Controlling the risks faced with the growth of aesthetic medicine
Press release of the French National Academy of Medicine (*)
October 4, 2022
According to recent published data , the global market for medical and surgical aesthetics is growing exponentially and expected to triple in ten years, as shown by an annual growth rate of 8% over the period 2018-2023. It is therefore understandable that the care supply in this field develops and diversifies strongly, with the risk of spiraling out of control and posing a serious problem of competence. Since 1988, cosmetic surgery in France has been a recognized specialty, “plastic, reconstructive and aesthetic surgery”. In their respective spheres and after practical training, surgeons from other specialties (ENT, stomatology, ophthalmology) can also perform some of these aesthetic surgical procedures. The acts of the so-called aesthetic medicine, which is not a specialty in itself, cover a range of treatments, aiming at delaying or even avoiding surgical interventions. Aesthetic medicine is part of dermatologists and specialized surgeons training. Only medical doctors can access a validated additional training in aesthetic medicine. They must be registered on the board of the National Chamber of physicians (Conseil National de l’Ordre des Médecins, CNOM). Aesthetic medicine uses, in particular, injectable products, including botulinum toxin (48.2% of procedures), fillers, such as hyaluronic acid (29.5% of procedures), and energy-based equipment, such as lasers, radiofrequencies or cryolipolysis. Like any medical act, the act of aesthetic medicine first requires a diagnosis and the search for contraindications to this act of physical modification. Aesthetic medicine must therefore be clearly distinguished from aesthetic care performed by beauticians. In particular, injections are prohibited by people (beauticians, bloggers, or others) who are not doctors . Today, these acts of aesthetic medicine are increasingly offered, especially via social networks, by unqualified pseudo-specialists, some influencers even promoting themselves. At the same time, many falsified and therefore dangerous products, but theoretically attractive due to their cheaper price, are circulating. These practices must remain prohibited, requiring the implementation of all necessary means of control.
While the practice of aesthetic medicine by doctors, with appropriate training and respecting the recommendations, makes it possible to limit the associated risks of these acts , the explosion of aesthetic medicine acts carried out by unqualified professionals results in an increasing number of “serious complications” which alert health professionals, such as infections, due to non-compliance with the rules of asepsis, paralysis or skin necrosis, linked to a poorly performed injection, or even deformations.
Faced with the alert of a growing risk of severe complications, the French National Academy of Medicine:
– Recalls that the practice of aesthetic medicine must be restricted to physicians, and proposes that appropriate, demanding and validating training, within the framework of a university or inter-university diploma, be required for new physicians, or specialists without a specific and sufficient training included in their specialty, who wish to move towards the field of aesthetic medicine;
– Calls for compliance with the obligations put in place on May 26, 2021 for manufacturers and importers of aesthetic devices: certification of a device classified as a “medical device” by an approved notified body under the new European regulations; definition of a mandatory training content for the use of the device; registration on the new European portal Eudamed; clinical follow-up, after access to the market, of all reported incidents;
– Recalls that the origin of the injected products must be known and accessible, that the National Agency for the Safety of Medicines and Health Products (ANSM) is responsible for providing the information on the safety of these products, and that the recommendations on the use of injectable products must be made by a health professional (qualified doctor with prescriptions);
– Suggests that the quality of clinical studies carried out by manufacturers should strictly comply with the rules of good clinical practices in these fields, without any conflict of interest;
– Suggests that access to information to find out a specialist authorized to practice aesthetic medicine be rapidly improved. Specific platforms validated by health professionals, such as those of national professional chambers, learned societies or CNOM, and not social networks, must be the reference, free of any commercial advertising, to respond to questions related to aesthetic medicine procedures;
– Suggests that the collection and reporting by doctors, but also “patients”, of serious side effects induced by aesthetic medical procedures be improved, mandatory, and followed by appropriate actions.
 Public health section of the CNOM, Injection of hyaluronic acid: an act reserved for doctors, Médecins, le Bulletin de l’Ordre national des médecins, July 26, 2022, p.11
 Goodman G.J. et al., Facial aesthetic injections in clinical practice: pretreatment and posttreatment consensus recommendations to minimize adverse outcomes, Australasian Journal of Dermatology 2020;61:217-225
(*) Press release from the Academy’s Rapid Communication Platform validated by the members of the Board of Directors on October 5, 2022.
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