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 and updated in 2016. This factsheet summarises the professional obligations imposed on doctors working in aesthetic practice.
What is aesthetic practice?
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. All doctors involved in aesthetic practice must ensure that the treatments are safe and efficacious in achieving the desired improvement in appearance and well-being.
Designation 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
Doctors are only allowed to perform aesthetic procedures that are covered under the Guidelines. The procedures in question have been grouped into two tables and are further sub-classified into three categories, namely non-invasive, minimally invasive and invasive procedures:
- Table 1 – aesthetic procedures which doctors (non-specialists and other specialists who are not indicated under Table 2) can perform if the requisite number of procedures performed during 1 October 2006 to 30 September 2008 (“the Relevant Period”) are met. If the doctor has not performed the requisite number of procedures in the Relevant Period, he/she will have to obtain a Certificate of Competence (“COC”).
- Table 2 – aesthetic procedures which certain specialists such as Dermatologists, Plastic Surgeons, Ophthalmologists (who are trained in oculoplastic surgery), Otorhinolaryngologists (ENT Surgeons with facial plastic training) and General Surgeons (who are trained in vascular surgery and in procedures such as Phlebectomy and Sclerotherapy) can perform.
For the full list, see Guidelines on Aesthetic Practices for Doctors, pp 6-13.
Doctors must take reasonable care to ensure that their patients do not have psychological or psychiatric illnesses involving self and body image before providing aesthetic procedures to them.
Doctors must not offer or perform aesthetic procedures on minors or persons with diminished mental capacity, unless they have independent professional assessments indicating that these procedures are indeed in the patients’ best interests.
As aesthetic practices do not cure or ameliorate disease and illness, and aesthetic treatments are elective and not medically necessary, doctors must advise their patients of side effects and adverse outcomes beyond those that are more common, For the purpose of obtaining consent, doctors must disclose risks that are lower than those required to be disclosed in conventional medicine. For the more invasive and surgical procedures, there must also be a reasonable “cooling off” period between patients giving consent and the treatment.
Singapore Medical Council’s Ethical Code and Ethical Guidelines requires doctors to provide treatment in accordance with generally accepted methods and 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.”
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.
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.
Members undertaking aesthetic procedures should check the scope of cover with their indemnity provider.
Note: The Guidances do not apply to beauty parlours, since these are not regulated by the Ministry of Health. Doctors are strongly advised to take advice from their defence body regarding the implications of affiliating themselves with such establishments.