Adopted by the 65^th World Medical Assembly, Durban, South Africa, Otober 2014

Preamble

Aesthetic treatments have become increasingly common in recent years as society appears to have become more preoccupied with physical appearance. These treatments are performed by practitioners with widely differing clinical and educational backgrounds.

For the purpose of this statement, aesthetic treatment is defined as an intervention that is performed not to treat an injury, a disease or a deformity, but for non-therapeutic reasons, with the sole purpose of enhancing or changing the physical appearance of the individual concerned. In this statement, the individual undergoing treatment is referred to as the patient. The treatments available include a great variety of interventions, ranging from surgical procedures to injections and different kinds of skin treatments. This statement focuses on interventions that are methodologically similar to those performed in conventional health care. Tattooing, scarring and similar interventions are therefore not considered in this statement.

Body image affects a person’s self-esteem and mental health and is an integral part of a person’s overall health and well-being. However, media images of “perfect bodies” have become the norm, causing some people, to develop unrealistic and unhealthy body images.

Many aesthetic treatments involve risks and may potentially harm the health of the patient. Minors[1] are particularly vulnerable, as their bodies are often not fully developed. In order to protect persons considering or undergoing aesthetic treatment the WMA has developed the following basic principles regarding aesthetic treatments.

Reaffirming the medical ethics principles laid out in the WMA Declaration of Geneva, the WMA Declaration of Lisbon on the Rights of the Patient and the WMA International Code of Medical Ethics, and consistent with the mandate of the WMA, this statement is addressed primarily to physicians. However, the WMA encourages other practitioners performing aesthetic treatments to adopt these principles.

PRINCIPLES

1. The patient´s dignity, integrity and confidentiality must always be respected.

2. Physicians have a role in helping to identify unhealthy body images and to address and treat disorders when these exist.

3. Aesthetic treatments must only be performed by practitioners with sufficient knowledge, skills and experience of the interventions performed.

4. All practitioners providing aesthetic treatments must be registered with and/or licensed by the appropriate regulatory authority. Ideally, the practitioner should also be authorized by this authority to provide these specific aesthetic treatments.

5. All aesthetic treatments must be preceded by a thorough examination of the patient. The practitioner should consider all circumstances, physical and psychological, that may cause an increased risk of harm for the individual patient and should refuse to perform the treatment if the risk is unacceptable. This is especially true in the case of minors. Practitioners should always choose the most appropriate treatment option, rather than the most lucrative one.

6. Minors may need or benefit from plastic medical treatments but pure aesthetic procedures should not be performed on minors. If, in exceptional cases, aesthetic treatment is performed on a minors, it should only be done with special care and consideration and only if the aim of the treatment is to avoid negative attention rather than gain positive attention. All relevant medical factors, such as whether the minor is still growing or whether the treatment will need to be repeated at a later date, must be considered.

7. The patient must consent explicitly to any aesthetic treatment, preferably in writing. Before seeking consent the practitioner should inform the patient of all relevant aspects of the treatment, including how the procedure is performed, possible risks and the fact that many of these treatments may be irreversible. The patient should be given sufficient time to consider the information before the treatment starts. Where the patient requesting the treatment is a minor, the informed consent of his or her parents or legally authorized representative should be obtained.

8. All aesthetic treatments performed should be carefully documented by the practitioner. The documentation should include a detailed description of the treatment performed, information on medications used, if any, and all other relevant aspects of the treatment.

9. Aesthetic treatments must only be performed under strictly hygienic and medically safe conditions on premises that are adequately staffed and equipped. This must include equipment for treating life-threatening allergic reactions and other potential complications.

10. Advertising and marketing of aesthetic treatments should be responsible and should not foster unrealistic expectations of treatment results. Unrealistic or altered photographs showing patients before and after treatments must not be used in advertising.

11. Advertising and marketing of aesthetic treatments should never be targeted to minors.

12. Practitioners should never offer or promote financial loans as a means of paying for aesthetic treatment.