Ethical Aesthetics Practice

How to remain Ethical in the aesthetics industry.

Compared to traditional medical practice, aesthetic medicine presents unique ethical challenges. In this consumer driven industry, heavily influenced by social media and the commodification of beauty, the traditional doctor-patient relationship has been turned on its Head. Ethical and clinical risk in this industry remains challenging. From the supply and storage of prescription only medicines, the advertising and marketing of products and treatments, consent and confidentiality, to accountability and managing conflicts of interest. Training courses rarely address these issues and practitioners are all too often left alone to navigate these sensitive topics.

There are hundreds of aesthetic procedures available, each one has different indications and side effects. There are even many treatments with limited evidence base, and therefore it is not always clear which treatment is in the best interests of the patient. Patient choice and budget adds further confusion and complicates the decision making process.

Patients can only make informed choices when they are given the relevant and important information, but managing patient expectations can be somewhat more difficult due to the influence of social media and access to web-based information that is not always reliable. Advertising and marketing aesthetic services, particularly on social media platforms such a TikTok, Instagram, and Snapchat can have a hugely detrimental impact on self esteem and body image, particularly when images are subject to manipulation by use of filters and photo-editing programs that promote unrealistic expectations. The JAMA facial plastic surgery reported that the use of filtered images on social media was blurring the line between reality and fantasy and potentially acting as a trigger for BDD, and the development of unrealistic expectations in patients.

The perpetual bombardment of discounted prices, marketing strategies to up-sell treatments such as 2 for1 offers can only push our industry into the shady grey of borderline unethical practices and ultimately having a negative impact on patient health and wellbeing.

The ASA Advertising Standards Authority has published guidance on the marketing of surgical and non-surgical cosmetic procedures. This includes exaggerated or unrealistic claims particularly with the use of before and after images, the trivialisation of certain procedures and the advertisement of prescription only medications. When using online marketing strategies, one must consider the effect on children, those under 18yrs and vulnerable adults. GMC rules state that marketing material for cosmetic procedures must be factual, clear and not misleading. Promotional activity must not target children and young people and must not try to pressure potential patients into making rushed decisions, for example, by using time-limited special offers. Patients should be given time to consider their decisions and be informed that outcomes vary from person to person. Honestly and transparency is an absolute must.

The Foundations of every Aesthetic Doctor or practitioner should be firmly rooted in ethics and safety. In my opinion every patient should be assessed as an individual, and thorough face to face patient assessment should form the cornerstone of every consultation. This includes assessment of patient needs and expectations, with an evaluation of physical and psychological health.

BDD body dysmorphic disorder is a mental health condition according to the NHS. It is an anxiety disorder related to body image and closely related to OCD where patients spend an unreasonable amount of time worrying about the flaws in their physical appearance, resulting in the development of compulsive and repetitive behaviours that disrupt their daily life. We as a profession must be able to refuse treatment when the risks clearly outweigh the benefits.

The consultation is the most important part of the process. Patients need to be made aware of all common complications and more serious risks specific to individual treatments and procedures. Informed consent is an absolute requirement and must be recorded and signed by the patient and the practitioner. Failure to obtain such consent could risk allegations of assault and therefore the process of consent protects both the patient and the practitioner. Patients should always be given the opportunity to ask questions, and not feel pressurised into any treatments. They should be given a summary of the risks versus the benefits of each proposed treatment and once they confirmed that they have understood the risks they should be allowed to decide in their own time. Consent should be done during a face-to-face consultation and at the same time maintaining detailed medical notes and pre/post treatment photographs. It is important to always remain honest, transparent and confidential. Financial incentives should never take priority over patient safety.

Cosmetic treatments often involve the use of prescription only medicines. The prescriber must always adhere to prescribing guidelines. It is illegal to advertise a prescription only medication and professional bodies such as the GMC, GDC and the NMC have banned the use of remote prescribing.

Guidance on SAFE, ETHICAL, LEGAL and RESPONSIBLE prescribing is available from the JCCP (the joint council for cosmetic practitioners).

The responsibility of the prescriber must be remembered, even when delegating treatment to other practitioners it remains the responsibility of the prescriber for oversight, managing outcomes and reporting of adverse events.

Doctors and Dentists are eligible to hold stock of prescription medication that has not been dispensed by a pharmacist. Use of these medications by other staff within the same organisation must include a PSD (patient specific direction) and administration of these medications must be in accordance with the PSD. Yet here we are asking ourselves, how many practitioners and clinics comply with these regulations.

Aesthetics training courses for medical professionals only. It is my belief that only medical professionals can truly understand the complexities of combining aesthetic procedures for bespoke treatment plans and optimal results. Aesthetics isn't just an ART, it is based on founding principles of science and medicine, and ethics. It requires a deep understanding, with study and knowledge of anatomy, physiology, and clinical practice.

We are educating the practitioners of the future who will carry the torch for ethical aesthetic practice and push the boundaries of aesthetic treatments and outcomes.

It is at this juncture that we will change the face of our profession and win the respect and approval of our patients and the public.

At Aesthetics HQ we have a vision of a regulated Aesthetics industry with the highest safety standards. I have spent the last 20 years in this medical speciality, and I continue to learn, expand my knowledge, and develop new skills. It remains my opinion and the opinion of many of my esteemed colleagues that Aesthetic medicine should remain firmly in the hands of those who uphold professional status and maintain the highest professional and ethical standards driven by research and clinical audit.

Every one of my patients is different, with different facial shapes and contours, different skin quality and texture, different degrees of symmetry and balance. And each of them displays a different tissue response to treatments, with varying degrees of tissue expansion and regeneration. This is why at Aesthetics HQ London Academy we encourage all our trainees to think independently, formulate personalised treatment plans with combination treatments using the safest injection techniques. But most of all we encourage our trainees to practice Aesthetic Medicine with a moral and ethical compass that keep them within the boundaries of professional guidance and the law.

Dr Abdul Naem

GP Surgeon and Expert Aesthetics Trainer

myskindoctorlondon.com

aestheticshqlondon.com