Dr Paul Charlson
FRCGP MBCAM DRCOG DOccMed DPD President, BCAM
Aesthetic medicine encompasses a range of treatments from skin peels, mesotherapy, laser treatments to thread lifting, minor surgical procedures and injectable treatments. Just because it is “appearance based” does not make safety any less important than for other medical procedures.
In England and Wales, the aesthetic medicine industry is unregulated. Many procedures are carried out in non-clinical environments, by non-clinicians. Psychologist, Johari talked about ‘unconscious incompetence’, which can be applied to practitioners who are unaware that they are incompetent. The annual Doctors appraisal framework, which helps to identify unconscious incompetence, is not universal among other clinical practitioner groups and certainly not in the ‘beauty industry’.
It is not always the practitioner’s fault; there are unscrupulous training providers who provide inadequate training and falsely certify practitioners, so they think they are competent.
Cosmetic practitioner training is voluntary
Any procedure needs to be carried out in a safe environment by an appropriately trained individual. Guidelines around what constitutes an appropriate standard of practitioner and trainer have now been set out by the Joint Council for Cosmetic Practitioners (JCCP) and their standards organisation the CPSA. However, the register of who is trained to the correct standard is voluntary and many practitioners are not registered. But, with these guidelines now in place, there is no excuse for practitioners to be ignorant of what is required.
You really do get what you pay for and research before purchase is vital.
Medical ethics and commercial aspirations don’t always match
In my view, many issues in aesthetic treatment result from the approach of the practitioner. It is about ethics and knowledge. A good practitioner will ensure they have the required knowledge and skills, and operate in an appropriate environment. They will understand about the ethics of medical treatment, which is often at odds with commercial concerns and patient demand. They are able to assess patients for physical and psychological issues which may compromise outcome.
This ethical approach may means excluding patients who might be unsuitable for treatment or referring them elsewhere. I would argue that, without significant clinical training, a practitioner is not able to do this.
Written consent is the bed rock of performing a treatment and again requires a knowledge of effects and side effects of treatment. The problem is many practitioners who get training focus on the technical aspects of performing a procedure rather than assessment, ethics and dealing with post procedural issues.
Young people tend to opt for cheaper practitioners
Ethical considerations are vital in aesthetics where there is massive social media pressure to appear “selfie ready”. This tends to drive the young into asking for treatment. This group often visit budget practitioners. It is difficult to have a viable business charging the prices that are sometimes quoted. Budget practitioners cut corners.
Examples of this might include cheap, poor-quality laser machines or imported dermal fillers or botulinum toxin with no quality controls, lack of adequate insurance and unclean premises with no provision for clinical waste, nor the materials or skills to deal with minor or major medical issues. Often, these practitioners are mercurial with no website or emergency arrangements nor are willing to see patients with issues.
If I was a patient what would I want to know about my practitioner?
I would ask about their clinical background and what training they have in aesthetics. I would enquire how many of the procedures they have performed. On visiting the clinic, I would assess the environment and ask about follow up arrangements. I would consider whether the practitioner has behaved ethically.
It is understandable but concerning that the public are often ‘unconsciously incompetent’ about choosing their aesthetic practitioner. As in many things, you really do get what you pay for and research before purchase is vital.
The British College of Aesthetic Medicine has a list of well-trained Doctors and Dentists on their website www.bcam.ac.uk