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I spent two years trying to improve patient mental health safeguarding in aesthetic medicine. What I actually learned was how an industry protects itself from the very changes it claims to want.

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.