Tuesday, February 19, 2008


Straits Times Feb 18, 2008
GPs quizzed on shoddy cosmetic treatments

Health Ministry is also looking at regulating aesthetic medicine
By Judith Tan

AT LEAST 20 doctors have been questioned by the Health Ministry in the last five months on their shoddy aesthetic practices.

This is part of a ministry clamp down to ensure general practitioners offering treatments such as Botox and collagen injections are appropriately trained.

A ministry spokesman told The Straits Times it is studying the regulation of aesthetic medicine - something the plastic surgery fraternity has been fighting for.

'Doctors who performed aesthetic or other health-related procedures need to substantiate them with scientific evidence on safety and efficacy,' she said.

GPs using unsafe practices will be referred to the Singapore Medical Council (SMC) for disciplinary review.

The medical watchdog told The Straits Times it received six complaints last year on aesthetic procedures performed by GPs.

Its spokesman declined to comment on complaints against specific doctors as investigations are on-going.

The MOH surveillance is a move away from its previous hands-off policy which favoured self-regulation by the medical profession.

Plastic surgeons, however, are up in arms over the leeway given to GPs to dabble in aesthetic medicine. They fear the public would be misled into thinking non-plastic surgeons are trained in surgery.

With a rise in the number of people wanting cosmetic treatments, some GPs have moved beyond coughs, colds and flus to performing cosmetic services.

Some have even become hugely successful in this field. Typically, a patient pays between $300 and $1,200 for Botox treatment to get rid of wrinkles. Treatments may be once every three months.

There are more than 1,400 registered GPs in Singapore. Although the number of GPs offering aesthetic treatments is growing, there is no official figure on how many of them are doing so, said the Singapore Medical Association.

The Straits Times understands that some GPs pay anything between $2,500 and $8,000 to attend online courses for which they receive the diploma a week later; or attend day-long seminars on procedures to be qualified.

Doctors say patients with botched treatments are unwilling to press charges because the procedures are private matters.

Another reason: GPs provide corrective surgery for botched treatment and patients are afraid payments would stop should they complain.

One patient, a 28-year-old woman who did not want to be named, had gone to a GP for fuller lips.

But she was injected with too much of the wrong type of lip filler and collagen, and ended up looking like a 'duck'.

Alarmed by the results, the GP - who the patient declined to name - brought her to a plastic surgeon who performed surgery to drain the filler. The GP is still paying for her follow-up treatments.

Dr Ivor Lim, consultant plastic surgeon with The Plastic & Hand Surgery, said aesthetic GPs are only trained in administering procedures like injecting Botox or collagen. 'But when things go wrong, they don't know how to correct the mistake or how to manage the complications. That is where the problem lies.'

MOH feels regulation would help ensure quality of treatment, its spokesman said.

Dr Chai Chin Yoong, a GP and medical director who started a clinic offering aesthetics and weight-management programmes at the Parkway Shenton medical group, thinks there are pros and cons to regulation.

'On the one hand, regulation will not only ensure quality of the work done, but also allows insurance companies to define a premium to cover the doctors,' he said.

But it would also mean that doctors will have to attend courses at approved institutions. 'This would mean higher fees, which would probably get passed on to patients,' he added.

It's about time for this to happen. It would only make sense that there be some kind of control over aesthetic procedures performed by GP's. I had never quite understood the Ministry's previous stand of self-regulation where aesthetic medicine was concerned.

I had been quite appalled to see "aesthetic practitioners" sprout up right, left & center all over Singapore, whether it be in the HDB heartland, or in the midst of the bustling CBD district or the residential enclaves of districts 9, 10 & 11. I wondered when the bubble would burst, and when the Ministry would realise that the ignorant public did not have the know-how nor the common sense to double check if the doctor he/she went to for their various aesthetic procedures had the training & the experience of doing a proper job, and more importantly, to do some research into what the possible complications of a botched job could be.

In the land of people willing to pay thousands of dollars for an aesthetic procedure & yet balk at coughing up $30 for a GP consult + medication to treat an URTI, I do not blame GP's for trying to make a living with aesthetic procedures. Some probably have gone for training. But a one-week course does not an aesthetic physician make.

As a doctor, I would be ethically bound to ensure that I have the appropriate training & experience in whatever invasive procedure I would perform on a patient. (And yes, chemical peels & Botox/collagen injections ARE invasive). In a prior job, I had been asked before by my boss if I would be willing to perform chemical peels on patients as this was a very profitable endeavour. I had always declined because I never felt that I had the qualifications nor the know-how to do it.

I am glad that MOH is starting to feel the same way too.

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