The Aesthetic Guide is part of the Informa Markets Division of Informa PLC

This site is operated by a business or businesses owned by Informa PLC and all copyright resides with them. Informa PLC's registered office is 5 Howick Place, London SW1P 1WG. Registered in England and Wales. Number 8860726.

'High road' supports profession

Article-'High road' supports profession

Dr. Carraway
We have learned that most things, including behavior patterns, conform to a bell-shaped curve distribution, with the large majority in the "median" range and some with one or two standard deviations on the high or low side. Applied to the area of ethics, this means that most of us follow the moral and ethical standards of the profession, but we could push the peak of the curve a little bit more towards the "high side" with a little bit more effort. We could give a nudge or a hand to those in the one or two standard deviations who perform below accepted behavior in this area.

Additionally, we can think more about teaching our residents and medical students how important it is to have a strong ethical approach in their practices.

We see in plastic and cosmetic surgery that some unscrupulous physicians might practice under the name of these specialties, but are not qualified to do so, and this often results in less-than-standard care for the patient. We have ethics committees in our specialty societies which try to help monitor this level of activity, and they depend strongly on information from the colleagues of those who are violators of ethical standards.


Patients often seem to know exactly what they want, but some of them simply come to us for the best advice about doing everything necessary to improve their appearance and self-esteem.

This gives us a lot of latitude and may result in the statement at one end of the scale that, "You really look good and don't seem to need anything" to a preparation of a list of surgical procedures which could carry that patient to a better appearance and sense of self-esteem. There is a lot of room for individual interpretation, and there is an opportunity to push people to do multiple procedures that may have marginal indications if surgeons are less ethical in their approach to these patients.

We additionally are faced with the problem of patients who actually demand more, and we somehow are coerced into doing more, hopefully not beyond what our good judgment and sense of ethics tells us to do.

Marketing, referrals

Some of the advertisements dealing with plastic and cosmetic surgery suggest that such procedures are really very easy to perform and the results are really very good. Sometimes this actually is the case, but not quite in the same sense as the advertising promotions might lead a patient to believe. Consider, for instance, the ads for "instant non-surgical facelifts" or "lunch-time facelifts."

Also, we should consider how we treat patients who come from other doctors. By speaking about the other physicians' treatment in a negative way or by unfairly comparing how good our own techniques are compared to others, it is possible to lure patients into our practice and to try new operative procedures.

Additionally, when patients come from another plastic surgeon to us with either a bad result or complications, it is well to put ourselves in the position of the treating surgeon to understand exactly why this might have occurred. If any one of us ever practices plastic surgery without a complication, it will probably be a first in this specialty.

Some plastic surgeons actually give referral fees to cosmetologists and hairdressers, either in the form of free services or financial remuneration. This is basically a "kickback" mentality and has been outlawed in medicine, both legally and ethically, for many years. Yet, some practitioners promote their practice by getting "word-of-mouth" advertising business from these referral groups. I believe this is an area where we need to help police the specialty, and this type of behavior should be reported to the ethics committees of our plastic and cosmetic surgery societies.

Constant vigilance

There are many other areas where we need to be constantly vigilant.

Hide comments


  • Allowed HTML tags: <em> <strong> <blockquote> <br> <p>

Plain text

  • No HTML tags allowed.
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.