Dr. Noor Hisham Abdullah : Aesthetic medical practice is not risk-free as many may perceive.
Aesthetic medical practice is popular in the recent years with the influence, partly from the Korea. This consumer driven lucrative “business” is not a medical specialty but an area of interest in medical practice. Public needs to be alert that all aesthetic procedures are not completely safe. It may cause bleeding, infections and even death.
PUBLIC NEED TO BE PROTECTED
Illegal practices are common in unregistered premises. The Ministry of Health Malaysia together with the relevant professional bodies has released the “Guidelines on Aesthetic Medical Practice for Registered Medical Practitioners” in year 2013. However, many may not aware the importance of these guidelines in protecting the public, at the same time, regulating the aesthetic medical practice in Malaysia. With the enforcement of these guidelines, the medical practitioners are subject to the Code of Professional Conduct and other related laws governing medical practice.
“Registered medical practitioner” is defined as a medical practitioner who is registered and holds a valid practising certificate under the Medical Act 1971 [Act 50]
Public should also aware that through these guidelines, medical practitioners are regulated with the scope of practice allowed. They are required to meet the minimum level of competency and are required to register under the National Registry of Registered Medical Practitioners Practising Aesthetic Medical Practice.
According to the guidelines, aesthetic medical practice is defined as:
An area of medical practice which embraces multidisciplinary modalities dedicated to create a harmonious physical and psychological balance through non-invasive, minimally invasive and invasive treatment modalities which are evidence-based.
These modalities focus on the anatomy, physiology of the skin and its underlying structures, to modify the otherwise „normal‟ (non- pathological) appearance in order to satisfy the goals of the patient and are carried out by registered medical practitioners.
CLASSIFICATION OF AESTHETIC MEDICAL PROCEDURES
Aesthetic medical procedures should be supported by scientific evidence and/or have local medical expert consensus that the procedures are well- established and acceptable.
These procedures can be classified into non-invasive, minimally invasive and invasive as follows.
1.Non-invasive procedures : This is defined as external applications or treatment procedures that are carried out without creating a break in the skin or penetration of the integument. They target the epidermis only. Example:
- Superficial chemical peels,
- Intense pulsed light
2.Minimally invasive procedures: This is defined as treatment procedures that induce minimal damage to the tissues at the point of entry of instruments. These procedures involve penetration or transgression of integument but are limited to the sub-dermis and subcutaneous fat; not extending beyond the superficial musculo- aponeurotic layer of the face and neck, or beyond the superficial fascial layer of the torso and limbs. Example:
- Chemical peel (Medium depth),
- Botulinum toxin injection,
- Filler injection – excluding silicone and fat,
- Skin tightening procedures-up to upper dermis (radiofrequency, infrared,ultrasound and other devices) ,
- Superficial sclerotherapy,
- Lasers for treating skin pigmentation, Lasers for treating benign skin lesions, Lasers for skin rejuvenation (including non ablative),
- Lasers for hair removal
3. Invasive procedures: This is defined as treatment procedures that penetrate or break the skin through either perforation, incision or transgression of integument, subcutaneous and/or deeper tissues, often with extensive tissue involvement in both vertical and horizontal planes by various means, such as the use of knife, diathermy, ablative lasers, radiofrequency, ultrasound, cannulae and needles.
The medical practitioner must communicate to the potential patient the risks involved, the possible outcome, obtain valid consent for the aesthetic medical procedure planned, and generally observe all aspects of the Code of Professional Conduct of the Malaysian Medical Council.
Importantly, public must aware that the medical practitioner should provide aesthetic medical services in a healthcare facility licensed or registered under the Private Healthcare Facilities and Services Act 1998 and Private Healthcare Facilities and Services (Private Hospitals and Other Private Healthcare Facilities, Private Medical Clinics or Private Dental Clinics) Regulations 2006.
In addition, medical practitioner is required to have a Letter of Credentialing and Privileging (LCP) for the aesthetic procedure(s) which he/she intends to perform. The LCP shall be issued by the Medical Practice Division, Ministry of Health Malaysia upon recommendation by the Main Credentialing and Privileging Committee of Aesthetic Medical Practice.
Members of the public may lodge complaints on aesthetic medical procedures carried out by a registered medical practitioner.
Malaysian Medical Council or other relevant units in the Ministry of Health Malaysia(MOH) may conduct an inquiry. The Council or MOH after due inquiry, may recommend to the Main Credentialing and Privileging Committee of Aesthetic Medical Practice for review of the Letter of Credentialing and Privileging, and possible removal from the National Registry of Registered Medical Practitioners Practising Aesthetic Medical Practice.
Source: Guidelines on Aesthetic Medical Practice for Registered Medical Practitioners, Ministry of Health Malaysia