Dr Patrick Bowler
Founder and Fellow Member of the British Association of Cosmetic Doctors

When Patrick Bowler embarked on a career in aesthetic medicine more than 30 years ago, he had no idea he was establishing himself as a pioneer and founding father of the fledgling specialty in the UK.

Dr Bowler was looking for a new direction after becoming disenchanted with government policy around general practice. He was influenced by his dermatology background and the early non-surgical facial treatments that he noticed in his wife’s magazines.

He set up a clinic in a barn at home in 1987, offering injectables and facial treatments, and business boomed. He had already established himself as a supplier of facial creams and lotions and was soon overseeing clinics in Brentwood and London and travelling to Europe and the USA where aesthetic medicine was more advanced.

“Then I noticed an article in a magazine featuring Rita Rakus, promoting aesthetic treatments, so I contacted her. At the time, the GMC was talking about appraisals and revalidation. We were independent and working in a field not recognised by the GMC, so we met up and discussed what we could do,” he said.

The pair put an advert in Pulse magazine for a meeting at the Law Society on 2 October 2001. The event attracted 27 doctors with a shared interest in aesthetic medicine – and the British College of Aesthetic Medicine (BCAM) was born!

The group was initially called the British Association of Cosmetic Doctors (BACD) and soon had a flourishing membership with two key aims: education, developing treatment protocols and systems for appraisal and revalidation.

After initially working extensively with fillers, botulinum toxin became available and he quickly recognised this would be a very popular treatment option. He focused on less invasive treatments than traditional cosmetic surgery, seeing patients who weren’t the usual rich and famous clientele of plastic surgeons.

“The pace of change and innovation made it ever more interesting, treating people with a number of different possibilities. It was interesting and satisfying to see how grateful patients were for any improvements. Even at that time we recognised the importance of properly assessing people psychologically before administering treatments, and patient satisfaction was generally very high.”

Dr Bowler said it was “the start of the wave of media and public popularity” that culminated in him being interviewed on breakfast TV and being involved in the show ’10 Years Younger’ that launched on Channel 4 in 2004.

“Rita was excellent at getting journalists interested in what she was doing, and so it snowballed,” he said. So all this publicity benefited the BACD members providing credibility and increasing numbers of enquiries

Following the foundation of BACD, Dr Bowler said there were “lots of battles to be fought” but the issue of regulation didn’t raise its head for quite some time. Regional forums were established so doctors could consult experienced, like-minded practitioners in their own area for support and advice.

Dr Bowler said educational meetings were well supported, and the group was able to collect meaningful statistics to influence growth and innovation.

Dr Bowler, who holds the BCAM Fellowship, retired from medical practice five years ago but retains a strong interest in the aesthetics sector.

“I was fortunate enough to be involved in setting it up at the beginning, with the vision that aesthetic medicine would grow and develop,” he said.

Dr John Curran

Some of BCAM’s earliest members have remained active in the College throughout its 20-year history, and none more so than Dr John Curran.

Dr Curran was a partner in a large private medical practice during the 1980s and 90s which offered general practice and dermatology services. During that time he developed an interest in laser medicine and decided to pursue it further.

In 2000 Dr Curran opted to practice cosmetic dermatology full-time and joined forces with others at the London-based Plastic Surgery Partners, with a broad offering spanning aesthetic medicine and cosmetic surgery.

He made the switch just as Dr Rita Rakus and Dr Patrick Bowler were discussing the need to pull together colleagues practising in the emerging area of aesthetics, forming the British Association of Cosmetic Doctors (BACD) with a meeting of 27 like-minded professionals at the Law Society on 2 October 2001.

Dr Curran said: “BACD was absolutely essential to the profession when it was formed. We recognised a need for proper unbiased education in the sub-speciality and the benefits of collegiate support in what was often isolated practice. There was also a pressing need for a route to revalidation as doctors in an environment which understood how and why we practised.”

He believes the College has maintained its importance and relevance for those practicing aesthetic medicine, providing a forum for peer-reviewed learning, offering support to practising clinicians and a creating a platform to make political and professional representation with the aim of enhancing patient safety.

The organisation has grown from 27 members to more than 400, all qualified doctors and dentists practising aesthetic medicine. Dr Curran believes the College plays a vital role in driving forward high standards and regulation.

“In 2000 the organisation was a great idea but in 2021 it is absolutely necessary. Patients are at risk in an environment of poor government regulation in our sub-speciality. The role of BCAM as a champion for ethics and excellence in practice and a mouthpiece for regulation, has and will continue to make a difference to patient safety.

“If we do nothing else but bring about better regulation then we will have served the public in the manner they expect of a professional body of medical practitioners,” he said.

Dr Curran has played an active role in supporting his fellow BCAM members with advice and guidance, especially in the complex area of VAT in aesthetic medicine. He hosted a popular breakfast briefing at the start of 2021 to help members understand the importance of recording details of their work to provide evidence to HMRC.

Dr Curran, who lives in Guernsey and runs the successful Healthxchange pharmacy business, has fond memories of the early days of the College when members travelled overseas for one meeting every year.

“Every year we had a meeting in the UK and one abroad. I absolutely loved meeting colleagues over a long weekend in places like Monaco, Majorca and Paris. The events were educational and inclusive but also glamorous in the evenings. There were unforgettable nights, and I am pleased to say I forged friendships which have lasted to this day,” he said.

Dr Hugo Kitchen

Dr Hugo Kitchen was one of the first doctors in the UK to offer injectable aesthetic treatments after setting up the Stratford Clinic in the 1980s, and he believes the support and shared expertise of BCAM has been invaluable over the years.

“I was originally cold-called by the Collagen Corporation of California in 1988, soon after setting up the Stratford Clinic, and was asked if I'd be interested in training to inject this new product for ‘wrinkles and ‘crinkles’. They'd provide a nurse to 'hold my hand', send patients for treatment and pay me a cheque every month,” he explained.

Dr Kitchen’s background in orthopaedics and microsurgery equipped him with the dextrous skills required for aesthetic treatments, and the new income stream was an attractive proposition. The new product - Zyderm Collagen – quickly gained popularity and Dr Kitchen was introduced to Dr Patrick Bowler, a GP who was equally fascinated by this new 'anti-ageing' revolution.

“Together with one or two other excited colleagues, we devised protocols and best practice to share experiences and techniques to better develop this product to give it some UK-based scientific forum and data. It was pretty much 'on the back of an envelope' stuff and Patrick thought it might be sensible to set up a small body to establish a professional brother/sisterhood of medical colleagues to act as a voice to answer questions from our growing number of patients and an increasingly curious media,” he went on.

The British Association of Cosmetic Doctors (BACD) was born and Dr Kitchen played an active role alongside other pioneers of aesthetic medicine such as Dr Rita Rakus, Dr John Curran, Dr Mike Comins and Dr Paul Cronin.

Treatments continued to develop at a pace and Dr Kitchen was invited to the first world teaching seminar in London given by Jean Coruthers, an ophthalmic surgeon from Vancouver who was demonstrating a new product.

“She was showcasing this new treatment called Botox, I never thought it would take off! A poison injected into your face - how I wish I'd bought shares in Allergan then!

“The rest is history. My surgical background diverted some of my interest into emerging new devices for dermatological conditions such as Intense Pulsed Light and lasers, and later new skin peels and a massively flourishing market in skincare and nutrition,” he said.

Dr Kitchen maintained his BACD membership throughout and, as numbers grew, there were twice-yearly conferences in the UK and at stunning overseas locations that offered the opportunity to network with colleagues, exchange stories and case studies and listen to invited speakers from around the world.

“The BACD was a truly professional, registered platform for learning and set a standard for excellence and training. We were of course being watched by members from other medical professions and when dentists created their own British Academy of Cosmetic Dentistry (BACD) we felt it was a time for a new identity and the British College of Aesthetic Medicine was born,” he explained.

BCAM has an established appraisal and revalidation system that many members utilise and which ensures standards and training are maintained as required by the General Medical Council (GMC).

Dr Kitchen said: “If I had a message to any new doctors or colleagues considering taking up aesthetics, it would be to practise within their level of skill and experience and to question any new techniques, products or research attracting them to do otherwise.

“Sometimes patients need to be told ‘no’ because ‘I'm not trained to do that’, or ‘I don't believe the outcome will be in your best interests’. As per our Hypocratic Oath, we are doctors first and businesspeople second.”

Dr. Rita Rakus

When Rita Rakus came to the UK from Australia in 1990 after successfully co-founding a respected high-tech pathology laboratory, she found herself in the midst of the fledgling world of aesthetic medicine.

Dr Rakus began her career in aesthetics by assisting an eminent plastic surgeon in surgery and with early fillers and botulinum toxin injections, and she soon recognised the trends that were set to revolutionise the world of cosmetic treatments.

But while she was learning and innovating, she realised there was no formal training pathway or appraisal and revalidation route in aesthetic medicine – and that was a problem. It didn’t fall into any of the recognised categories, so she and fellow aesthetics pioneer Dr Patrick Bowler decided they needed to take action.

“I was always at the cutting edge, frequently going to the USA and seeing new machines and treatments. They have advanced dramatically over the years, but it’s so important to have really good training programmes too,” she said.

The two doctors met for coffee in London at the Langham Hotel and formulated a plan, literally on the back of a serviette, and the British College of Aesthetic Medicine (then called the British Association of Cosmetic Doctors) was born. The aim was to unite the growing number of doctors practicing aesthetic medicine, providing training and expert professional advice and a route to revalidation.

“When I first started, there was no-one you could talk to if you needed help or advice, it was a no-man’s land. Forming the association was very exciting, it came at the right moment when it was a virgin industry,” she said.

The association brought together doctors from across the UK who could share their expertise and experience as aesthetic treatments rapidly developed, combining science, psychology, and artistry. And Dr Rakus said it had gone from strength-to-strength…

“BCAM is best-placed to provide ongoing education and the best possible training because it has the highest membership criteria, it’s the crème de la crème of associations. Think of it like a Ferrari – would you rather have an F1 driver or a learner driver at the wheel?” she said.

Dr Rakus said the founder members of BCAM had all grown alongside the association, becoming the leading lights in the aesthetics sector.

“That’s the value of BCAM, it has made us leaders in our field and we have been able to share our expertise with others. It’s been a very exciting journey,” she said.

Dr Paul Cronin

BCAM founder member Paul Cronin attributes his career in aesthetic medicine to his mother, who visited a GP for botulinum toxin injections and told him he should learn how to administer them.

“I blame it on my mum, I was doing okay as a GP when she rang me one day and said ‘you need to learn how to do this Botox thing’. She said it would be something different and interesting to do, and it started as a way to earn a bit of extra money but has developed into a life-long career,” he said.

After having started ‘dabbling’ with Botox and fillers in 1999, Dr Cronin was one of a group of medics who attended the inaugural meeting of the British Association of Cosmetic Doctors (now BCAM) in London in October 2001. He immediately recognised the value of talking with fellow doctors about new aesthetic treatments, promoting education and formulating a process of certification for members.

“I was asked to help set up the certification days, which doctors had to attend as part or their membership. One of the key things that’s still relevant today is that aesthetic medicine is very isolated – most people work on their own doing treatments so it’s good to have a network of people to talk to,” he said.

Dr Cronin said the membership criteria was important from the start and the early certification process ensured a minimum standard of practice and quality of care. The College has grown in numbers and stature over the years, and Dr Cronin said it now represented a strong body of medical opinion in the field of aesthetic medicine.

“Above all, BCAM members are a great bunch. We’re the same kind of people, independent and entrepreneurial, and it’s really helpful to work with others who know what you’re talking about,” he said.

Dr Cronin has no hesitation recommending BCAM membership to fellow doctors and believes the College’s huge network of pioneers in the field of aesthetics is of great value, providing shared experience and strength in numbers. He said the training offered by BCAM and its annual conference were both valuable benefits of membership. Dr Cronin continues to provide appraisal services for BCAM and is one of the BCAM Academy mentors helping to guide new members to develop their career.

“At the beginning it wasn’t easy, learning the techniques and finding patients. I was only doing aesthetic medicine half a day a week to start with. I was there at BCAM’s first proper meeting all those years ago. Incredible to think from a group of around 30 people we’ve now grown to more than 400 members.,” he said.

Dr Rajiv Grover

Dr Rajiv Grover is a plastic surgeon and former president of The British Association of Aesthetic Plastic Surgeons (BAAPS). He is an honorary member of BCAM and has lectured to the College and its predecessor, the British Association of Cosmetic Doctors (BACD), more than 10 times since its inception.

Dr Grover has been involved with BCAM since its earliest days and recounts his fond memories of the past 20 years:

“It was a pleasure to be asked in 2002 to lecture to one of the first meetings of the BACD on facial anatomy, facial ageing, and the implications for safe injecting. What struck me about the group was how forward thinking they were, how inclusive and how keen everyone was to raise standards and put a scientific platform in place to underpin the development of this new specialty. Nearly 20 years on I still have many friends from that group who were present at those first meetings.

“The nature of the specialty has changed beyond all recognition in the past two decades. In the 1990s there was little to assist patients with rejuvenation between a face cream and a facelift. The initial injection techniques were limited to botulinum for glabella, forehead, and crow’s feet along with injectable fillers for the lips and nasolabial folds. That pretty much summarised the state of the sector.

“I had previously been introduced to the Restylane brand, having attended its launch on a river boat cruise in the late 1990s where Rita Rakus had been chosen by Q-Med (later bought by Galderma) to demonstrate the product for lip and facial injections. I could see huge potential for this and was enthused to collaborate with Q-Med to research into facial ageing and assist in the development of products for facial contouring with volume rather than just treating lines and wrinkles.

“From my perspective as a plastic surgeon focussing on facelifting, the non-surgical treatments offered a great way to slow down ageing and maintain the results of surgery hence collaborating with BACD/BCAM to lecture and learn was a unique privilege.

“In the first decade of the BACD there were few stipulations about where meetings could be held and how they were funded so part of the fun in lecturing was that the meetings were in exotic locations like Mallorca, Monaco, and Gleneagles. Each was over three to four days with plenty of time for socialising as well as education. This was a great environment for everyone to get know each other and as much was learned and shared by the members in restaurants and bars as was learnt in the lecture theatre.

“In particular, the senior founding members of the BACD (Rita Rakus, Patrick Bowler and John Curran) were very generous to everyone in sharing their learning experiences both in clinical work as well as business skill to assist younger members who were starting out. With changes in the regulation of the pharmaceutical sector these ‘jollies’ became rather more conservative, but the same spirit of camaraderie remains through to this day.

“What has impressed me enormously and kept me enthusiastic to maintain my links with BCAM is their drive to raise standards and develop this sector as a medical specialty in its own right which it deserves to be, perhaps even more so for our patients. For anyone thinking of developing an interest in aesthetic medicine I would strongly recommend their attendance at BCAM meetings and to aspire to become Full Members because it is without doubt the premier association to learn, develop and maintain skills in this sector.

“Other contributors to this 20^th anniversary section have stated the importance of applying the Hippocratic oath to one’s approach and safeguarding the patient’s safety and interests first.  The murky ground between medical treatment and business is critical for us to navigate and still be respected by the GMC and the court of public opinion.

“It has been a pleasure to be associated with BCAM, I have thoroughly enjoyed lecturing and definitely learned so much more than I imparted from the collective wisdom of the members. I thank BCAM not just as a leading medical association but as group of friends.”