It is important not to take sides too soon in any debate and let the various parties present their arguments. In this context, I mean ‘argument’ as a structured rational to support a specific position. With regard to aesthetic medicine and cosmetic surgery, the debate over who should be doing what, and how they should be trained and assessed, is only just beginning. One of the reasons for this is that there has been far too much time spent protecting what can only be described as selfish-interests. The perspective shared by Professor Frame in this issue is going to challenge some of the preconceived notions about the assumption of competence through virtue of specialty training. It is becoming increasingly obvious that the current spectrum of medical and surgical specialties in most countries does not address the depth and breadth of an exclusive practice based on aesthetic or cosmetic interventions. We are now also receiving feedback from other health professionals concerning possible restrictions on their activity based on primary qualifications. What is the basis for saying, for example, that a medical degree or a nursing qualification is a pre-requisite for a specific course of training in cosmetic interventions involving ‘penetration of the epidermis’? I ask this out of genuine curiosity, and papers from practitioners of all professions who work in the beauty and aesthetic sectors are welcome.

I feel there is very much a Ying and Yang in the spectrum of activity covered by PMFA News and an excellent example of that is the discussion on female genital surgery in the February/March 2014 issue. I do believe that more open discussion is needed to allow for more informed opinions to be expressed. It is important to appreciate there are a range of indications for female genital surgery. There are those related to congenital anomalies and, of course, secondary to trauma or tumour or degenerative disease. The term, however, includes a range of procedures, which do not have a strictly medical indication; some are related to cultural beliefs and may include illegal procedures causing genital mutilation. At the other extreme are procedures which are designed to enhance the aesthetic features of the genitalia or optimise their functional interaction in the pursuit of sexual pleasure. There are distinct challenges to ensuring ethical practice in this field. There are equally significant challenges in training and assessing competence for those who wish to include aesthetic female genital surgery in their ‘portfolio’.

Whilst we are looking at practical applications of aesthetics in terms of interventions, we do need pay much more attention to what constitutes a successful outcome. For this we need more sharing of personal experiences from the client / patient perspective. When you see your next grateful patient in the clinic you might ask them if they would like to share their experiences. Such feedback would undoubtedly be of great value.

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Andrew Burd (Prof)

The Chinese University of Hong Kong.

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