Under the influence of South Korean soap operas and celebrities, medical aesthetics has been a boon in the Chinese mainland and Hong Kong over the last decade. Particularly, well-heeled vicenarians have driven the growth of this industry. Aesthetic treatments that were used to camouflage aging are increasingly being employed to prevent skin senescence.
The natural tendency to look beautiful is an evolutionary process most animals live by, for pleasant appearances often imply a healthier physique. Over generations, this ensures superior genes are promulgated in the species. We homo sapiens are beholden to the same fate. Our yearning to be physically appealing and healthy deserves to be expressed. Since not long ago, topical products made of plant extracts and some traditional Chinese medicine have emerged to freeze skin aging. And as with the traditional medical field, technological advancements in medical aesthetics brought along with it better efficacy within a shorter period — such is welcomed by those who would have opted for facial surgeries, irreversible procedures that result in unprepossessing appearances in the first few weeks.
In most medical specialties, doctors and nurses team up to provide the best care for patients. Medical aesthetics usually comprise a team of three groups: doctors, nurses and sales consultants. The third group has proved to be the root cause of the most serious problems in this field. Sales consultants are incentivized by handsome bonuses to coax patients into spending maximally, even over their budgets. To extract the most value out of each patient, some sales hyperbolically conjure up post-treatment effects unfounded by science while others egregiously benchmark the patient’s facial appearance on heavily edited avatars of celebrities. Together, good cops and bad cops become the financial pulse of an aesthetic company. As such, sales consultants hold oversized clout over other employees in the company without the downside risks of being stripped of a license. The term “medical” aesthetics is misleading. Doctors have little control over the vastly commercialized industry apart from the injection procedure itself. Even customers have quipped that doctors are merely technicians. It makes little sense that physicians are liable to complaints about underdelivering what sales consultants have been overpromising while they pocket the extra change. At times, aesthetic physicians have called for a stricter code of salesmanship, but to no avail. Moreover, company owners are quick to defend these extortionate practices for their own gains. Therefore, physicians bear the brunt yet have little skin in the business. Such misalignment of incentives among the company owner, sales consultants and aesthetic physicians sets the pretext for a perfect storm.
Recently, the Chinese mainland has committed itself to regulate aesthetic medicine. Two streams of thought stand out, and both can be solved by propping up physicians’ roles in this industry. The first thought outlines that overselling should be frowned upon, or even prohibited, in medical aesthetics. Acts of overselling include bluffing the efficacy of treatments and (falsely) associating facial appearance with success. Second, enforcement should be tougher on companies that allow therapists without a physician license to perform aesthetic procedures or prescribe treatment with parallel import drugs.
Tellingly, aesthetic conglomerates, which profiteered along the gray areas of these two streams of thought, have seen their stock prices tumble in both the Hong Kong and mainland stock markets recently. This serves as a signal that the mainland’s policies are on point, especially when compared to the day procedure center rules that the Department of Health have yet to implement in June next year. At the crosshairs of the mainland’s new regulations are companies deemed “too big to fail”. The dominating position of these giants has stifled competition from new entrants — usually small clinics led by aesthetic physicians. A healthier industry is expected to emerge from such reforms when greater power is bestowed upon these physicians, the would-be clinic owners. Physicians are restricted from advertising by law and conduct, and few would dare risk their license to overstep the red line. Most would abide by primum non nocere and offer appropriate aesthetic treatments. The role of sales consultants in recommending treatments would be commensurately downsized. Concurrently, the vision of aesthetic conglomerates dissolving into small-medium clinics is in lockstep with China’s national plan for common prosperity. A level field would be kept for fair and vibrant competition across the industry. And high-profile bad apples should be plucked off with conviction.
Unfortunately, the day procedure center rules are counterintuitive to China’s national vision of medical aesthetics. These regressive rules impose higher logistical thresholds for individual clinics to reach in order to thrive, hence buttressing the survival of dominant aesthetic conglomerates as well as widening the wealth gap, albeit unintentionally — publicly traded aesthetic companies awash with shareholders’ cash may modify clinic setups however the Department of Health wants, leaving physician owners of small clinics, which earn much less revenue, to bear the outsize cost of logistics redesigning. Repressing small-clinic physicians does not help to better regulate the field of medical aesthetics. With the nation’s greater goal of common prosperity in mind, Hong Kong should be politically deft in drafting policies. To protect patients who seek aesthetic treatments, sales consultants must be reined in as much as aesthetic physicians are empowered — and this requires abolishing the DPC and regulating salesmanship.
The author is a licensed medical doctor in Hong Kong and holds a Master of Public Health degree from Johns Hopkins University in the US state of Maryland.
The views do not necessarily reflect those of China Daily.