and more skin-type-dependent than device marketing suggests. Settings appropriate for one Fitzpatrick skin type can cause lasting pigmentary change in another, and post-inflammatory hyperpigmentation is the most common avoidable complication in this family. A practitioner who asks about skin type, sun exposure and pigmentary history before quoting a price is doing the assessment properly.
Regenerative claims, and how to hold them
The fastest growing part of the field is the regenerative category, which covers polynucleotides, biostimulatory injectables, platelet preparations, growth factor products and exosome-derived preparations. The biology behind several of these is real and is being studied seriously.
The claims made in clinic, though, usually run ahead of the human evidence. Much of the supporting work is preclinical, uncontrolled, short, or measured on markers rather than on outcomes patients would recognise. That is exactly the pattern this journal grades conservatively elsewhere, as in our review of senolytics, where a plausible mechanism and an enthusiastic market coexist with thin human data.
The regulatory position adds a second layer. Products in this category can fall under medicines, medical device or cosmetic rules depending on composition and claimed action, and some have been the subject of regulatory attention in the United Kingdom. A patient is entitled to ask what regulatory category a product occupies and what it is licensed or certified for, and a clinic that cannot answer has not asked the question itself.
What treatments cost, and what price signals
Indicative UK ranges for 2026 give a reference point. A single area of anti-wrinkle treatment is commonly advertised between £150 and £300, multiple areas between £250 and £450. Hyaluronic acid filler is frequently quoted between £300 and £600 per millilitre. Device courses vary far more widely, with a single session of a fractional or microneedling treatment often between £250 and £600 and a course priced accordingly. Ranges outside London are generally lower.
Price is not a proxy for quality, and expensive treatment by an inexperienced injector is worse value than any discount. What price does indicate is the cost structure a clinic is working within. Consultation time, prescriber involvement, stocked emergency medication, insurance appropriate to the procedure and a review appointment all cost money. A quotation far below the prevailing range has removed something, and it is reasonable to ask what.
The decision that actually determines the outcome
Across all four families, the variable that most affects the result is the person holding the syringe or the handpiece, followed by the quality of the assessment that preceded it. Product choice matters, but it matters considerably less than the sector's marketing implies, because products are broadly comparable within a family and technique is not.
A useful consultation does three things. It establishes what is bothering you in your own terms rather than in the clinic's menu terms. It identifies whether the problem is muscular, volumetric, textural or skeletal, since treating the wrong category produces a technically competent result that does not address the complaint. And it includes the option of not treating, which is the clearest single indicator that advice and sale have not been merged.
Everything else follows from that. Establish who is treating you and where their registration can be checked. Ask what happens if it goes wrong and who answers. Insist on time between the advice and the appointment. Those three habits will improve a patient's outcome more reliably than any choice between competing products, and they apply equally to a first treatment and a fifteenth.