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Previously, anything to do with skincare is either completely medical, with doctors look at it from a disease point of view and disregard the treatment value of all cosmetic products; or completely cosmetic, that all problems can be dealt with by cosmetic style skincare without any medical intervention.

The distinction between these 2 approaches are getting narrower and more blurred. The medical sector has research academics working in research departments of universities, while big commercial institutions has funding to hire doctors and researchers specialised in this area to develop new products.

Over the last two decades, with the growing popularity of high energy devices, and different types of injectable therapies, Dermatologists begin to recognise and add to their specialty a sub-division called Cosmetic Dermatology. There are many international medical journals that focus on these areas, and many renowned professors submit their research studies for publications. Gradually, Cosmetic Medicine or Aesthetic Medicine develops into kind of a sub-specialty on its own.

Aesthetic Medicine can be defined as the medical practice of using any non-invasive or minimally invasive treatments, which are evidence-based, in the aim to improve the external appearance of an individual. All such aesthetic procedures should be carried out within the limit of topical and local anaesthetics only.

Aesthetic Medicine has grown very rapidly over the last 2 decades. Patients, or clients, are no longer satisfied with physical, bodily health, but also want to have a good stamina, as well as a minimal impact of aging on their external appearance. They want quick, non-invasive or minimally invasive, relatively safe treatments, with the least downtime affecting their daily routines. At the beginning, it was mainly some low risk procedures like micro-dermabrasion, chemical peeling, then came some high energy devices like lasers, IPL which were used for hair removal, pigmentation and so on. More to follow were the different types of injections such as hyaluronic acid dermal fillers, collagen fillers, botulinum toxin. Apart from treatments on the face, even the body contouring has moved from the traditional salons into medical centres. The rests also include the hair regrowth treatments and dental beautification.

Nowadays in Hong Kong, lots of medical centres and private hospitals provide a whole range of aesthetic treatments, on top of existing plastic surgeries. There are also commercial salons hiring general practitioners to provide these services. Under the current system, any registered medical practitioners can provide treatments of the aesthetic natures, rather than restricted to the reign of dermatologists and plastic surgeons. What is more, there is no stated requirement on the qualifications and the level of experience required, before a doctor can go all out to do aesthetic treatments. 

Few years back, after the DR incidence when someone died as a result of cowboy style irresponsible aesthetic treatments, it was a general consensus that aesthetic treatments should be carried out only by registered doctors. Then the question arose: Is Aesthetic Medicine a specialty? Should it be done only by Dermatologists and Plastic Surgeons? The reality is, apart from these 2 long-established specialties, doctors of any specialties, such as O&G, ENT, or even GP, are all doing some kind of aesthetics to patients / clients.

To become a specialist, a doctor can receive the prescribed training only in the goverment sector, and this public sector provides services to treat only diseases, and no cosmetic treatments will be provided for obvious reason. Therefore, plastic surgery and dermatology basically do not provide much, if any, professional training in aesthetic procedures. These specialists acquire their skills in this aspect through self-training mainly after they have gone into private services.

This viewpoint is also openly acknowledged by Professor Burd, who was the professor in Plastic Surgery of the Chinese University of HK and the consultant in charge of the burn unit in the Prince of Wales Hospital. He proposed that HK should introduce and develop Aesthetic Medicine as a single specialty and allow doctors to receive orientated, professional training in these areas.

Plastic surgeons serve, through surgical interventions, to improve structural abnormalities and thereby regain better functionalities, without too much emphasis, or high expectation, on the cosmetic appeals. During their in-house training, they may not have done a single case of upper eyelid surgery, and high energy devices such as lasers are also without their service or training boundary.

As for the Dermatologists, their training is to treat skin and sexually transmitted diseases, not including any that are of cosmetic natures. It is hardly imaginable that they would treat wrinkles with botulinum toxin during their course of training. When they finally go through some self-training in private practice, they are only marginally better than the general doctors.

Because of their financial or business interest, they argue that aesthetic medicine should be included under the specialty of Dermatology and practised by Dermatologists. They even proposed the terms of genuine or fake skin doctors, labelling those doctors with diplomas or master degree in Dermatology as fake skin doctors.

In reality, any specialist from any specialty, actually does not equal to an aesthetic doctor. What is more, there are lots of Dermatologists know how to deal with only skin and sexually transmitted diseases, while do not provide any aesthetic services.

Unfortunately, we do not have Aesthetic Medicine as a specialty in HK at the moment. Even though there are a lot of these trainings available internationally, the HK Medical Council is too reserved to step forward, in recognising some of these trainings and qualifications. They actually go backwards by banning these from being quoted by doctors. A doctor was recently criticised and sentenced for suspension from the registry, for being quoted as an "aesthetic doctor" in a press article. The absurd reasoning behind was that, such quotation was misleading the public into believing that the doctor concerned was a Dermatology specialist. When a person with balanced mind looks at the situation based on the above, this accusation does not make any sense.

Conclusion

Aesthetic Medicine embraces many different areas, including some minor surgeries, some dermatological science, some high energy devices, some injectable treatments, and some externally applied products. No any one single specialty can alone know it all and provide the whole bulk. When the public is looking for a doctor for such services, for aesthetic reasons, it is more important to look at the actual relevant experience, apart from paying attention to just the qualifications.