Cosmetic dermatology. No apologies, a few regrets.

Abstract

While I agree with the need for discussion on the ethical aspects of cosmetic dermatologic surgery, I would not argue that the main reason to hold such a discussion is to dispel the notion that this branch of our specialty is somehow tainted, frivolous, and immoral. Rather, I would hope to make the argument that the specialty has a primary responsibility to the public and organized medicine to oversee the diagnosis and treatment of conditions pertaining to the skin, including those aspects that may relate to the appearance as well as the health of the skin. The human history of obsession with appearance did not begin with the carbon dioxide laser. The public will continue to avail itself of any and all technologies that may enhance appearance. Naturally, they will turn to us as the masters of diagnosis, treatment, and the science of the skin. What then is our role in the quest for improved appearance? Specifically, Ringel asks, “What is the ethical justification for getting involved in the treatment of aging skin?” Not to what end, asks Ringel, but by what right? Ringel argues that cosmetic dermatology uses false logic and even more questionable ethical grounds to justify and promote the treatment of aging skin. She opines that (1) aging is not an illness, (2) aging is not a mental illness, and (3) cosmetic surgery is based on a contractual (not a professional) model aimed only at promoting patient satisfaction irrespective of patient health. Underlying Ringel’s arguments as a whole is the premise that cosmetic surgery somehow condones and promotes ageism. I would like to respond to each objection in turn. AGING IS NOT AN ILLNESS, BUT PHOTOAGING IS A PATHOLOGICAL CONDITION