The Ethics Crisis in Medical Aesthetics
When Profit Meets Patient Safety
The medical aesthetics industry stands at a critical ethical crossroads. The industry has witnessed unprecedented growth over the past decade. As such, investment in the industry has increased from private equity.
The Fundamental Tension: Profitability vs. Patient Welfare
Every medical aesthetics practice owner faces a stark reality: you need revenue to survive, but patients trust you with their physical wellbeing, inside and out. This tension creates ethical dilemmas that go far beyond simple business decisions. When physician ownership of medical spas dropped to just 37% by 2022, while non physician ownership more than doubled in five years, we witnessed a fundamental shift in how aesthetic medicine prioritizes supervision, training, and clinical decision-making.
The question isn't whether practices should be profitable. The question is: At what point does the pursuit of profit compromise the ethical principles that should govern medical practice?
Beyond Compliance: Understanding True Informed Consent
Most practices believe they're meeting informed consent requirements by having patients sign forms. They're wrong.
Recent legal analysis reveals that informed consent has evolved far beyond a signature on a document. The landmark Montgomery vs. Lanarkshire Health Board case established that physicians can be found negligent even when following accepted practices, if they fail to disclose material risks that a reasonable patient would want to know. In that case, a 0.1% risk of shoulder dystocia led to a successful negligence claim because the physician failed to disclose it, assuming patients wouldn't want the information.
For aesthetic practices, this precedent is devastating. Here's what true informed consent requires:
Legal Requirements:
Comprehensive disclosure of the procedure's nature and purpose
All material risks and potential complications, regardless of rarity - note the recent GLP-1 lawsuit for evidence that this disclosure requirement is real
Alternative treatment options, including non-treatment
Expected outcomes and limitations
Off-label use disclosure (though not legally mandated, increasingly expected)
Documentation of the consent discussion, not just the signature
What Informed Consent Should Actually Do:
Empower patients to make autonomous decisions based on complete information
Set realistic expectations that help to prevent "buyer's remorse"
Build trust through transparency, even when it might cost you a sale
Protect practices from litigation by demonstrating thorough patient education
The gap between legal compliance and ethical practice is where most lawsuits originate. A gynecologist's assumption that disclosing risks would cause all patients to choose cesarean sections resulted in a negligence verdict. Aesthetic practitioners making similar paternalistic decisions, "I won't mention this rare complication (e.g., occlusion) because it will scare them away", are exposing themselves to both ethical violations and legal liability.
The Realistic Expectations Dilemma
Social media has created what researchers call "appearance anxiety", a condition where patients seek procedures to match filtered, edited images that don't represent reality. Ninety-one percent of practitioners believe ethical standards should guide aesthetic procedures, yet many struggle with the ethical boundaries when a patient demands a treatment that won't deliver their desired outcome.
The data on unrealistic expectations is sobering. Studies show that social media influencers, who rarely have medical credentials, have become primary information sources for aesthetic treatments. These influencers highlight best outcomes while underreporting risks, complications, and the need for ongoing maintenance. The result? Patients arrive at consultations with expectations divorced from clinical reality.
Ethical practitioners must:
Decline procedures when professional judgment indicates they won't meet patient expectations or they risk pushing the patient further toward dysmorphia
Provide thorough assessments of treatment limitations
Document discussions about realistic outcomes
Suggest reasonable alternatives that genuinely serve the patient's goals and best interests
Resist the temptation to overpromise to secure bookings
The principle here is simple but difficult: honesty about treatment limitations is more valuable than short-term revenue.Under-promising and over-delivering builds long-term practice reputation. Over-promising and under-delivering builds malpractice claims.
The Competency Crisis: When Training Takes a Back Seat
The influx of providers entering aesthetic medicine has created a competency crisis that threatens patient safety and industry credibility. Research published in 2024 documents that "the lack of regulation and standardized training in aesthetic medicine presents significant challenges to patient safety, provider competency, ethical and legal compliance."
Here's the disturbing reality:
Many providers undergo brief training programs or weekend courses before performing complex procedures
State-level laws vary widely, creating confusion about scope of practice and supervision requirements
In some states, oversight is minimal or outdated, allowing unqualified individuals to perform high-risk procedures with little accountability
Even where regulations exist, enforcement is often inconsistent and poorly defined
Over the last few years we saw a dramatic increase in self-proclaimed "aesthetic experts" offering treatments in unregulated environments. Platforms like Groupon and social media became marketing tools for non-professionals, enticing patients with lower prices and quick results. The consequences? Vascular occlusion, nerve damage, infections, facial asymmetry, and permanent disfigurement, complications that are significantly higher with untrained injectors.
The Self-Regulation Mirage
The medical aesthetics industry largely relies on self-regulation, a system that sounds responsible but often fails in practice. Professional associations, that are often times revenue driven, create ethical guidelines, but these lack enforcement mechanisms. State medical boards are understaffed and reactive rather than proactive. The result? A patchwork regulatory environment where patient safety depends more on individual practitioner integrity than systematic oversight.
Recent enforcement trends show increasing scrutiny:
Approximately 17 states proposed legislation directly impacting medical aesthetics in the past year
State attorney generals have launched investigations into medical spas operating inappropriately
New Jersey's AG announced enforcement actions against individuals allegedly performing unlicensed medical procedures in spa-like settings
The FDA's MAUDE database documented nearly 194,000 medical device adverse event reports in 2022, with reporting trends rising
But enforcement is retrospective, it addresses problems after patients are harmed. True ethical practice requires proactive commitment to:
The Four Pillars of Medical Ethics:
Autonomy: Respecting patient decision-making through complete, honest information
Beneficence: Acting in the patient's best interests, even when it conflicts with revenue goals
Non-maleficence: "First, do no harm", the foundation that should override all commercial considerations
Justice: Ensuring fair access to safe care and maintaining consistent standards
The Marketing Ethics Gap
False, deceptive, and misleading marketing represents an insidious threat to patient safety. The FTC and FDA share regulatory authority, but enforcement is reactive and inconsistent. Common violations include:
Guaranteeing results that cannot be ethically guaranteed
Using testimonials that don't reflect typical outcomes
Exploiting patient before-and-after photos without proper context
Creating unrealistic expectations through edited images
Failing to disclose material risks or limitations
Promoting off-label uses without appropriate disclaimers
A California medical spa received an FTC warning for advertising guaranteed results. Only after revising language and adding disclaimers did it meet compliance standards. But how many practices continue similar marketing because they haven't been caught?
The ethical question is straightforward: Does your marketing serve patients or deceive them?
The Corporate Practice of Medicine Problem
Many states prohibit non-physicians from owning medical practices, the corporate practice of medicine doctrine. Yet management service organizations (MSOs) have created structures that test these boundaries. When commercial entities control medical decision-making through financial arrangements, patient care suffers.
Recent legislative trends focus on increased oversight of third-party investors and private equity involvement in medical aesthetics. New York's omnibus spending bill now requires certain healthcare entities to notify the Department of Health before consummating "material transactions." These laws recognize that when financial interests dominate medical practices, patient welfare takes a back seat.
Moving Forward: Practical Ethics for Practice Owners
For Medical Directors:
Implement comprehensive training protocols that exceed minimum state requirements for both those you oversee and yourself.
Establish clinical pathways that prioritize patient safety over procedure volume
Create systems for declining inappropriate procedures, with financial support for staff who make these decisions
Conduct regular competency assessments for all practitioners
Develop complication management protocols and ensure all staff are trained
For Business Operations:
Price services to reflect true costs, including proper oversight and safety measures
Build marketing strategies on transparency and education rather than promises
Create compensation structures that reward patient outcomes, not just procedure volume
Invest in continuing education for all clinical staff
Maintain comprehensive liability insurance and legal counsel familiar with aesthetic medicine
For Patient Interactions:
Develop thorough consultation processes that explore patient motivations and expectations
Create standardized informed consent processes that go beyond forms
Implement cooling-off periods for major procedures
Establish psychological screening protocols for patients showing signs of body dysmorphic disorder
Document all patient communications thoroughly
The Allergan Ethics Initiative
In March 2024, Allergan Aesthetics launched "Moving the Needle on Ethics," recognizing that the industry needs coordinated ethical standards. Their research across 13 countries revealed that 91% of practitioners believe ethical standards should guide medical aesthetic procedures—yet formal ethical training remains absent from most educational programs.
Beginning in 2024, the Allergan Medical Institute implemented ethics training for practitioners. While this represents progress, it's voluntary and limited in scope. The industry needs mandatory, standardized ethical training as a prerequisite for practice.
The Path Forward
The medical aesthetics industry cannot afford to prioritize growth over ethics. Patient safety incidents are rising. Regulatory scrutiny is increasing. Public trust is eroding. The practices that survive and thrive will be those that make ethical practice not just a compliance requirement, but a core business strategy.
Here's the uncomfortable truth: ethical practice may cost you some patients and some revenue. The patient who wants an inappropriate procedure will find someone willing to perform it. The practice cutting corners on training and oversight will offer lower prices. The marketing that overpromises will generate more leads.
But unethical practices eventually face consequences—malpractice lawsuits, regulatory actions, damaged reputations, and most importantly, harmed patients. The practice built on ethical foundations may grow more slowly, but it grows sustainably and will withstand the test of time and regulatory scrutiny.
The Bottom Line
Every aesthetic practice owner must answer a fundamental question: Are you running a medical practice that happens to be profitable, or a business that happens to involve medical procedures?
The answer to that question determines whether you're part of the solution or part of the problem.
References:
Pennsylvania Patient Safety Authority. (2024). Patient safety incidents in non-hospital aesthetic facilities.
Ramirez, S., et al. (2024). The primacy of ethics in aesthetic medicine: A review. Plastic and Reconstructive Surgery – Global Open, 12(6).
Gaskell, A., et al. (2025). The need for regulated training and certification for providers entering into aesthetic medicine. Journal of Clinical and Aesthetic Dermatology.
Zarsky, B. S. (2025). Legislative and enforcement trends in medical aesthetics: 2025 and beyond. The Aesthetic Guide.
World Academy of Cosmetic Surgery. (2025). Aesthetic practice standards 2025: Complete guide to safety regulations.
Allergan Aesthetics. (2024). Moving the needle on ethics: Elevating the conversation around ethics in aesthetics.
Kapoor, L. (2015). Informed consent in aesthetic surgery. Journal of Cutaneous and Aesthetic Surgery, 8(4).
Various authors. (2024). Ethical and regulatory gaps in aesthetic medical practice in top Asian medical tourism destinations. PMC.
