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Guidelines on Aesthetic Practices by Doctors
Posted on Thursday, July 24, 2008 - 09:00 PM

For better professional self-regulation of aesthetic practices, the Academy of Medicine, Singapore (AMS), College of Family Physicians, Singapore (CFPS) and the Singapore Medical Council (SMC) shall jointly implement a framework for aesthetic practitioners.

2. The AMS and the CFPS, in unison, have developed the Guidelines on Aesthetic Practices for Doctors ("guidelines"). These guidelines were forwarded to the SMC's Aesthetic Practice Oversight Committee (APOC) which recommended that the SMC adopt the guidelines as professional standards of aesthetic practice. After reviewing both the guidelines and APOC's recommendations, the SMC has decided to adopt these guidelines as professional standards of aesthetic practice. The guidelines will take effect from 1 November 2008.

3. The primary intention of the guidelines is to enhance the safety of patients who seek aesthetic procedures offered by doctors, especially when the procedures involved carry higher risks or have little supporting evidence of efficacy or safety. The guidelines serve as a yardstick for the SMC to determine the professional and ethical conduct of doctors performing aesthetic procedures and will enable doctors who wish to perform aesthetic procedures to do so under appropriate, risk-adjusted regulatory oversight.

4. The guidelines resulted from a rigorous and consultative process by the two professional medical bodies and incorporated the Report of the Workgroup on Recommendations on the Regulation and Training of Aesthetic Medicine in Singapore appointed by the Ministry of Health.

5. The key areas of focus of the guidelines are as listed below. Please refer to Annex A (www.msc.gov.sg) for a summary of the guidelines.

I. Categorising of aesthetic procedures

6. Currently practiced aesthetic procedures will be grouped into two lists: A and B. List A procedures generally have moderate to high level of evidence and/ or local expert consensus that such procedures are well-established and acceptable.

7. List B procedures generally have low or very low level of evidence and/or have local expert consensus that they are neither well-established nor acceptable. Doctors may only perform such procedures either as clinical trials with approval from appropriate research ethics committees, or as before-and-after studies with sufficient scientific rigour to produce conclusive results of the procedures’ efficacy and safety.

II. Training requirements and premises where procedures are performed

8, List A procedures that are non-invasive to minimally invasive may be performed by MBBS-level doctors with certified competence in the respective procedures within the clinic setting. Doctors who wish to perform invasive procedures in List A need to be trained in dermatology, plastic surgery or other surgical disciplines as indicated in Annex A. There are no training requirements specified for List B procedures as these are non-evidence based and therefore any form of training would not be considered legitimate.

III. Administration of aesthetic practices

9. The APOC has been set up by the SMC to establish professional regulatory oversight of aesthetic practices by doctors. Please refer to Annex B for the composition of the committee. In addition to complying with the guidelines, doctors who practise aesthetic procedures would need to comply with additional licensing requirements set by MOH and may be subject to audit as and when needed.

Aesthetic practice by doctors in Singapore

10. The practice of aesthetic procedures has become increasingly prevalent in Singapore, with many new aesthetic procedures coming onto the market in the last few years. There is currently no formal training available for doctors performing aesthetic procedures and many of such procedures have also not been rigorously tested in clinical trials. Injuries sustained from aesthetic procedures also often go unreported.

11. Currently, doctors are bound by SMC Ethical Code and Ethical Guidelines to “treat patients according to generally accepted methods and use only licensed drugs for appropriate indications”. Doctors who do not comply with the guidelines may face disciplinary action by the SMC. However, the present regulatory framework is not ideal as remedial actions are taken only after patient harm has resulted.

12. With the new guidelines, there will be better professional self-regulation of aesthetic practices, and help raise public awareness and facilitate patient decision making when seeking aesthetic services provided by doctors.

24 JULY 2008
ACADEMY OF MEDICINE, SINGAPORE
COLLEGE OF FAMILY PHYSICIANS, SINGAPORE
SINGAPORE MEDICAL COUNCIL

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