What to do Before Undergoing an Aesthetic Procedure or Cosmetic Surgery: A Legal Guide

If you are considering to undergo an aesthetic procedure or surgery, there are certainly many matters to consider. After all, it involves someone "tinkering" with your body - not to mention the cash you are about to shell out. In this article, we outline the law on aesthetic medicine in Malaysia, and give some practical steps you may take before undergoing a aesthetic medical procedure.

It was reported in the news recently that a 23-year old woman passed away after a liposuction gone wrong in Kuala Lumpur. The procedure was discovered to have been conducted by a practitioner that was not licensed to conduct such procedures. It is truly shocking that a "simple" procedure could cost the life of a healthy young woman. What is clear is that none of these procedures are as simple as they are made to sound.

Not many people know that in Malaysia, aesthetic procedures must only be conducted by medical practitioners who are specifically registered to practice aesthetic medicine. The law provides that all medical practitioners who wishes to practice in aesthetic medicine must have the requisite experience and qualification to conduct aesthetic medical procedures. This is to prevent mishaps like the aforementioned liposuction fatality.

The Guidelines on Aesthetic Medicine in Malaysia

The Guidelines on Aesthetic Medical Practice for Registered Medical Practitioners ("Guidelines") define "aesthetic medical practice" 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.'

From its definition, we observe that aesthetic medicine encompasses a multidisciplinary, science-based practice, and must only be carried out by a licensed medical doctor, i.e. a medical practitioner holding a valid practising certificate under the Medical Act 1971. The reason for this emphasis is to highlight that aesthetic medicine is more than just an "art", but is also "science" that carries significant risks. As stated in the Guidelines, complications from aesthetic procedures include aesthetic reactions, bleeding, infections, and even death.

The Guidelines divide aesthetic medical procedures into 3 categories, according to their degree of intrusiveness. They are:

Non invasive: procedures that are carried out without creating a break in the skin or penetration of the integument, targeting only the epidermis. Examples include chemical peel (superficial, microdermabrasion and intense pulse light (IPL));

Minimally invasive: procedures that induce minimal damage to tissues at the point of entry of instruments, targeting the sub-dermis and subcutaneous fat. Examples include laser for treating skin pigmentation, laser for hair removal and filler injection (excluding silicone and fat); and

Invasive: procedures that penetrate or break the skin, often with extensive tissue involvement using means such as knife, ablative lasers and needles. Examples include hair transplant, phlebectomy (removal of vericose veins) and tumescent liposuction.

Apart from their varying degrees of intrusiveness, the other distinction is that while all medical practitioners may be allowed (if registered) to conduct non invasive procedures, only medical and surgical specialists can carry out minimally invasive procedures, while only surgical specialists can practise in invasive procedures.

Whichever the category, one thing is clear: those who wish to practice in either category of aesthetic procedure must first of all be a licensed medical doctor who must be specifically qualified and be registered in the National Registry of Registered Medical Practitioners Practising Aesthetic Medical Practice ("Registry").

The 3Cs: What Should You Do Before Undergoing Aesthetic Procedures?

As mentioned above, aesthetic procedures carry risks of injury. That is why one must take appropriate steps before undergoing such procedures. In this section, we list down several recommended steps to take:

Consult: consult with at least 2 qualified aesthetic medicine practitioners and obtain all necessary information and advice before deciding to go ahead with a procedure. A second (or third) opinion helps!

Check: check that the aesthetic medicine practitioners whom you consult and the practitioner who will eventually be conducting the procedures are qualified, licensed and registered with the Registry to carry out the particularprocedure which you are planning to undergo. Just because a practitioner is registered to conduct a laser hair removal (a minimally invasive procedure), it does not mean that he/she is registered to conduct a phlebectomy, for example. The Registry with all the registered practitioners may be found on the Ministry of Health website here (Note: the licence is renewed annually. Thus you will want to check again if the licence of the practitioner has been renewed if your procedure is scheduled to take place in the following year after your checking).

Consent: an informed consent must be obtained from the patient before any medical procedures are undertaken. Aesthetic medical procedures are no different. Ask the medical practitioner as much information as possible on the risks of the planned procedure that you will be undergoing. If possible, get it in writing. Also, highlight to the practitioner any specific concerns that you may have. For instance, if you are undergoing a laser hair removal on your facial area near your nose, you would want to emphasise to your practitioner that the aesthetic presentation of your nose is of paramount importance to your social life (if it indeed is). Since aesthetic procedures are multidisciplinary in nature, there is also a need to obtain information about risks from not just one, but two or more practitioners concerning the procedures. For instance, if the procedure involves surgery and anaesthetic, you will also want to consult and obtain specific risks on the surgery and the anaesthetic processes, and not just on the aesthetic procedure itself.

The views in this article is meant to be a general information, and shall not be treated as advice. © 2020 All Rights Reserved.

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