Ethics in aesthetic practice: results from a survey of medical doctors attending aesthetic medicine programs in Italy

Background: Within a rapidly evolving digital age in which social media plays a key role, the number of aesthetic medicine procedures performed globally is increasing. Methods: Physicians who participated in training courses in aesthetic medicine in Italy run by two different medical societies SIME (International School of Aesthetic Medicine Carlo Alberto Bartoletti Foundation) and Agorà (Post-Graduate School of Aesthetic Medicine Agorà), completed a survey (November 2023 − January 2024) to assess their viewpoints on ethics in aesthetic medicine and findings combined. Results: Of 452 physicians, 72.6% − 88.2% strongly agreed about the importance of maintaining up-to-date aesthetic medicine knowledge, protecting patient confidentiality, appropriate patient communication, prioritizing patient care and safety, respecting patient dignity and privacy, and obtaining informed consent. Around half of the respondents strongly agreed with correlations between social media (including the use of filters, idealized photos, and the constant sharing of content for personalized feedback) and psychological dysfunctions/body dissatisfaction, and that physicians should examine patients with highly filtered photographs for warning signs and unrealistic expectations. Approximately 15.4% − 55.0% strongly agreed with the importance of focusing on the patient’s best interest, not performing procedures on those with unrealistic expectations, letting patients decide who to involve in consultations, education in key ethical principles in aesthetic medicine (including patient autonomy and self-determination), submitting experimental aesthetic procedures to a territorial ethics committee, and obtaining informed consent from adolescents for their procedures (as well as their parents/caregivers). 43.0% − 52.0% strongly disagreed that it was unnecessary to communicate all treatment information to patients, hear and respect patient opinions, or involve patients in decisions. One-third of respondents reported previously encountering ethical issues for treatment. Conclusion: In a survey of physicians focused on ethics in aesthetic medicine, most strongly agreed with key ethical principles in aesthetic medicine; however, more formal education/training was required to highlight the importance of patient autonomy and self-determination principles, involving patients in decisions, focusing on the patient’s best interest, hearing/respecting patient opinion, avoiding procedures on those with unrealistic expectations, communicating all treatment aspects to patients, letting patients decide who to involve in consultations, and understanding the negative impact of social media on patients.