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Cosmetic ethics: to treat or not to treat?



In determining whether it's ethical to treat a cosmetic patient, experts tell Cosmetic Surgery Times that the answer involves both clear-cut warning signs and subtler insights into patient motivation and expectations.

Best medicine: prevention


Dr. Matarasso
Ethical decisions are "a situation that every physician, especially those physicians who are involved in cosmetic medicine, is intimately involved with. And it indeed is a very fine line deciding when to treat, when not to treat and how to advise patients," Seth L. Matarasso, M.D., clinical professor of dermatology at the University of California, San Francisco School of Medicine, says. In addressing ethical issues, he says, "The first line of attack is prevention." If one sees red flags during an initial consultation, he explains, it's much easier to disengage at this stage than after one has become medically involved.

"The hardest part of practicing aesthetic medicine is not the procedure, but the consultation — the judgment required." This is according to Vic A. Narurkar, M.D., a San Francisco-based dermatologist in private practice, assistant clinical professor of dermatology at the University of California, Davis Medical Center and president of the American Society of Cosmetic Dermatology and Aesthetic Surgery (ASCDAS).

Sources tell CST red flags include:

  • obsessive-compulsive behavior
  • doctor shopping
  • rudeness or excess flattery
  • sudden whims
  • unkempt appearance
  • litigiousness — for example, a prospective hair transplant patient once told Dr. Matarasso he was suing his boss to pay for his surgery.
  • unrealistic expectations


Dr. Narurkar
"Often," Dr. Matarasso says, "a patient will hold up a celebrity or famous person as someone they're trying to emulate. One must remind them that these people have professional hair and makeup artists — it's all about smoke and mirrors."

"We hear a lot of hype about the nonsurgical facelift, facelift in a jar or lunchtime procedures that can make one look 20 to 30 years younger. This is particularly true with the tissue tightening procedures, which are being promoted without any adequate long-term studies for their safety as well as their true efficacy," Dr. Narurkar says. He says he turns away or suggests alternatives to less than 10 percent of patients.

Consent issues also impact ethical decisions, experts say.

"Cosmetic treatments should really be desired by the individual," Jean D. Carruthers, M.D., clinical professor of ophthalmology at the University of British Columbia, Vancouver, notes.

Dr. Carruthers says, "If one feels a patient doesn't understand what they're asking for, or that they need more time or that they're wanting to have something done and it's not their idea, it's pretty clear that the safest thing to do is explain things to them, give them information to take home," and perhaps revisit the topic in the future.

"I wish more cosmetic surgeons looked at the emotional well-being of the patient before doing surgical procedures. It seems that many patients who come in for liposuction are looking for an 'out' to diet and exercise," Joel Schlessinger, M.D., an Omaha-based solo practitioner and president-elect of the ASCDAS, adds.


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