For Insurers

Where the motivation is subjective, the risk disclosure has to include subjective outcomes. If a procedure is chosen for psychological reasons, psychological outcomes belong in the consent conversation. When a procedure fails to deliver them — when the patient is left with a technically acceptable result and the same distress they walked in with — that is a harm.

Informed consent in aesthetic practice has developed its own meaning. For most aesthetic practitioners, it is a combination of verbal explanation, practitioner judgement that the patient appears to understand, and a signed consent form. That process is not experienced as inadequate. Practitioners generally approach consent from a duty of care perspective: they feel they are on the same page with the patient, they have covered the key points, and the signature confirms agreeme

Cosmetic patients are warned about scarring, swelling and allergic reactions. Why are the psychological risks of cosmetic procedures still left out of consent? BDD is estimated to affect somewhere between 19% and 24% of cosmetic surgery patients. That is roughly one in five. It is associated with poor satisfaction after treatment and poor psychological outcomes. It is not a remote possibility to be noted in passing.

Lynn G v Hugo is a case with huge implications, yet it has largely gone unnoticed. Practitioners remain unaware of it, despite the fact that it dismantles some of the very assumptions they tend to rely on. "I know my patient, I would have picked up on it." People have a tendency to think "this could never happen to me"- until it does.

The aesthetic industry does not have a regulation gap. It has a regulation illusion. Rules exist, guidance has been issued, membership bodies have published standards, and the sector has continued largely as before. The party with the genuine power to change that is not a government body or a professional association. It is insurers, and most of them have not yet used that power in any meaningful way.

In most areas of healthcare, disputes usually turn on familiar clinical questions. Was the diagnosis sound, was the treatment choice reasonable, was the procedure performed properly, and was the patient warned about the relevant risks? In cosmetic practice, those questions still matter, but they often do not get to the heart of the dispute.

The medical aesthetics industry has spent years talking about the need to identify unsuitable patients. On paper, that sounds sensible. If a big part of the risk sits in patient motivation, expectations, or appearance-related distress, then screening for those issues can seem like the obvious answer. However, that logic falls apart when it meets the real conditions of cosmetic care.

Since July 2023, Australia has introduced some of the strictest rules in the world around psychological screening in aesthetics. The goal is well-intentioned: to safeguard patients, especially those vulnerable to mental health challenges like Body Dysmorphic Disorder (BDD). But while the policy sounds protective on paper, the reality is much more complex.