Fresh rules for the cosmetic procedures industry in England are "appalling" and pay "only lip service" to patient safety, warn surgeons.
Ministers have announced new regulations to tackle an industry accused of selling everything from surgery to Botox "like double glazing".
It will become illegal to offer dermal fillers without training and a register of all breast implants will be set up.
But surgeons' groups immediately damned the move as another missed opportunity.
Dermal fillers used to plump up lips and get rid of wrinkles are one major area of contention.
A review of the industry by the medical director of the NHS in England, Sir Bruce Keogh, warned fillers could cause lasting harm, but were covered by only the same level of regulation as ballpoint pens and toothbrushes.
He said they were a crisis waiting to happen and should become prescription only.
However, this will not take place - a move criticised by plastic surgeons.
Rajiv Grover, a consultant plastic surgeon and president of the British Association of Aesthetic Plastic Surgeons (BAAPS), told the BBC: Frankly, we are no less than appalled at the lack of action taken - this review, not the first one conducted into the sector, represents yet another thoroughly wasted opportunity to ensure patient safety.
"Legislators have clearly been paying only lip service to the sector's dire warnings that dermal fillers are a crisis waiting to happen.
"The ability to classify fillers as prescription only would have allowed three birds to be killed with one stone.
"It would effectively have controlled the marketing and sale of these fillers, it would have regulated who can perform these injections and it would have provided an automatic ban on advertising.
"This is an opportunity missed."
Filler
The rise of fillers is one example of how the cosmetic procedures industry had boomed - from £750m in the UK in 2005 to a predicted £3.6bn by 2015 - yet regulations are widely seen as failing to keep pace.
"Win a boob job" competitions, mother-daughter offers and time restricted deals on surgery have also been criticised.
During one of the biggest health scares to face the industry - surrounding substandard breast implants made by the French company Poly Implant Prothese (PIP) - a lack of records meant some surgeons were unable to tell their patients whether they were affected.
Ministers in England said the industry had to change and have announced:
- The Royal College of Surgeons should set standards for the training and practice of cosmetic surgery
- Health Education England to review training for dermal fillers and Botox injections
- Legislation to make it illegal for people without that training to perform non-surgical procedures.
- A registry of breast implants to prevent a repeat of PIP
- A review into a system of redress if things go wrong with treatment
- More rigorous consent process to let patients have time to fully consider their decision to have surgery.
- A clamp down on irresponsible advertising with the help of the Advertising Standards Authority.
Ministers in Scotland, Wales and Northern Ireland will decide separately if they want to introduce any of the measures.
Health minister Dan Poulter used the report's foreword to say: "At its worst, this is an industry that is exploiting people's insecurities, driven only by profits and with no regard to the physical and mental wellbeing of patients."
"So it is hard to believe that, while these procedures can change the way you look temporarily and sometimes permanently, to date there has been virtually no regulation of the industry and no controls over who can perform these treatments or where they are carried out, despite the fact that they can so easily go wrong.
"This is the beginning of a process in which we shall ensure proportionate and appropriate improvements in the industry to better protect the consumers and patients of tomorrow."
Mr Grover added: "With all the evidence provided by the clinical community, choosing not to reclassify fillers as medicines with immediate effect or setting up any kind of compulsory register beggars belief.
"Most shockingly of all, the fact that there is no requirement for the actual surgeon involved to provide consent for the procedure makes a mockery of the entire process.
"It's business as usual in the Wild West and the message from the government is clear: roll up and feel free to have a stab."
In a statement, Sir Bruce Keogh said: "I'm pleased to see today that the government has accepted the vast majority of recommendations and in some cases proposed workable alternatives to make the cosmetic industry safer.
"Plans to bring in training and clear standards for both surgical and non-surgical procedures will go a long way to bringing the improvements we need to see as will looking into the best way to protect people if their treatment in the private sector goes wrong.
"This is the beginning of a journey, not the end, but I am confident these changes will create a much safer and skilled cosmetic industry which should reassure both consumers and practitioners."
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