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Aesthetic and anti-ageing medicine

This fairly new field of medicine is developing fast and there is a really huge confusion as only very few people are fully aware of what exactly this is and the qualifications that must be acquired to be able to practice and respond safely to the client’s needs. I have asked Dr. Joanna Karamon to give us an updated view on this subject and I believe everyone will find it very interesting.
Dr. Maria Alice

Clarifying aesthetic medicine
The term “aesthetic medicine” has in recent years become a very popular description for a plethora of treatments and procedures, with an ever-growing number of individuals calling themselves aesthetic medicine practitioners or specialists, but the general public is often still quite confused as to what aesthetic medicine actually involves.

So to clarify the picture, let’s look at some basic definitions:

Plastic and reconstructive surgery aims to restore the function or correct the appearance of an abnormality resulting from trauma, previous surgical intervention(s), illness or a disease process, or an inherent genetic malformation or deformity.

Cosmetic surgery aims to correct or alter (through invasive/surgical procedures) specific aspects of the face or body which would otherwise have been considered normal and free of disease (i.e. ones that have no specific medical indication) but are perceived as sub-optimal by the individual.

Aesthetic medicine aims to accomplish the same as cosmetic surgery, but through non-invasive or minimally invasive techniques, thus allowing the individual to voluntarily change their physical attributes to suit/accommodate their perceptions of the aesthetic.

Aesthetic medicine has in some ways become a dark horse, viewed by the rest of the medical fraternity as a vanity-driven, unregulated, on-demand service, where the medical ethos of providing care and healing has been turned into the big business of pandering to clients’ whims and wishes to make them “young and beautiful”, whereby non-essential and non-lifesaving medical services and procedures are provided to an elective, paying client. This seemingly “frivolous” pursuit of “beautification”, “upgrading” and “remodelling”, together with the rampant and aggressive commercialisation of such procedures by social and mainstream media, has changed the general perceptions regarding our bodies , which nowadays are seen by many as just another “commodity” or business venture.

Unfortunately, aesthetic medicine is in many countries still not recognised as a legitimate sub-speciality, requiring a structured, uniform and universally recognised training. This has led to many procedures encompassed by aesthetic medicine (most notably being botulinum toxin and derma filler injections), being provided by poorly trained, non-medical personnel, who after doing a four-hour course can effectively call themselves “practitioners” … if not experts!

However, for all their pooh-poohing of the aesthetic medicine field, the medical fraternity is finally recognising that in order to protect the safety and welfare of all patients, some basic guidelines have to be in place for these procedures to be performed correctly and ethically. In fact, the UK General Medical Council issued in June this year specific guidelines to all registered doctors who perform cosmetic procedures, which can be summarised in these seven points:

1. Patient consent: it is the responsibility of the medical practitioner who performs the cosmetic procedure to discuss it with the patient, giving them the information they need to make an informed decision. This responsibility must not be delegated.

2. Time for reflection: patients must be given all the time they need, and all the information they require about the risks and possible outcomes, before deciding whether to go ahead with a procedure.

3. Psychological needs: when discussing cosmetic interventions with a patient, the medical practitioner must consider their vulnerabilities and be satisfied that their request for the procedure is voluntary and not influenced by any other underlying psychological condition.

4. Competence: The medical practitioner must recognise his/her own limits and ask for advice or refer a patient to a colleague if they cannot safely meet their patients’ needs.

5. Information: It is the patient’s right to be provided with all information regarding the procedure to be undertaken; this includes written information to support continuity of care, which explains the medicines or implants used, their possible side-effects and complications, as well as how to proceed if they arise.

6. Treating minors: if the practitioner judges that the child/minor does not want to have the cosmetic intervention, or that it would not clinically or psychologically benefit the minor, then they must not perform it, even if the parent has given consent.

7. Marketing: advertising must be clear, factual and not use promotional tactics that could encourage patients to make ill-considered decisions. It also includes a ban on offering procedures as prizes.

In this consumer-driven world where the customer is always right and money can buy anything, it would be easy to lose sight of one’s moral compass when faced with the lucrative profits an aesthetic medicine practice can provide. In such a setting, it is important to remember that an aesthetic practitioner is still first and foremost a medical practitioner whose conduct should be governed by the moral and ethical standards they pledged to uphold.

As Drs Sterodimas, Radwanski and Pitanguy (world-renowned plastic surgeons) said, “a patient desiring cosmetic surgery should not be assured of getting it on the strength of that desire alone”. How do we ensure then that the services provided by the aesthetic practitioner are more than just (as Atiyeh et al put it) “a mere consumer’s contract instead of a medical act”? The answer is simple: ethics.

It should be the responsibility of the aesthetic practitioner to guide and advise their patients on what procedure is most safe, academically/scientifically sound and correct, and indicated for that particular individual’s concern(s), without being guided by profit margins and/or personal prestige. After all, as Alan R. Nelson, ex-president of the World Medical Association, so aptly put it: “Without ethics our art would allow us to deceive”.

Dr Joanna Karamon
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Dr Joanna Karamon is a consultant in General and Family Medicine.
Diploma Aesthetic Medicine (AAAM). MSc Skin Ageing and Aesthetic Medicine (Manchester University). Medical Director – Aesthetic Department, Luzdoc International Medical Service/Medilagos