There has been a four-fold increase in the number of people performing botox procedures in Britain.

Researchers from University College London (UCL) have carried out an audit of the number of practitioners offering botox and facial fillers. It comes after the Mirror launched the campaign to Ban the Cosmetic Cowboys to stop the Wild West in cosmetic procedures. The new paper highlights how the botox - full name botulinum toxin - industry operates with "limited regulatory oversight" - despite being a prescription-only medicine.

Lead author Dr Alexander Zargaran said: "The proliferation of botulinum toxin providers who do not have professional healthcare backgrounds raises questions regarding the adequacy of training standards.

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"Our findings show that while more than 90% of those treatments are given in hospitals or clinics, there are a range of non-clinical settings where botulinum toxin - a prescription-only medication - is being administered, including beauty salons, spas, and even mobile setups which might lack the adequate safety infrastructure."

Botox involves injecting the substance using a very thin needle into muscles or skin to temporarily block nerve signals. This process causes the targeted muscles to relax, softening lines and wrinkles. The effect typically lasts three to six months. Possible complications include eyelid drooping, bruising and headaches.

UCL researchers analysed information from websites and social media platforms between January and July last year and identified 19,701 practitioners across 5,589 clinics. This was a 437% increase in the number of practitioners and a 357% increase in the number of clinics compared with the same analysis in 2023.

The study, published in the journal Aesthetic Surgery Journal Open Forum, found that aestheticians who were not medically trained doubled from 12% to 24.8% during the same period.

The Mirror has highlighted how hundreds of unregulated clinics offering cut-price and often dangerous surgical treatments by unqualified staff, sometimes with just hours of training. Rogue outlets have caused life-changing injuries and even cost lives.

Last year, the medicines regulator, the Medicine and Healthcare Products Regulator Agency (MHRA), said it launched a number of investigations following a spike in hospital admissions believed to be linked to the use of unlicensed botox products. Dozens of cases of botulism were confirmed over the summer, with people left "seriously ill" as a result.

Some 28% of practitioners identified in the study were doctors. Doctors charged up to 38% more than aestheticians, dentists charged up to 33% more and nurses charged 4% more. Clinics without clinically trained staff were more common in poorer areas of the country.

Dr Zargaran added: "This study provides the most comprehensive overview to date of aesthetic botulinum toxin practice in the UK. The UK aesthetic medicine market has expanded rapidly, with significant differences in practitioner qualifications and treatment settings across socioeconomic groups."

Following pressure from the Mirror, the Government last year made the term “nurse” legally protected. It is now a criminal offence for people who are not qualified as a nurse to use the title.