Plastic surgery and aesthetic medicine: abuse worries professionals. ‘But woe to demonise them’, is the warning from UniCamillus professor Barbara Cagli

The boom in the use of aesthetic medicine is worrying practitioners. The data presented at the latest Italian Society of Aesthetic Medicine (SIME) congress, entitled ‘Image, Ethics and Science’, held in Rome in early May 2024, does not lie. The volume of business in this field is clearly growing, with around $14 billion USD being handled by the entire industry in 2022 and an estimate of $23.4 billion USD by 2027. Approximately 80% of requests for surgery come from women, but there is also a sharp increase noticed in men (+25% since 2008). The numbers are also fuelled by the more or less subliminal urges that come from everyday life, with social life increasingly exposed to the outward judgement of others. Social media in particular play a key role in this mechanism, which drives more and more people to resort to plastic surgery.

‘Such a large increase in the use of aesthetic medicine is a serious problem’, warned SIME President Emanuele Bartoletti, ‘because there is an increasing risk of encountering overly condescending physicians or, worse, unqualified people who unscrupulously perform meaningless treatments’. On the same page is Professor Barbara Cagli, lecturer in Plastic Surgery at UniCamillus University and author of more than 50 scientific articles in indexed journals on the clinical activity of aesthetic and reconstructive surgery. ‘The competence of professionals to whom one turns is a fundamental point. A serious and well-prepared specialist has a duty to say no to patients requesting something that is not actually correct with regard to the real reason for the request. There is a code of ethics of our profession and following it is part of our job’.

The plastic surgeon, it should be remembered, is a highly specialised physician. A professional who, after obtaining a degree in Medicine and Surgery, specialises and trains for five long years in Plastic, Reconstructive and Aesthetic Surgery. ‘The concept of “aesthetics” should not be demonised, but it must be emphasised that a specialist is quite different from someone who improvises as such’, explains Professor Cagli. ‘First of all, we are talking about a different training timeframe: five years of specialised training is one thing, attending a CPD or some random training course is another. The key point lies in the Italian law that does not require one to already be a medical specialist in order to be able to practise aesthetic medicine’.

One aspect is particularly close to the UniCamillus lecturer’s heart: ‘The plastic surgeon is not just one who does the touch-up or the puncture. They also do that. I stress it, nothing should be demonised and there is no shame in having hyaluronic acid injections. I myself perform them when it is the case for my patients. But one must always question how these procedures are performed and what preparation there is behind every medical action, also because even an incorrectly injected vial can create problems for a patient. Plastic surgery, however, like other forms of surgery, is inevitably burdened by the possible occurrence of complications. That is why it is all the more important to rely on specialists, who really have the training to deal with a surgical or medical procedure on a patient―let’s not just look at how many followers a specialist has but take a few minutes to read their CV’.

The same SIME report also revealed another fact that should set off alarm bells about the direction our society is taking: around 45% of those who turn to aesthetic medicine are young people aged between 19 and 35. Professor Bartoletti argues that ‘it is important to pay attention to young people’s dependence on this type of therapy, because it is becoming increasingly worrying and exposes them to the risk of undergoing transformations they may regret later on in life’. However, it is equally crucial to uncover from these numbers all those realities that go far beyond appearance.

There is certainly a problem in our society that tends to give more weight to appearance than to substance, says Professor Cagli, but the issue can be seen from many points of view. Appearance is certainly not something that is going to disappear in the coming years; on the contrary, the growing trend of surgical operations will increasingly be understood as a need related to extending life, wanting to be fit and taking care of oneself. Psychophysical well-being, as the WHO also says, is part of a person’s state of health: feeling good about yourself helps you feel better.

Basically, one cannot lump all plastic surgery operations together, since not all plastic surgery is purely cosmetic, an end in itself. And on this the UniCamillus lecturer wanted to clarify: ‘One thing escapes many people. Cosmetic surgery also has a very important therapeutic value. Behind the figure of how many young people resort to plastic surgery and aesthetic medicine, there are actually many different situations. And in many cases, the interventions help to feel better, psychophysically improving the patients’ quality of life and consequently their emotional sphere. An example is that of operations on malformed or oversized breasts, which cause discomfort in some women. There is always too little talk about how much these procedures represent a rebirth for these patients. A woman suffering from gigantomastia, i.e. having breasts of much larger proportions than her chest, experiences great discomfort, and in some cases is prevented from even playing sport, perhaps not being able to wear a swimming costume at the beach. But even operations such as otoplasty, for those with so-called “floppy ears”, or rhinoplasty to intervene on those with, for example, breathing problems, all seem like futile interventions, but in fact they are not. They have a clear functional and therapeutic implication. In this sense, we need to start by better contextualising the idea of aesthetic medicine and surgery’.