FROM HEAD TO TOE
(continued from page 13) sician will be off-site.
medical Ethics” which described four principles of modern medi-
cal ethics: beneficence, nonmaleficence, autonomy and justice. In
other words, (1) act in the best interest of our patients, (2) protect
them from harm and negligence, (3) ensure they are making their
own healthy choices and (4) assist in a fair distribution of services.
Adherence to these principles offers insight about the ethical prac-
tice of medicine, including aesthetic medicine. Exactly what is a “medical spa” and what services are appro-
priate? Injectables such as Botox and fillers? Laser treatments?
Chemical peels?
Do we as aesthetic physicians/surgeons have any unique ethi-
cal issues we must always consider?
Ideally medicine is meant to help people who are suffering
and who are in need of help. Aesthetic medicine can do the same.
Aesthetic surgery that works only according to market principles,
however, runs the risk of sacrificing its true focus on the needs of
patients. So, might it also risk becoming just part of a beauty in-
dustry enterprise whose primary focus is on selling to consumers
rather than helping people? The notion of aesthetic medicine as a
moral institution based on trust would be in danger of being lost.
Should this happen, patients (consumers) likely will regard
aesthetic surgery as a commodity that is bought rather than a ser-
vice provided by a trained professional. They also may come to
view aesthetic doctors as businesspeople first and physicians sec-
ond. Patients imbue their doctor with a unique level of trust (often
with their lives), and this is the difference between patients and
clients.
In recent years, the rapidly expanding aesthetic field has at-
tracted surgeons from other specialties and even from nonsur-
gical specialties. Aesthetic procedures and surgery may even be
performed by non-physicians who may or may not be qualified to
safely perform such procedures. Since much of this is fee (cash)
for service, where there is more money, more ethical questions
will arise.
At least four factors have contributed to the growing number of
“non-physician providers” of aesthetic procedures: (1) increased
use and acceptance of non-physician clinicians in health care (2)
the great variability of state laws defining the practice of medicine,
(3) the blur between medical procedures and beauty treatments,
and (4) the emergence of hybrid medical spas and retail clinics.
Not only is there a growing use of APRNs and PAs, but also
the increased emergence of non-physician operators like aestheti-
cians, cosmetologists and electrologists.
The beauty and medical industries themselves contribute to
the consumer marketplace ambiguity of who does what. Adver-
tisements portray new cosmetic procedures and devices as magic
wands free of side effects and downtime. The delivery of “health
care” in salons, spas, walk-in clinics and health clubs only adds to
the consumers’ confusion about the medical nature of cosmetic
procedures. A spa might employ a physician to serve as a medi-
cal director. This allows the spa to purchase medical devices and
drugs for performing clinical procedures. It is likely that this phy-
14
LOUISVILLE MEDICINE
One opinion comes from the Medical Board of California:
“There is a tendency for the public, and some in the profession,
to view laser treatments, Botox and cosmetic filler injections as
cosmetic rather than medical treatments. The use of prescriptive
drugs and devices, however, is the practice of medicine, and the
same laws and regulations apply to these types of treatments as
those driven by medical necessity.” 2
On the other hand, do medispas make aesthetic procedures
more accessible to more people, following the fourth ethical prin-
ciple of more equitable distribution of services?
Other issues also present challenges.
1. While new technology continues to bring energy-based re-
juvenation machines to market, sometimes their actual clinical
efficacy is suspect. Some promote “maxi results” with only “mini
treatments.” We physicians feel pressure to keep abreast with the
latest technology so we may make investments based on hope
rather than science. When we market and employ these devices,
are we helping sustain and endorse an imperfect market, being
complicit in dubious claims?
2. Stem-cell enriched fat grafts are marketed for rejuvenation,
with promises that the procedure is reliable, safe and effective.
While there is potential to treat many medical conditions and dis-
eases, whether there is any benefit from almost all types of stem
cell treatments remains unproven. Research is ongoing. Again, if I
endorse an unproven treatment, do I help promulgate an unprov-
en but lucrative business?
3. Social media has become the primary “media influencer”
in the medical arena and not just aesthetic medicine. Prospective
patients demand information, and an aesthetic practice without
a website exists in a vacuum. Medical social media exists outside
the internally protected confines of peer-reviewed literature, lacks
regulatory oversight, encourages informality and provides a for-
mat that makes allowances for hyperbole, hype and style over sub-
stance.
One study found that 70% of people seeking to inform them-
selves about aesthetic surgery relied on the internet as their main
source of information. The quality of the surgeon’s website is the
most powerful influence on their choice of aesthetic surgeons.
Stylistic and aesthetic factors extraneous to medical practice (e.g.,
how well-made the social media page appears) are the drivers. 3
Another survey of US plastic surgery practices’ websites found
that only 40% describe potential complications of procedures. 4
While the primary goal of websites and other social media ap-
plications such as Facebook, Snapchat and Twitter may be to ed-
ucate the public, this phenomenon is more than that. It becomes