Dr Katie Grant, a Medical Protection medicolegal adviser, advises on best practice.

Whether you are already regularly performing aesthetic procedures or considering expanding your own area of practice, it is essential you make sure you are doing so safely.

Read this article to: 

• Learn how to practise cosmetic medicine safely 
• Understand the medicolegal risks with aesthetic medicine 
• Learn from a common scenario which might occur during practice

Cosmetic and aesthetic medicine is an ever-changing area of practice, where procedures and technologies often develop rapidly. Against this background, patients who choose to undertake these types of treatments may have particularly high expectations.

Medical Protection defines cosmetic or aesthetic procedures as treatments or procedures which have as their primary purpose the alteration of the non-pathological external appearance of the patient. As such, unlike most medical treatments, these procedures are often not provided to treat specific pathology, but at the request of the patient. However, this does not mean that standards or expectations are lower; you should still provide the best possible care for your patient.

Whether you are already regularly performing aesthetic procedures or considering expanding your own area of practice, it is essential you make sure you are doing so safely. In preparation, you may wish to ask yourself the following seven questions:

1. Have I got the necessary training, skills and expertise?

Doctors working in cosmetic and aesthetic medicine, like in any area of practice, should ensure they have the necessary training, skills and expertise to assess and treat patients. You should work within your own area of competence. Your actions should do no harm and be seen to benefit the patient positively.

2. Am I working within the relevant regulations and guidelines?

For members seeking indemnity for aesthetic practice, Medical Protection expects those individuals to comply with any relevant regulatory/governmental guidelines and to limit the scope of their practice to aesthetic procedures and treatments for which they hold a valid licence or certificate and to those permitted under the terms of their MPS membership, if different.

Failure to meet any of the above may impact your indemnity provision. Please check with your provider. 

If you are not certain regarding your obligations, contact Medical Protection’s team of medicolegal advisers (fellow doctors with legal training) or one of our local legal advisers for expert guidance (please see links and contacts at the end of this article).

3. Am I adequately indemnified?

Appropriate professional protection is essential to protect patients and yourself. The Medical Protection membership team is available to discuss the scope of your practice, our understanding of the type and nature of the procedures you perform ensures you are in the appropriate membership category. Our guidance is different for specialists and non-specialists, so please ensure that the scope of your practice is limited to what is specified in your indemnity provision. 

Medical Protection can also assist with a variety of issues that may arise from your clinical practice, including investigations, complaints and Medical Council matters. 

4. Am I working in an appropriate setting using the correct products and equipment?

 When offering cosmetic treatments (which may be relatively new to the market), you should be mindful of the evidence of their effectiveness and their safety profile, so that you can explore and discuss whether they are suitable for your particular patient. 

In addition, where you work is an important consideration. You should be satisfied that where you are performing the procedures is appropriate, bearing in mind any applicable regulations. Do you have access to the necessary equipment and support in case of a complication or medical emergency? 

5. Have I sought informed consent? Is the procedure medically necessary?

In many cosmetic and aesthetic procedures you will not be curing a disease or treating a medical condition as such, so you should be particularly mindful of the importance of informed consent. Any treatment should still be medically appropriate for your patient. Patients seeking treatment in this area may even be more vulnerable than others. 

You should ensure that the patient is of the age and mental capacity to be able to consent to the proposed treatment. They should be aware of the balance of the risks and benefits of any treatment, and any available alternatives. Consenting is a process, not a one-off event, and patients may benefit from a ‘cooling-off’ period between any initial consultation and agreement to undergo a procedure. 

Patients may occasionally have unrealistic views about possible outcomes or what can be achieved. During your discussions, you should be open and honest regarding this, aiming to make clear the limits of any treatment or procedure. 

Promotional material and advertisements should not be misleading, and must adhere to any relevant regulations.

6. Have I documented everything clearly? 

Detailed and contemporaneous medical records are essential and may be invaluable in the event of a complaint, claim or Medical Council referral. You should clearly document your assessment of the patient (including history and examination), the consenting process, the details of the procedure or treatment performed, and any follow-up advice provided. 

Before discharging the patient, you should consider if they have the necessary information regarding what to expect in their recovery, highlight any potential issues to look out for, and give details of who to contact in case of a problem. 

7. What if the patient has concerns post-procedure? 

Despite your best efforts, sometimes things go wrong. Occasionally, despite a satisfactory outcome, a patient may be unhappy with the treatment they have received. Providing a detailed and conciliatory response may help reduce the chance of a complaint escalating. Medical Protection is able to advise and assist members in responding to complaints, as well as other issues that may arise from their clinical practice. 

Some patients may contact you for advice and treatment if they are dissatisfied with the results obtained from other clinicians. These cases may be more clinically challenging and patients’ expectations may be unrealistic. Of course, you are not obliged to treat patients if you do not feel treatment is necessary, nor should you assist if you do not feel you have the necessary skills or expertise.

Case Study 

A 52-year-old female patient presented to her doctor concerned about her frown lines. She was due to attend a family party and wanted to look “fresher”. 

She consulted with Dr A, who took a history and examined the patient. He suggested use of Botox® to her forehead, and discussed the potential risks and benefits, alternatives and possible outcomes. 

He provided the patient with some written advice to review at her leisure, and asked her to contact the clinic if she wanted to go ahead. 

The patient booked in and had Botox® injections ten days later. Although the procedure went without incident, the patient subsequently contacted Dr A requesting “compensation” as she had developed a “droopy eyelid” on the right side. She said because of this she was too ashamed to attend the party. 

Dr A contacted Medical Protection and a medicolegal adviser and local specialist lawyer assisted in drafting a conciliatory response to the member. Dr A apologised for any inconvenience experienced by the patient, but explained that he had discussed (and documented) eyelid drooping as a risk of this procedure. He was able to refer back to his detailed records and consent form which specifically listed ptosis as a potential complication. Although he empathised with the patient, he did not offer any compensation. He heard nothing further from the patient after sending his response. 

The case mentioned in this article is fictional but is an example of a common scenario that might occur in practice.

Further Information

The Medical Council of Hong Kong

The Hong Kong Association of Cosmetic Surgery

More support from Medical Protection

If you have any queries about the scope of your practice and your current membership grade, please contact Medical Protection on: 1800 815 837