A holistic approach to aesthetics

Lack of regulation and negative headlines have helped tarnish the reputation of aesthetic medicine in recent years, but it wasn’t always thus. Professor Steve Davies, consultant endocrinologist, aesthetic trainer and the director of courses for the Learna Diploma-MSc programmes based in Cardiff, looks back to the sector’s early days and explains why it needs to remember its founding principles

Within the medical profession, aesthetics can sometimes be seen as the poor relation. Its work is often trivialised, and media coverage of aesthetics tends to focus on botched or exaggerated treatments, fillers-gone-wrong and NHS services having to pick up the pieces.

But this view overlooks the fact that aesthetics, while it may not directly save lives, can certainly vastly improve quality of life for all kinds of people with different motivations for seeking treatments.

When aesthetic medicine as we know it today was first established in 1973, coinciding with the founding of the French Society of Aesthetic Medicine and long before the introduction of injectable treatments, there was better appreciation of the importance of a holistic approach to aesthetics. Specialties like endocrinology, dermatology, biokinetics, psychiatry, together with cosmetic surgery alongside principles of art, were appreciated as being fundamental to human aesthetics in these formative years. Not to mention the ethical principles and client-centred approach to treatment that underpins the discipline.

But as the sector has developed, some of these principles seem to have been forgotten. The lack of regulation, combined with the rise in demand for treatment in recent years, has created opportunities for those without medical backgrounds, or adequate understanding of these foundational principles of aesthetics to offer treatments, focusing on capital gain, often at the expense of the patient experience. This has resulted in a more negative perception of aesthetics taking root, something that those of us operating within the sector are keen to correct.

A return to the foundational principles of aesthetics, including broader awareness of what these guiding principles are, will help to shift perceptions of the sector and set it on a clear path for the future.

Ethical principles of aesthetics

One of the guiding principles of aesthetics is the Latin proverb, primum non nocere – first do no harm. Patient safety is of the utmost priority, and all practitioners must endeavour to meet the highest standards of patient care, treatment, and safety.

With the sector still lacking legal regulation, the onus on maintaining these standards falls primarily to individual practitioners, alongside organisations and networks like the Joint Council for Cosmetic Practitioners (JCCP), the British Association of Cosmetic Nurses (BACN) the British Association of Aesthetic Plastic Surgeons (BAAPS) and British Council of Cosmetic Medicine (BACM), which have developed their own tools and resources to promote industry standards, including the JCCP’s PSA government approved register of aesthetic practitioners.

But the chasm created by the loose and often entirely absent regulation in the UK allows for aesthetic treatments to be conducted by those without adequate concern, or an awareness of the ethical factors that are so crucial to aesthetics.

Risk

First and foremost, the risks associated with aesthetics must be considered. As with many medical treatments and interventions, risks are inevitable, and must be minimised and mitigated against. Understanding, awareness, and handling of risk is one of the key characteristics of an ethical cosmetic practitioner.

Awareness of the risks at play in aesthetic practice requires the broader understanding previously mentioned – the ability to look holistically at factors affecting the treatment, the ingredients and equipment involved and the patient’s condition – both medically, physiologically and mentally. This educational background and understanding plays a pivotal role in patient safety. Studies reveal that the increased educational achievement is associated with improved safety across a variety of specialties – this also applies to aesthetics, where understanding of facial anatomy and understanding of products is essential to minimising adverse reactions.

In the absence of regulation, non-healthcare technicians are able to undertake invasive procedures on the face with the potential for disastrous consequences, such as blindness, infection and skin necrosis. All these complications are – where practitioners are informed of risk and how to mitigate against it – potentially avoidable or, if recognised early, reversible.

Experienced aesthetic practitioners undertake their own unique risk assessments for each procedure to identify potential complications and how to resolve them. Through auditing and documenting complications of procedures they perform, they have an idea of their own personalised complication rate, which patients can be informed of in order to give their informed consent. While some may quote standard complication rates to their patients for various procedures, medico-legally this is not adequate for informed consent. This approach originally began in surgery, where surgeons are expected to quote their complication rates to patients who can understand and measure it against national benchmarks1, ensuring that the risks are understood by the patient.

Client-centred approach

A client, or patient-centred, approach is a central principle of aesthetics, and particularly important to consider when it comes to informed consent and ensuring that the patient’s best interests are at the heart of any aesthetic treatment.

Beyond the understanding, assessment, and handling of risk, there are four pillars commonly used within medical ethics that also extend to aesthetics: justice, autonomy, beneficence and non-maleficence.

Justice means allowing people opportunities to live free from stigma, adverse treatment or discomfort based on their appearance. Autonomy refers to the patient’s ability to choose and communicate their aims for their treatment, and while this autonomy and patient-led process is essential, this is also where practitioner advice and consultancy is incredibly important in communicating the procedural process, risk, and any concerns.

Then the last two pillars: beneficence, meaning the treatment must benefit the patient, ensuring improvements for their general condition, wellbeing, self-esteem, mental health; and non-maleficence, managing patient expectations and determining the underlying desire for the treatment, and whether it’s beneficial. This is also where the practitioner must identify that the motivations behind seeking this treatment are healthy and safe.

This principle is in line with the JCCP decision in 2019 to require member clinics to introduce new practices to protect the psychologically vulnerable through assessing patients’ suitability for treatments in an attempt to spot those seeking to alter their appearance due to mental health problems2. Autonomy also means appropriate and informed consent to make a decision about treatment, with clear communication of risks, abilities, complications etc.

These pillars are core to a client-centred approach – where every element of a treatment is discussed with a client, with focus and attention paid to the consultation process, to ensure informed consent and adequately assess suitability for treatment.

The role of the practitioner is to listen to and understand the client’s specific concerns and aims, and offer realistic solutions. Mental health conditions, like body dysmorphia, can affect an individual’s capacity to consent. For this reason, among others, it’s also important to recognise aesthetic treatments as a process and not a single event. The GMC suggests a minimum ‘cooling off’ period of two weeks, giving patients the time to reflect on information and reach a voluntary, informed decision3.

There are a multitude of reasons people seek aesthetic treatment, and it’s one of the elements of aesthetics that makes it quite a unique discipline in the sense that it can be reconstructive, for example, due to trauma or injury, or entirely cosmetic and non-pathological. It also, in the UK, sits almost entirely outside of the NHS.

Even cosmetic, non-pathological treatments that may be deemed less urgent often seek to correct issues that are stigmatising, affect the patient’s confidence and self-esteem, or result in adverse treatment. Or simply seek to fit with contemporary beauty standards. We’ve seen recent spikes in demand for treatment spurred on by the rise of social media and influencer trends, not-to-mention the reported ‘zoom boom’ of the pandemic. Other reasons for the rise in demand over recent decades, aside from the media and influencer driven demand, include the consumer culture and the emphasis and celebration of youthfulness, relative increases in disposable income, and the technological and medical advances in aesthetics and cosmeceuticals.

A holistic understanding of aesthetics

A practitioner’s awareness of the reasons one may seek aesthetic treatments, other factors at play in why they may desire, or how they might to respond to treatments, are all important factors in providing the best possible, individualised patient care. This is where the holistic understanding that medical professionals offer is paramount. The knowledge of anatomy, awareness and understanding of the way that muscles and nerves affect the face and neck, familiarity with safety practices and expertise in clinical interactions are all central to supporting patients with holistic advice and guidance when it comes to aesthetics.

That’s why medics are generally trusted to carry out aesthetic procedures, due to their history of training, awareness of scientifically tested and regulated procedures and treatments, and the high standard of practice, not to mention CPD, maintained in the industry.

This appreciation of the holistic perspective medics can bring to aesthetics makes it a lucrative industry for many medical professionals, with the potential to make a difference to people’s general wellbeing and quality of life without some of the more challenging elements of working in healthcare. Bringing more medical professionals, of diverse specialties, into aesthetics can only be a good thing in terms of broadening understanding within the sector, and enabling clients to access better informed, holistic consultancy and treatments.

A return to these core principles of aesthetics is essential for correcting negative perceptions of the sector, raising standards within the profession and improving client experience, ensuring that their safety and wellbeing is always paramount.

Learna has recently developed and introduced a new fast track assessment for aesthetic practitionersin collaboration with the JCCP, the first of its kind in the UK, providing students with a level 7 equivalent accreditation and enabling them to apply to join the JCCP’s government PSA approved register.

 Notes

1 Healey MA et al. Complications in Surgical Patients. JAMA Surgery. 2002; 137(5): 611-618. https://jamanetwork.com/journals/jamasurgery/fullarticle/212419

2 https://www.theguardian.com/society/2019/apr/27/cosmetic-clinics-to-assess-mental-health-before-offering-botox

3 https://www.gmc-uk.org/ethical-guidance/ethical-guidance-for-doctors/cosmetic-interventions/communication-partnership-and-teamwork#paragraph-24