Better standards needed for Hong Kong beauty and cosmetic industries
Andrew Burd says regulation of the beauty industry cannot happen without a review of practices in the cosmetic industry, given the troubling areas of overlap between the two
Poets and philosophers have long pondered the nature of beauty. Now medical politicians aspire to enter the discussion with a proposal to explore more regulation of the "beauty" industry. The problem is that there is no clear understanding of what does and what does not constitute a "beauty" treatment. Indeed, is it possible to distinguish between a health therapy, a beauty treatment and a cosmetic procedure?
No review of the beauty industry can take place without a review of the cosmetic industry. While major players in the cosmetic industry are more likely to be members of the medical profession, major players in the beauty industry are more likely not to be. And yet there is a symbiotic relationship between the two, with areas of overlap that constitute a troubling "grey" zone.
Ultimately, when a member of the public, be they a client or a patient, seeks a service from either the beauty or the cosmetic industry, they have an absolute expectation that the provider of the service works within an ethical framework that mandates safety as the first priority.
Looking at the recent cases of serious infections (one fatal) contracted while undergoing invasive procedures in a Hong Kong "beauty clinic", there is no doubt that these were medical in nature.
In the United States, extracorporeal manipulations such as laboratory culture to expand cell numbers cause a redefinition of those cells as pharmaceutical products. Delivery back to the human body has to have the same level of evidence of safety and efficacy as a new drug. Also, facilities where cells are manipulated have to have very strict controls and regulations. The same should apply in Hong Kong.
A sad reality is that the cosmetic industry is as poorly regulated as the beauty industry. Both provide a very valuable service. Both have extremely good practitioners who take pride in their work and in the satisfaction they see in their clients. Both, however, have rogue practitioners motivated more by personal profit and greed than a sense of professionalism.
Deaths have occurred in cosmetic surgery clinics in Hong Kong and, from reviewing the police records, it is obvious that patient safety was not the primary concern of these operating surgeons. After the tragic death of a young woman undergoing cosmetic surgery in a Jordan clinic in 2010, the Medical Protection Society and the Medical Association jointly held a seminar to review the safety of cosmetic practice in Hong Kong. It was at this seminar that I first became aware of Singapore's guidelines on aesthetic practices - setting out the principles regarding who should do what, and where various procedures should be performed.
In July 2010, I wrote to Dr York Chow Yat-ngok, then secretary for food and health, to inquire about the implementation of similar guidelines for Hong Kong. An official wrote to say that the government did not want to intervene in the regulation of professional bodies and the medical profession was autonomous in this respect, essentially regulated by the Medical Council. I was disappointed, as I was concerned about the broad scope of the cosmetic industry that extends beyond the medical profession. But there are also structural deficiencies in the current regulation of medical practice due to the composition and limitations of the Medical Council.
I discussed the response with Dr Choi Kin, then president of the Medical Association, who suggested that if we really wanted to help improve patient safety in the community we could consider setting up some university-based instructional courses for non-specialist practitioners to attend. These are the people who are delivering a significant proportion of the aesthetic medicine in the community and in the "beauty" clinics.
To this end, earlier this year I held preliminary talks with various stakeholders including the Medical Association about the possibility of setting up a post-graduate diploma course in aesthetic medicine. Such a part-time, one- or two-year course would cover such aspects as the definition of aesthetic medicine, legal, moral and ethical issues around its delivery, the pathophysiology of ageing and the rationale of non-surgical treatments.
The response of various stakeholders, including members of the beauty industry, was very positive. The only objections have come from some representatives of two specialties - plastic surgery and dermatology.
Some private practitioners in these specialties make unjustifiable claims to be the exclusive experts in aesthetic medicine and fear the competition to their income. Is it really justifiable to put physician profit before patient safety? Absolutely not.
The Hong Kong public needs to be protected from the greed and lack of professionalism of a minority of practitioners in the beauty and cosmetic industries. At the same time, people need to be protected from false or unrealistic claims in all health- and beauty-related businesses.
How this can be achieved is another matter. Self-regulation is always a problem with inherent conflicts of interest. Legislation is a cumbersome tool. One way forward would be to bring all relevant stakeholders together to explore common ground and build on that. It can be in no one's best interest to be regarded as reckless and dangerous.
Professor Andrew Burd is chief of the division of plastic, reconstructive and aesthetic surgery, department of surgery, Chinese University of Hong Kong