THE Dermatological Society of Malaysia views with concern recent reports of cosmetic procedures resulting in complications. Our society would like to clarify certain issues relating to this.

The term “aesthetic medicine” and “aesthetic physician” are often used loosely and inappropriately, especially in advertisements. This, despite the fact that “aesthetic medicine” is not a recognised speciality in Malaysia.

The new National Specialist Register has lists of established specialists such as plastic surgeons, dermatologists, ENT (ear, nose and throat) surgeons, etc. But there is no specialist category of “aesthetic physician or aesthetic consultant”. The public should beware of any person calling themselves by that title. Importantly, neither should the media confer that title on anyone. This would only add to the confusion.

“Aesthetic medicine” is an area of medical practice that includes procedures from many disciplines, for example, dermatology, plastic surgery, dentistry, ophthalmology and endocrinology. It is not possible to be proficient in all these speciality procedures, hence there can never be someone who is solely an “aesthetic specialist/surgeon”.

With certain exceptions, cross-speciality work is not recommended. For example, non-dentists should not attempt aesthetic dentistry procedures; gynaecologists should not do facelifts; nephrologists should not perform dermatological procedures.

In the area of aesthetic dermatology, there is often a notion that this is an “easy”, skin-deep speciality, and that anyone can be proficient in it, including beauticians.

In reality, dermatology training requires five years of undergraduate medicine, plus at least seven years of post-graduate study with ongoing training in aesthetic procedures. A short three-day course will not suffice.

Dermatology is not an easy discipline. There are more than 3,000 diseases and one condition can have many different subtle guises. For example, our Asian skin can suffer from many types of facial pigmentation. These can be difficult to diagnose, even by experienced dermatologists.

Some (e.g. Hori’s nevus) are amenable to laser treatment, but others (e.g. melasma) are made worse by lasers. Both Hori’s nevus and melasma can look alike, and if the diagnosis is wrong, attempted laser treatment can make the pigmentation worse. Furthermore, laser treatment of cancerous pigmented lesions (e.g. basal cell carcinoma, melano-ma) may mask the true nature of the disease till it is too late.

Dermatologists are trained in the diagnosis and treatment of diseases of the skin, hair and nails, and some have a special interest in aesthetic dermatology. A full listing of gazetted dermatologists can be found in the “Members” section of our official website, www.dermatology.org.my.

We agree with the Health Ministry’s guidelines that all doctors who perform invasive cosmetic procedures, such as ablative lasers, should be properly trained and accredited.

In 2006, the Cosmetic Dermatology & Laser Medicine Board was formed to set standards of training in this sub-speciality, and to act as an advisory to the public and the ministry on related matters. For more information or advice, the public can write to info@dermatology.org.my.

DR ALLAN K.C. YEE, President, Dermatological Society of Malaysia

Source: NST – January 31, 2008