Navigating a brave new world

Perhaps there is no field in medicine like cosmetic dermatology, where scientific advances appear to run light-years ahead of ethical analyses f those changes.

Growing patient interest in the power of cosmetic interventions has led to an exponential market demand for fillers, lasers and injections of botulinum toxin. Almost every year there appear to be dramatic appearances of either new lasers or fillers. Currently, Food and Drug Administration (FDA) trials are being conducted evaluating botulinum toxins that may compete with Botox (Allergan).

New creams with a variety of growth factors are said to represent the fountain of youth. This explosive phenomenon may simply coincide with advances in the science of anti-aging. In the alternative, it all might be attributed to America's obsession with celebrity, youth and beauty.

Regardless of its etiology, cosmetic dermatology has gained a foothold in American medicine and culture. Its procedures are now an integral part of dermatologic practice. In fact, procedural dermatology is a newly recognized fellowship program that is now accepted by all of mainstream medicine. At the core of this post-dermatology residency training is not only Mohs skin cancer surgery, but also the myriad aspects of today's cosmetic dermatology.

Because it is largely, if not exclusively, a fee-for-service business, cosmetic dermatology has become one of medicine's few remaining golden eggs. As is the nature of all occupations, where money goes, ethical questions are expected to follow.

Heightened obligations

A recent Archives of Dermatology article sparked a lively debate on such questions. A wide variety of new popular books have also begun to dissect critical issues about the preservation of youth. While critiques of cosmetic dermatology range from the conservative ("leave Mother Nature alone") to the feminist ("beauty infatuations subordinate women"), the inherent "goodness" of our field will ultimately be analyzed by others.

What is clear is that physicians who engage in cosmetic dermatology assume - or should assume - heightened obligations to patients. Hopefully, individual practitioners and professional societies can begin to address these concerns now - before the science of and the social demand for cosmetic procedures race so far ahead of the ethical analysis that it will never catch up.

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