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In June 2008, the first cosmaceutical television advert broadcast took place in the UK, featuring Restylane, an injectable dermal filler that claims to smooth wrinkles around the mouth and nose. The official classification of Restylane is medical device by law, but it’s frequent, unofficial classification as a ‘cosmaceutical’ arises from its cosmetic and pharmaceutical function.  

Cosmetic surgery is unique term that refers only to the enhancement of the appearance, toward an aesthetic ideal. Plastic surgery however, is a term used to denote surgery undertaken to correct defects of form or function, including cosmetic, as well as reconstructive surgery. UK consumers invest more in cosmetic surgery than any other country in Europe. In 2005, 19,601 cosmetic procedures were performed on women, compared to 15, 019 in 2004. Cosmetic procedures are also proving increasingly popular with men, who now represent 11% of the total number of procedures compared to 8% in 2004. Rhinoplasties (nose jobs) are the most popular procedure for men, followed by anti-aging procedures such as facelifts, eyelid surgery and brow lifts. Breast augmentation, blepharoplasty and face and/or neck lifts are the top three procedures that continue to proliferate in the UK. The statistics, collated by the British Association of Aesthetic Plastic Surgeons, suggest that cosmetic enhancement is no longer a taboo subject. These figures are also only a partial reflection of the number of operations carried out; whilst the association has 170 members, there are at least double those numbers of surgeons in the UK carrying out procedures that are not members and are therefore not included. Despite escalating popularity, procedures often carry risks and are in many cases costly and sometimes painful so should not be undertaken lightly. As consumers become more determined to achieve the perceived aesthetic ideal, cosmaceuticals are becoming increasingly prominent in our culture.

Cosmaceuticals blur the division between cosmetics and drugs. There are multiple slightly variable definitions of both ‘drugs’ and ‘cosmetics’, but some commonalities do exist. The term cosmetic refers to a preparation designed to enhance the body superficially to hide a real or comprehended deficiency or flaw, by direct application. This application is considered to be decorative, lacking in depth or significance, as opposed to a response to a medical requirement.

The definition of a drug is more complex. Generally, a drug is a chemical substance which, when absorbed into a living organism, alters normal function. Drugs are distinguishable from endogenous substance which originates from within an organism, tissue or cell, by their introduction into the body from outside the organism. Differing meanings are determined by context, by medicine, government and colloquial use, for example. For the purpose of this article, the pharmacology definition of a drug will apply - a chemical substance used in the treatment, cure, prevention or diagnosis of disease or used to otherwise enhance physical or mental well-being, for a limited duration or indefinite period of time.

Individual governments regulate the availability or drugs to the public. Over-the-counter (OTC) medication is available from pharmacies and supermarkets for example, without special regulation or the involvement of medical practioners. Behind-the-counter medication (BTC) medication must be dispensed by a pharmacist, but does not require the authority of a doctor, and finally prescription-only medicine (POM) can only be prescribed by a licensed medical professional.

There are also numerous bodies that regulate drugs in the market place. The Medicines and Healthcare products Regulatory Agency (MHRA), is a government agency responsible for ensuring that medicines and medical devices work and are acceptably safe. They are responsible for public information as well the investigation and handling of complaints and patient feedback, which they encourage. The National Biological Standards Board (NBSB) is a non-departmental public body, established in 1975 by Act of Parliament. The board takes responsibility for safe-guarding and advancing public health by assuring the quality and safety of biologicals, and also manages the National Institute for Biological Standards and Control (NIBSC). This organisation conducts independent testing of biological medicines for the UK market and both bodies respond to and advise on public health issues.

The Association of the British Pharmaceutical Industry (ABPI) is a trade association for more than 75 companies in the UK producing prescription medicines. Its member companies research, develop, manufacture and supply more than 80% of the medicines prescribed through the NHS. The ABPI is also joined by any organisations with an interest in the pharmaceutical market.

Generally speaking, a cosmaceutical will have two uses thus cannot be easily categorised. For example, a shampoo is a cosmetic because it is used to clean hair, which is a superficial choice as opposed to a medical prerequisite. An anti-dandruff shampoo is used to treat a medical condition, as well as to clean hair, so could be considered a cosmaceutical; moisturisers and make-up that provide sun protection are further examples. Whilst cosmaceuticals are required to meet the cosmetic and drug safety standards, the term is not recognised by law; it is often used by cosmetic companies to denote significant medicinal or drug like benefits, allegedly beyond the capability of a regular cosmetic.

Visually, the difference between a cosmetic and a drug is defined by the manufacturer by its intended use, using product labelling. Claims made on labels, in advertising, press releases, on the internet or in any form of promotional material serve to define the use of the product. Use may also be determined by abstract factors, such as the perception of the product in the eyes of the consumer. Ingredients also determination use; a good example of which would be toothpaste which contains fluoride.  These are all key indicators for cosmaceutical products.

The promotion of medical devices direct to consumers is permitted, unlike prescription medicines, which enables manufacturers to advertise via mainstream channels. Q-Med, manufacturers of Restylane, want to take on established cosmetic creams marketed by the likes of L’Oreal and Oil of Olay, claiming their product can produce superior and long lasting results. The first of these adverts was launched on UK television in May 2008, assisted by creative agency Eurocom, enabling the product to reach a much wider demographic. Collette Skilling, marketing director of Q-Med UK, said the product is poised to make an impact in the extremely lucrative and competitive anti-ageing market: “Restylane was the first dermal filler to market over 12 years ago and is now the leading dermal filler worldwide with over nine million treatments performed. Our press advertising has been very successful over the years, but with research now showing increased customer dissatisfaction with creams, we believed that the time was right as market leader to take the initiative and be the first to television with a clinically proven and credible alternative,” said Skilling.

Rather than compete against the colossal budgets of cosmetic giants such as L’Oreal, Q-Med aim to communicate with their audience by marketing Restylane as an ideal solution between the limited affect of creams, and surgery, a step too far in many consumer’s minds, as well as financially or medically unavailable. “We then had to ensure that the production values we attached to the advertisement reflected the quality of the brand and matched or surpassed that of the competitors already established in the medium,” said Tony Chant, managing director of Eurocom. 

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