Common Problems with Aesthetic / Cosmetic Lasers

Aesthetic and cosmetic medicine is one of the fastest growing segments of medicine today. Non-invasive cosmetic procedures are on the rise. These procedures include neurotoxins, dermal fillers, laser resurfacing, laser removal of hair and tattoos, radiofrequency for skin tightening and more. Injections and lasers used for weight reduction are also an example of a non-invasive cosmetic procedure. As this specialty grows, it becomes even more important to look at the ethical principles associated with this practice.

Clients seeking aesthetic and cosmetic procedures are often influenced by misleading advertisements. This raises questions regarding the ethical principle of autonomy. Autonomy is the respect for the patient’s right to self-governance, choice for care and the right to accept or refuse treatment.1 Autonomy does not exist alone; it is influenced by other ethical principles including beneficence, non-maleficence and justice. The principle of autonomy dictates that the client has the right to make his or her own decision as to what procedure he or she want to have. Therefore, the client’s right to an informed consent must be respected. For informed consent to take place, however, the patient must be given the correct information as to the realistic expectations, the risks involved and the alternative options available to the procedure that has been chosen.

Due to misleading media advertisements, clients will often come to the first consultation thinking they know exactly what procedure they want to have. In reality, it may not give them the optimal results. The advertised procedure may not be correct for their personal skin type or their age, or misleading photographs may promise unrealistic results. The patient may be in an emotional state from an unhappy relationship, facing a career crisis or have body dysmorphic disorder. These individuals will have unrealistic expectations about the capacity of a non-surgical procedure, expectations fed by the unrealistic results displayed in industry photos and advertisements. They look at the procedure as the way to repair a damaged marriage, for that job promotion or for emotional security: “If I just get this procedure, I will be beautiful and happy.” An example is a dark-skinned client coming in and requesting IPL hair removal. For a patient with Fitzpatrick skin type VI, this treatment would be contraindicated. It is up to the practitioner to inform the client why the procedure would put the client at high risk for complications and would not be beneficial. If the client insists, the practitioner must remain ethically bound to refuse even if it means costing them a sale.

The principle of beneficence requires the practitioner to act in the client’s “best interest.” It is important for the practitioner to assess the risks versus the benefits of the procedure, the motivation of the client for having the procedure and how it will affect quality of life.

The principle of non-maleficence requires the practitioner to do no harm and to act in the client’s best interest. The practitioner should be reluctant to perform a procedure on a client who has unrealistic expectations. The practitioner must also, again, discuss the possible side effects of the procedure, the post-procedure treatments and the follow-up procedures that may be required. At this point the practitioner may suggest alternative procedures and treatments that may be more beneficial for the client or refer the client to another medical professional that specializes in other treatments that would yield the desired result. An example would be a patient desiring skin tightening following significant weight loss. This client would be better served by the services of a plastic surgeon rather than attempting to tighten large amounts of redundant tissue with radiofrequency tightening of the skin.

The principle of justice requires the practitioner to be respectful of the client’s wishes, to listen to the client and to educate the client about what to expect from the desired procedure, not just to look at what the practitioner stands to gain financially from doing the procedure.