American College of Aesthetic and Cosmetic Physicians
History and Politics of Aesthetic/Cosmetic Medicine

Aesthetic / Cosmetic medicine was in its infancy stages in the 1980s and 1990s.  Until recently in the mid 2000 decade, aesthetic / cosmetic medicine has exponentially taken off and is now a very well accepted field of medicine.  The drive of this explosive growth has mainly been due to technological advances.

Aesthetic means “to look pleasing” and Cosmetic means “to beautify an appearance”.

Aesthetic / Cosmetic medicine is a field in medicine that usually involves minimal cutting, no general anesthesia, and patients are usually self pay.  This relatively new field of aesthetic / cosmetic medicine basically involves three main categories.
  1. Injectables - such as Botox and dermal fillers to help decrease the look of the natural aging process.
  2. Lasers - this technology has rapidly surpassed some of the traditional medical training and can be used for a wide variety of applications such as hair removal, vein removal, collagen stimulation, nontraditional liposuction, hair stimulation, teeth whitening, and many more.
  3. Minimally invasive cutting and suturing – These are minor procedures that do not require general anesthesia such as hair transplants and certain skin lifts etc...
Of course, these three categories are presented to simplify a more involved field of medicine.

Aesthetic Medicine is constantly evolving and is not what one learned in medical school.  Traditionally aesthetic and cosmetic medicine has been a field that was exclusive to dermatologist and plastic surgeons.  Currently, physicians from all specialties perform aesthetic procedures.  Within the United States, some states allow medical technicians to do procedures with supervision by a physician.  Similarly, many states also allow nurses to perform procedures with supervision by a medical doctor.  While other states allow these procedures to be performed by nurses without supervision as long as the facility has a medical director present in the building.  However, the majority of states require that only physicians perform these aesthetic procedures.

This is now possible because new technology have made procedures more simple, easier to use, and more accessible to the doctor and patient.  Many previous procedures that required a hospital operating room are now noninvasive and office based procedures.  Since many of these procedures are currently done in private medical offices, hospitals cannot dictate which specialty can do the procedures based on hospital politics or policies.  Another large factor that allows a large variety of physicians to perform these procedures is simply that most patients are “self pay”.  These procedures are considered “elective” or “cosmetic” which are not considered a medical necessity.  This disables insurance companies or the government in determining which type of physician can perform or be compensated for these aesthetic procedures (since insurance companies or the government are not the ones reimbursing these physicians).

With advancing technology and new discoveries in medicine, different medical fields experience changes.  For example, at one time cardiothoracic surgeons were the leaders, authoritative figures, and money makers in a hospital.  With the invention of the stent, cardiologists have literally overthrown these historic giants.  There have been turf wars among specialties for ages.  The best example of this has been seen with interventional cardiologists, interventional radiologists, and vascular surgeons competing to do similar or the same procedures.  Many fields in medicine overlap, this can be seen with a family practitioner delivering a baby and doing well child exams on that baby - thus, taking the job of an OB/GYN and pediatrician.  This can also be clearly seen with a family practitioner performing colonoscopy in a small rural town but being hindered from performing them in large metropolitan cities because of turf wars and politics.

Many specialties feel entitled to different procedures.  However, entitlement does not translate to being more qualified.  [No field of medicine would be foolish enough to criticize each other given the vast array of medical knowledge each specialty holds]  Botox injections or the use of lasers are not beyond the scope of medical knowledge to most physicians who get appropriate training.  This field of medicine was not created to take away from the dermatologist or plastic surgeon that spent countless years of training in their respected field.  The reality is that the plastic surgeon and the cosmetic derma surgeon will never be at a loss of business from other specialties practicing aesthetic / cosmetic medicine.  Dermatologists take care of complicated skin conditions such as cancer and plastic surgeons spend hours in the operating room performing complicated reconstructive surgeries.  These procedures can never be emulated or performed by a non trained physician of other fields.

The danger lies in the fact that since the procedures associated with aesthetic and cosmetic medicine are minimally invasive, this might give healthcare professionals the false sense of being complacent that nothing can go wrong.  This word of caution also applies to the dermatologist or surgeon who might not have been trained in these minimally invasive procedures or use of lasers.  Just because a healthcare provider of any specialty can perform some of these procedures, that does not mean they should.  Health professionals who plan to implement aesthetic / cosmetic medicine into their practice should have appropriate training and understanding of the technology, as well as a complete understanding of the risk and complications associated with the practice of this type of medicine.

The bottom line is that all physicians and healthcare providers who choose to take part in this exciting field of cosmetic and aesthetic medicine are moving forward together and we need to stay ahead of the current technology and remain advocates for patient safety.