Ethics as the foundation of aesthetic surgery

In the field of surgery, particularly aesthetic surgery, ethics is not merely an addition but the very foundation upon which the entire medical practice is built. Dr. Chiara Botti, a plastic surgeon and medical director of the Villa Bella Clinic in Brescia, as well as a lecturer at the Universities of Verona and Padua, emphasizes the importance of an ethical approach to plastic, reconstructive, and aesthetic surgery. For Dr. Botti, integrating patients’ aesthetic desires with medical principles is not only a matter of technical competence but also an ethical and professional responsibility, where every clinical decision is guided by profound moral considerations.

The ethics in plastic surgery

Dr. Chiara Botti, plastic surgeon and medical director of Villa Bella Clinic, underlines:
«Plastic surgery, like any other branch of medicine, must be guided by the fundamental ethical principles that regulate medical practice – she explains -. The first of these is primum non nocere—first, do no harm. This requires profound technical competence and a strong sensitivity to understanding patients’ needs and motivations».

Communication plays a pivotal role: «Talking to the patient is essential. Often, a deeper discomfort lies behind a physical issue. My experience has taught me that dialogue is key to correctly interpreting requests and evaluating whether the intervention can truly improve the patient’s quality of life».

On the concept of beauty, she notes: «Our profession aims to recreate a beautiful normality. We do not want to produce cookie-cutter results, like making every patient look like a Barbie doll. Everyone is beautiful in their own way, so beauty lies in rediscovering harmony and individualised aesthetics».

Balancing requests with ethical limits

Another critical aspect is balancing patients’ aesthetic requests with the limitations and risks of surgical procedures. «It’s important to respect each person’s unique harmony. For instance, I work with patients of various ethnicities, and creating a Norwegian-style nose for a Saudi Arabian woman would not serve her well. Respecting both individual and ethnic harmony, along with the patient’s preferences, is key. However, there are limits to what can and should be done».

Doctors must also be prepared to say “no” when requests conflict with professional ethics: «It’s crucial for a surgeon to feel no obligation to fulfil every patient’s request, especially when they are unrealistic. For example, a patient might want a very small nose, but noses that are too small can compromise breathing. It’s our responsibility to explain what is achievable without sacrificing functionality».

The psychological aspect is equally significant: «When the issue extends beyond physical appearance to deeper psychological concerns, it’s essential to explore that aspect. The risk is creating the most beautiful nose in the world but not the happiest patient. This is why listening, listening, and listening again is fundamental, as is thorough communication to bridge the gap between what we say and what patients perceive».

The Role of social media and informed decision-making

In today’s world, social media plays a central role in accessing medical information. «There’s nothing inherently wrong with this, as TikTok, for instance, features both skilled and less skilled doctors. But it’s crucial to verify the doctor’s credentials, ensure they work in appropriate facilities, and understand their approach through in-person consultations. A good doctor-patient relationship is built on trust, which cannot be established solely online».

Dr. Botti stresses the importance of discussing potential complications openly: «If a doctor oversimplifies the risks, that should be a red flag. Aesthetic surgery is still surgery and must not be taken lightly. Being aware of what could go wrong is essential before undergoing any procedure».

Injectable treatments: quick but risky fixes

A pressing issue in aesthetic medicine is the rising popularity of injectable treatments, or “quick fixes.” These procedures, though seemingly simple, carry significant risks, especially when performed by unqualified personnel. In Italy, many medical professionals are permitted to administer fillers, but a deep knowledge of facial anatomy is critical to avoid severe complications such as ischemia or necrosis. In extreme cases, incorrect injections, particularly in the periocular area, can lead to blindness.

Dr. Botti advocates safer, more natural alternatives like lipofilling, which uses the patient’s own fat: «At the latest BBF (Bottis’ Best Face 2024), many surgeons highlighted the dangers of these injectable treatments. Increasingly, the focus is on replacing synthetic fillers with autologous materials, such as fat taken from other parts of the body».

The importance of education in aesthetic surgery

Training for surgeons at events like the BBF has a strong educational impact. «At our center, we’ve been teaching surgery to residents and young surgeons for many years. Our congresses are part of a continuous learning process that we also carry into the operating room. The goal is to teach technically refined and ethical surgery. We invite renowned international colleagues to integrate our knowledge with fresh perspectives. Every time I teach, I learn so much in return».

The focus on combining technical skill with an ethical foundation ensures that aesthetic surgery remains a practice dedicated not only to beauty but also to patient well-being and integrity.