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Recent breaking news regarding a local model succumb to death after a liposuction done in an “aesthetic” clinic by a so called “23 years old doctor” is a just a tip of the iceberg on the reality that is plaguing the beauty and medical industry.
The usage of term “medi"spas / “aesthetic”/ “clinic” to boost a beauty centre credibility, many without valid license to operate as a medical clinic, is getting out of control. It is sad that most are not even reported to the authorities. These complications usually end up at the doorstep of plastic surgeons and dermatologists who are then expected to clean up the mess they made.
While it is easy to recognize well established public healthcare centre in receiving adequate and reliable treatment and services as they are under the jurisdiction of our country's Ministry Of Health, in private sectors however, it may not be so easy to do so. With so many beauty centers parading themselves as “clinic”, “aesthetic” and “medispas”, any Tom Dick and Harry now started to claim themselves as “aesthetician” and “beauty doctors”.
The most dangerous ones are those who actually started offering medical and surgical services that should only be done by certified medical practitioners. They are in reality illegal medical practitioners. As expected, many gullible clients end up with devastating sequaelaes and complications at the doorstep of plastic surgeons and dermatologists.
Anything Deeper Than Epidermis Level Is Off Limit To Beauticians
To curb this in the interest of public safety, the ministry has come up with a proper guideline as solution. For those who don't know, aesthetic services in our country has its own guideline. Even certified medical doctors have their own limitations and need to adhere to Guidelines on Aesthetic Medical Practice for Registered Medical Practitioners in Malaysia.
Certain aesthetic services are delegated and can be only be done by certain medical practitioners, on the basis of their training. Not all doctors are being trained to do aesthetic procedures.
Based on this national guideline, the aesthetic medical practitioners are divided into:
1. Core
2. Non Core
"Non Core" group are required to have requisite number of procedures performed for each procedure on case by case basis to be able to offer their expertise in specific procedure that only "The Core" group are allowed to do.
Aesthetic practitioners "Cores" are mainly plastic surgeons, dermatologist, and general practitioners with aesthetic training. Some other specialities also can become a "Core" as part of aesthetic practitioner, provided only in certain selected procedures.They are vascular surgeon, ENT surgeon and breast surgeon.
Not All Aesthetic Medical Practitioners Are The Same
So how does this works? There are 3 levels of aesthetic medical practitioners.
Level I : General Practitioners (With Aesthetic Training)
➡︎ Non Invasive: Chemical peel (Superficial), Microdermabrasion, IPL
➡︎ Minimally Invasive : Chemical peel (medium), Botox, Filler (except silicone and fat), superficial sclerotherapy, Lasers for skin pigmentation, rejuvenation and hair removal, Skin tightening procedures - RF, US, Infrared to up upper dermis).
Level II : Medical Specialities (Core: Dermatologist)
➡︎ Non Invasive: As Level I
➡︎ Minimally Invasive: As Level I
+ PLUS :
➡︎ Invasive: Lasers of vascular lesions, lasers for ablative skin resurfacing, chemical peels (deep), Ultrasound device
➡︎ Cases By Case Invasive Procedures : Hair transplant, Phelebectomy, Tumescent liposuction
Level III: Surgical Specialists (Core: mainly Plastic Surgeons)
➡︎Non Invasive: All Level I & II
➡︎Minimally Invasive: All Level I & II
➡︎Invasive: All Level I & II
+ PLUS
Any plastic procedures and operations that is not mentioned in Level I & II
such as :
Abdominoplasty (tummy tuck)
Liposuction
Fat graft
Rhinoplasty (nose job)
Rhytidectomy (face lift)
Implants - face / breast / buttock etc
Brow lift
Breast surgeries - augmentation, reduction
Blepharoplasty (eyelid surgeries)
To sums it all up, as a plastic surgeon, my scope is not limited by aesthetic procedures that can be done by GP Aesthetician and Dermatologist. In contrary, the scope of procedures of plastic surgery (unless mentioned in level I and II) is off limit to general practitioner aesthetician and dermatologist. The scope of procedures of dermatologist is off limit to general practitioner aesthetician. Same goes to any beautician who are offering such services to their clients. Even non invasive procedures such as chemical peel (superficial), microdermabrasion and IPL need to be done by certified aesthetician and dermatologist at least.
Plastic surgeons, GP Aesthetician and Dermatologist each has their own role and own limitations in aesthetic services. Whats more of a beautician, no matter how trained they are. A person with non medical background will never know how to handle medical complications simply because they are not trained to.
Aesthetic Procedures Has Its Own Risks and Complications
Some of aesthetic complications that I have encountered caused by unlicensed medical practitioners i.e. "quack" since the beginning of my plastic surgery training include penile siliconomas (who would have guessed penile injection is very common among men), nasal siliconoma, implant extrusion, breast filler infection, silicone pneumonitis (lung inflammation due to silicone migration from a buttock filler injection) and also botched nose jobs. Some of these complications are so severe that young plastic surgeon like me dare not to touch further and seek help from our senior plastic surgeons who are willing to handle it.
Know Your Doctors
We know it is not easy to really know and certify whether your doctor in an aesthetic centre is licensed to do your procedure or not. For this matter, our ministry has made National Registry Of Registered Medical Practitioner For Aesthetic Practices list of doctors online. It is quite accurate and even specific for non cores medical practitioners as you can know what type of procedures your doctor is allowed and trained to do.
So before subjecting yourself under the operating / procedure light:
Know what kind of procedure you are going to put yourself into.
Know the invasiveness and the limitation of your beauty centre, aesthetic centre and clinics.
Know the limitations of your beautician and doctors.
For more information on plastic surgery procedures and to find out latest updates about plastic surgery in Malaysia, come visit the official website of Malaysian Society Of Plastic & Reconstructive Surgery at www.msprs.org.my
Remember, safety first. Your safety is priceless and can’t be bargained.
Cheap is always expensive.
Dr Siti Muyassarah Rusli
Plastic, Reconstructive & Aesthetic Surgeon
MD. (KSMU), M.Surg (Plastic Surgery) (USM)
Plastic, Reconstructive & Microsurgery Fellowship (Vienna, Austria)
Stephen S Kroll Fellowship (Gent, Belgium)
Note : This post is my personal view and does not necessarily represent the view of any organization and establishment I am working with officially.