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AESTHETIC MEDICINE – THE PAST, PRESENT AND FUTURE

 

Then & Now

In the early seventies, a French doctor, endocrinologist Dr J J Legrand, began a momentum for French doctors on the aesthetic side of medicine alongside mainstream healthcare. The movement grew into Belgium, Spain and Italy, and thereon to the US and the world into what is today the practice and science of aesthetic medicine.

Initially on simple skin care and facial treatment, aesthetic medicine borrowed extensively from mainstream medicine. Fat grafts in orthopedics found new life as compatible long-term fillers to flesh out wrinkles in ageing faces. Chemical peels scrub old cells freeing up fresh ones to glow and grow. Botulinum, a R&D outcome, took off as a popular injection for removing wrinkles and creases.

Today, effective aesthetic medicine, as a minimally invasive practice, is based on doctors having a safe and skilled pair of hands leveraging on reliable leading edge medical technology in new lasers, chemical peels, fillers and injectables of natural or bio-ingredients. It spans surface treatments by chemical peels and lasers to minimally invasive procedures such as thread-lifts, botulinum type A injections, derma fillers, fat grafts and hair transplants.

Difference with Conventional Medicine

Conventional medicine, with hundreds or thousands of years' history, has the primary aim of healing or caring for the sick and ill. When a person is sick or ill, his or her sole aim is to see a doctor to be cured or healed. Since time immemorial, health agencies, health insurers, governments and medical schools worldwide see it as their duty and obligation to build and sustain a medical community capable of delivering conventional medical care for curing and healing such patients.  

Aesthetic medicine has a history of only decades. The average person who seeks aesthetic medical treatment is a healthy consumer. His or her sole aim is to improve their appearance. This difference is so important that we refer to such a person as a "consumer-patient". This person is not a conventional patient. This person is first a healthy consumer and then a patient. So seeking aesthetic medical treatments is a lifestyle consumer decision by the consumer and is not typically covered by health insurance, welfare or employee benefits.

Today, demand for elective aesthetic procedures from healthy consumers seeking to improve their appearances or slow down the visible signs of ageing is large. Even during indifferent economic growth, popular entertainment media and the Internet has stirred up popular demand. Although the average consumer is unlikely to know the difference, aesthetic medicine is minimally invasive, quite unlike invasive cosmetic surgery which is the invasive surgery for face-lifts, breasts implants and high-volume liposuction .

So aesthetic medicine doctors (AM doctors) are in fact treating healthy people, subjecting them to some degree of medical risks in order that these people can look better. The undeniable dilemma for aesthetic doctors, is that medical aesthetic procedures, no matter how minimally invasive, would still carry some risks.  As a result, it is ethically more challenging when practising aesthetic medicine as compared to conventional medicine.

More Than Skin Deep – A Mental Element

Aesthetic medicine bridges the gap between beauty and health. It is important because beauty is not just skin deep. Beauty includes the need to feel good under one's own skin, in having a psycho-physical balance. We cannot ignore the importance of aesthetic from a psycho-sociological point of view, especially when today's society highly rate attractive appearances. So consumer-patients do seek out aesthetic doctors to improve their appearances, perhaps to improve self-confidence or simply to get a job. However, it's a thin mental line for AM doctors to effectively distinguish between the many consumers who are healthy both physically and mentally to undergo aesthetic treatment from the few patients who perceive their own bodies negatively as they have a form of psychosomatic disorder. The latter can become "beauty-obsessed" and seek excessive treatments. The old adage of "too much of a good thing may become bad " rings true for such patients.

Aesthetic Considerations Concern Conventional Medicine
 
Human beings wanting to look good is a universal truth. Even when a sick patient is facing a minor ailment or a life threatening condition, he or she still seek to come out looking as normal as possible. Aesthetic consideration is of relevance even in conventional medicine.

When doctors pause and take a look, they find daily examples of aesthetic consideration in many conventional medical disciplines. Examples such as: when overweight patients consult family doctors for slimming tips; dentists extracting a tooth are asked to whiten teeth yellowed by age or tobacco; young parents-to-be on fertility treatment ask for dermatological treatment for over-active acne; sun lovers removing suspicious moles, ask about skin treatment and wrinkle removals. Even cancer patients, ravaged by effects of treatment, ask if something can be done to make them look better. The list goes on. Then of course, there are medical conditions where conventional medicine itself aims a cure that delivers an improved aesthetic appearance such as - in treatment for congenital malformations, such as port wine stains and strabism.

Then there are examples when different conventional medical disciplines collaborate as a team for better aesthetic outcomes, such as: a surgeon treating cancer of the face with surgery while a dermatologist treat skin texture with medication and creams; a dermatologist curing heavy acne infestation by working with a team of dietician, an endocrinologist, a psychologist, a cosmetologist, a beautician or a gynaeocologist (if the patient is female); or an accident victim with grievous wounds healing with more normal appearances with a team of vascular specialist, angiologist, phlebologist, plastic surgeon, dermatologist, dietician, endocrinologist, physiotherapist, bioclimatologist, orthopedist, physical education instructor, and a rehabilitation therapist.

Aesthetic consideration in today's world is becoming a frequent consideration for many doctors in conventional medicine, even when the doctor is not directly dedicated just to treat healthy consumer-patients look better. Today, doctors across multiple conventional medical disciplines need an appreciation for aesthetic consideration more than ever before as today's patients do care about better aesthetics even when the are looking to be cured or healed of whatever their affliction through conventional medicine.

Spontaneous Growth of Aesthetic Medicine

The root difference that conventional medicine cures and heals the sick and the ill whereas aesthetic medicine is about helping the healthy to look better has major implications.

For centuries, public welfare agencies, governments and medical academia are prioritized, as they should be, towards conventional medicine for curing and healing the sick. Given its noble objective, conventional medicine globally is slower to play a role in standards and helping evidence-based research of aesthetic medicine, which is seen as a less noble form of "lifestyle" consumerism medicine. Conventional academia and professional medical standards bodies have for many years past developed formal board recognition on many conventional medical disciplines. They do these to nurture higher standards and promote research and professional sharing of know-how. For instance, conventional plastic surgery is a long recognized specialty with its conventional practice training on healing or curing via reconstructive surgery for war, accident, or cancer-ravaged disfigurements. The horrible war wounds of the First World War in fact led to many cutting edge plastic surgery procedures and raise the respect and standing of plastic surgeons.

Aesthetic medicine or AM came into being on its own spontaneously over the past decades and was not through the conventional medical academia. AM, being minimally invasive, and delivered in a clinic premises, was, is and can be learnt by peer-to-peer, via courses sponsored by suppliers, or industry-training organizations. Aesthetic medicine is practised by doctors ranging from family doctors to many disciplines in conventional medicine . It is largely self-regulated, with doctors deciding for themselves as to their own level of competence and ability. It remains the aim of AM doctors in the aesthetic medicine community to practise responsibly and ethically to the highest of standards so that the collective performance and urging of this community may over time receive some form of formal recognition by conventional medicine.

For AM Doctors, it's an Ongoing Personal Process

Until aesthetic medicine becomes a conferred medical specialty by conventional medicine, by conventional academia and institutions, or until it becomes a core curriculum in conventional medical schools, aspiring practitioners or AM doctors seeking higher competence of skills have to acquire or continuously work on their competence, on-the-job, or apprenticed or mentored by dermatologists and plastic surgeons, or by experienced aesthetic medicine peers and seniors or by courses with AAAM. For the forseeable future, our community generates its own supply of aesthetic doctors from within the medical community.

However, just by taking courses or passing board assessment tests at AAAM or at any other courses or by peer learning, is not and cannot be the "be all and end all".  Having met our Board standards or passing AAAM courses cannot and do not in any way imply that AAAM is constantly monitoring or taking recurring assessment of the practice competence or standards of its past graduates. Just as no medical schools continue to undertake any ongoing assessments of their graduates after they left school. Doctors must not stop maintaining, learning and honing their skills and they are themselves to be the judge in good faith of their own competence levels. Aesthetic medicine is in part a medical science and an art. It takes competent skills, honed repetitively, experiential feedback and continuous learning and by repetitive practice to build on one's core training in basic medical school training. That is why all participants at AAAM courses must have a basic medical school degree and a valid medical licence from their own jurisdiction. All AAAM courses, certificates or board certifications are not medical licenses to practice medicine. All doctors must seek to comply on an ongoing basis with all applicable licences, competence requirements and approvals in their own jurisdictions.

As for AAAM memberships, doctors all over the world who maintain memberships enjoy privileges when attending our courses and medical congresses and receive our publications.

Doctors Duty to Respond Responsibly and Ethically to Demand

Consumer driven aesthetic medicine, where patients are healthy, electing for aesthetic treatment, paying with their hard-earned discretionary income, is different from conventional "heal-the-patients" obligations.

Misinformation and media hype abounds which can lead consumer-patients to make poor decisions, form unrealistic expectations and under-estimate the medical risks. It is over this situation that AAAM has always felt that the aesthetic doctors community owes a duty to react responsibly and ethically when facing growing numbers of consumer-patients. Any botched cases, or even properly performed cases, but falling short of unreal consumer-patients expectations, will have adverse repercussions for the aesthetic practice community.

The aesthetic medicine discipline grew spontaneously over decades and is relatively young compared to conventional medicine. It is by and large self-regulated. So far AM doctors have been carefully ethical and competent and regulators in many countries have generally left these doctors to self-regulate their own entry into and the conduct of their practice of aesthetic medicine. But with growing number of aesthetic procedures and consumer-patients, some healthcare agencies are considering or have implemented some basic regulations. The aesthetic medical community welcomes these measures as being in the overall good for the AM community and the general public. The AM community has to be ready for some form of basic regulations. When regulators start to see a need to set some regulations, it means at the same time that they start to see it as having a standing in medicine and to regard it as a form of medical discipline - which can only be good news for the community. One way of being ready is to develop an internationally acceptable set of ethics and protocol. Another is to raise funds for the conduct of more evidence-based trials, which is relatively lacking in this sector.

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