Evidenced based Aesthetic Primary Care Forum 3 Oct 2015

Aesthetic Medicine 1.Aesthetic Medicine 2.Science and evidence of Aesthetic Medicine 3.Aesthetic Medicine in Singapore 4.The future of Aesthetic Medicine

Definition of Aesthetic Medicine There is currently no internationally accepted definition of aesthetic medicine

Definition of Aesthetic Medicine UK – “Operations and other procedures that revise or change the appearance, color, texture, structure or position of badly features, which most would consider otherwise to be within the broad range of ‘normal’ for that person” USA –”a subspecialty of medicine and surgery that restricts itself to the enhancement of appearance through surgical and medical techniques. It is specifically concerned with maintaining normal appearance, restoring it, or enhancing it beyond the average level toward some aesthetic ideal”

American Academy of Aesthetic Medicine First coined by Dr JJ Legrand, a French Endocrinologist in the early 70s A new medical discipline that involves multidisciplinary collaboration to provide answer to the total aesthetic needs of the community Aesthetic medicine exalts the association between health and beauty because beauty means to “feel good under one’s own skin and to have a perfect psychophysical balance”

Growth of Aesthetic Medicine Prevailing culture to prolong youthfulness and self image Increase disposable income Technological and medical advances with minimal downtime and complications Social acceptance, taboo no more Media driven demand and promotion

Aesthetic Medicine Cosmetic Surgery Breast augmentation Rhinoplasty Blepharoplasty Liposuction Abdomnioplasty Cosmetic Dermatology Topical Creams Chemical Peels Laser / Light Rejuvenation Botulinum Toxin injection Soft Tissue Fillers Laser / Light Hair removal

American Society of Aesthetic Plastic surgery 2014 US figures $12 billion on surgical and non surgical procedures / year 10 million cosmetics procedures/ year 91.4% women More men are turning to aesthetic procedures, surgical and non surgical

Most Popular Procedures – Men & Women Top 5 Surgical Procedures Liposuctions 342,494 Breast Augmentation 286,694 Eyelid surgery 165,714 Tummy Tuck 164,021 Nose surgery 145,909 Top 5 Non Surgical Procedures Botox 3,588,218 Hyaluronic Acid 1,696,621 Hair removal 828,480 Chemical Peel 484,053 Mircodermabrasion 417,034

Aesthetic Medicine 1.Aesthetic Medicine 2.Science and evidence of Aesthetic Medicine 3.Aesthetic Medicine in Singapore 4.The future of Aesthetic Medicine

Evidence based Aesthetics Medicine Many aesthetic treatments claim are supported by good scientific evidence Skin treatments – Acne / scars, pigmentation, chemical peeling, wrinkles Device based – Laser / IPL, face lifting / firming ( RF, HIFU ), cryolipolysis Injectable – Toxin, fillers injection

Papers written Wrinkles and Retinoids Botox and Crow’s feet in combination with Glabellar lines Botox and forehead lines

Laser Dr Leon Goldman – “Father of lasers in Medicine in United States” Dr Rox Anderson – Theory of Selective photothermolysis 1963 Ruby Laser 1964 Photoexcision with Continous wave CO Selective photothermolysis 1996 (Er); YAG 2004 Fractional photothermolysis

Aesthetic Medicine 1.Aesthetic Medicine 2.Science and evidence of Aesthetic Medicine 3.Aesthetic Medicine in Singapore 4.The future of Aesthetic Medicine

Practice of Aesthetic Medicine Consumer driven medicine Industry driven medicine - Laser / device industry, cosmeceutical industry -Minimize risk / side effects, exaggerating benefits Media driven medicine -Media benefits as vehicle of advertising Current trending -Increased interest among medical / dental practitioners offering aesthetic procedures for which they were were never trained during their medical training

SMC guidelines on Aesthetic practice for doctors Aesthetic Practice Oversight Committee ( APOC)

SMC Classification of aesthetic procedures Based on currently available scientific evidence, aesthetic treatments and procedures are classified into List A - Moderate to high level of evidence; and / or Local medical expert consensus that procedure is well established and acceptable List B -Low or very low level of evidence; and / or Local medical expert consensus that procedure is neither well established nor acceptable

List A aesthetic practices Non invasive Chemical peels Microdermabrasion Intense pulsed light RF, IR skin tightening procedures Photodynamic therapy External Lipolysis (heat/ultrasound) Minimally invasive Botox Filler injection Phlebectomy Sclerotherapy Threat lifts Lasers (vascular lesions, skin pigmentation and skin rejuvenation)

List B aesthetic practices List B contains aesthetic treatments and procedures that re currently regarded as having low / very low of evidence and / or being neither well established nor acceptable. Mesotherapy Carboxytherapy Microneedling dermaroller Skin whitening injections Stem call activator protein for skin rejuvenation Mechanized massage ( eg “endermologie” for cellulite treatment)

The future of Aesthetic Medicine Patient safety concern and diagnostic skills Maintaining professional standard and excellence with adequate training Misrepresentation - Dermatologist / Plastic surgeons - Other specialist /GP Upholding credibility of doctors, avoid the lost of confidence and trust in the medical profession