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The unfortunate death of a young woman allegedly following a liposuction procedure in a beauty centre has been widely discussed among the public and aesthetic practitioners alike. It prompted me to write in to share some information concerning medical aesthetic practice in Malaysia.

The category of aesthetic medicine is relatively new. In 2013, the Health Ministry defined aesthetic medicine as “An area of medical practice which embraces multidisciplinary modalities dedicated to creating a harmonious physical and psychological balance through noninvasive, minimally invasive and invasive treatment modalities which are evidence-based. These modalities focus on the anatomy, physiology of the skin and its underlying structures to modify an otherwise ‘normal’ (nonpathological) appearance in order to satisfy the goals of the patient and are carried out by registered medical practitioners”.

There are many ways to classify aesthetic medicine procedures. It depends on the applicability of the procedure to the patient. The Health Ministry’s Aesthetic Medical Practice Committee classifies aesthetic procedures into three categories.

The first is noninvasive. “This is defined as external applications or treatment procedures that are carried out without creating a break in the skin or penetration of the integument. They target the epidermis only.”

Second is minimally invasive procedures. “This is defined as treatment procedures that induce minimal damage to the tissues at the point of entry of instruments. These procedures involve penetration or transgression of the integument but are limited to the subdermis and subcutaneous fat, not extending beyond the superficial musculoaponeurotic layer of the face and neck, or beyond the superficial fascial layer of the torso and limbs.”

Lastly, invasive procedures. “This is defined as treatment procedures that penetrate or break the skin through either perforation, incision or transgression of integument, subcutaneous and/or deeper tissues, often with extensive tissue involvement in both vertical and horizontal planes by various means, such as the use of knife, diathermy, ablative lasers, radiofrequency, ultrasound, cannula, and needles.”

In other words, the noninvasive procedures only target outer layers of the skin, such as a superficial chemical peel, intense pulsed light, and microdermabrasion. Minimally invasive procedures targets deeper skin layers and muscles and include treatments such as botulinum toxin or dermal fillers. Invasive procedures are all the surgical procedures that need cutting and perforating the inner layer of the human body and require specialised expertise for procedures such as such as nasoplasty or liposuction.

Who can perform medical aesthetic procedures?

According to the Private Healthcare Facilities And Services Act 1998, and the Aesthetic Medical Practice Guidelines 2013, aesthetic medicine procedures can only be performed by registered medical practitioners (doctors) with letters of credentialing and privileging in licensed premises. The regulations stipulate that all medical professionals need to follow very stringent rules before performing procedures to safeguard public health. The service provider’s (doctor/clinic/medical centre/hospital) obligation is to display all the certificates or documentation correctly for the patient to see.

In summary, before you agree to undergo aesthetic medicine procedures, make sure to verify:

> That the premises has its license displayed (clinic license from the