Advice on aesthetic practice for doctors
Correct as of February 2011
The guidance document Guidelines on Aesthetic Practices for Doctors was drawn up by the Academy of Medicine, Singapore (AMS), College of Family Physicians, Singapore (CFPS) and the Singapore Medical Council (SMC), in 2008. This factsheet summarises the professional obligations imposed on doctors working in aesthetic practice.
What is aesthetic practice?
Any aesthetic treatment must go beyond the principle of “do no harm” and be seen to benefit the patient positively
Aesthetic practice is defined as an area of practice involving “operations and other procedures that revise or change the appearance, colour, texture, structure, or position of bodily features, which most would consider otherwise to be within the broad range of “normal” for that person.”
Any aesthetic treatment must go beyond the principle of “do no harm” and be seen to benefit the patient positively.
Limits of aesthetic practice
Aesthetic practice is not seen as a specialty, and so titles such as “aesthetic plastic surgeon”, “aesthetic dermatologist” or "aesthetic physician” cannot be used.
All doctors involved in aesthetic practice should comply with Section 64 and Section 65 of the Medical Registration Act when displaying or using any qualification, title, or designation for publicity purposes.
Classification of aesthetic procedures
The guidance classifies aesthetic procedures into two lists, based on currently available scientific evidence:
- List A – Moderate to high level of evidence and/or local medical expert consensus that the procedure is well-established and acceptable (eg, chemical peels, microdermabrasion, liposuction and rhinoplasty).
- List B – Low or very low level of evidence and/or local medical expert consensus that the procedure is neither well-established nor acceptable (eg, skin whitening injections, stem cell activator protein for skin rejuvenation).
It is not acceptable to experiment or authorise experiments or research which are not part of a formal clinical trial and which are not primarily part of treatment or in the best interest of the patient
For the full list, see Guidelines on Aesthetic Practices for Doctors, pp 2-5.
List B procedures cannot be advertised, and can only be performed under a research framework, ie, as a clinical trial, or as a series of before-and-after studies with enough scientific rigour to show evidence of the procedure’s effectiveness and safety.
Singapore Medical Council’s Ethical Code and Ethical Guidelines states: “It is not acceptable to experiment or authorise experiments or research which are not part of a formal clinical trial and which are not primarily part of treatment or in the best interest of the patient, or which could cause undue suffering or threat to the life of the patient.”
List B procedures should not be performed unless all other conventional or evidence-based treatments and procedures have been used on the patient without good outcomes, and if the doctor reasonably believes the patient will benefit from the procedure and that the proposed treatment poses very minimal or no health risk to the patient. MPS advises doctors to keep detailed records of any discussions about treatment options with patients and their associated risks and benefits.
The SMC recommends that any doctor performing aesthetic procedures has sufficient and appropriate indemnity and should also ensure that their clinical and technical skills are kept up-to-date.
Keep detailed records of any discussions about treatment options with patients and their associated risks and benefits
For List A aesthetic procedures, doctors who have acquired a training certificate but have not performed the requisite number of cases done with good outcomes can submit a notification to the SMC to verify whether they are competent to perform aesthetic procedures.
Doctors who wish to undertake List B procedures must notify the SMC’s Aesthetic Practice Oversight Committee on the designated form before carrying out any such procedures. Doctors providing List B services will be subject to regular audit by the Ministry of Health.
Doctors who perform any aesthetic procedure not in accordance with SMC or MOH guidelines may be liable for disciplinary action by the SMC.