Update on the regulation of aesthetic medical procedures in France

Introduction

Following the May 31 decree limiting the purchase of hyaluronic acid for subcutaneous injections to medical doctors and dental surgeons(see article on the fight against illegal injections), France’s Conseil national de l’ordre des médecins(CNOM) is now recognizing an inter-university diploma (DIU) as a qualification for practicing aesthetic medicine in France.

Who is concerned

All medical doctors wishing to continue or start an activity in aesthetic medicine. They will need to pass either a validation of acquired experience (VAE) or the validation of this DIU.

Dates and places to remember

The first students will be able to start the 2-year DIU in 2025. The number of places will be limited to 60 students per year. The DIU will be taught at the Paris Créteil, Marseille and Bordeaux faculties.

The format

There will be 160 hours of teaching over two years. Most of the theory will be delivered via distance learning. The practical part will be a mix of practical workshops and internships with accredited doctors.

VAE

Validation of acquired experience will enable you to avoid the new DIU in aesthetic medicine.

These are just a few of the requirements:

A minimum period of exercise

Minimum 5 years’ experience in aesthetic medicine

DU and DIU

University and inter-university degrees in aesthetic or anti-aging medicine would be an asset.

Continuing professional development (CPD) up to date

As in the rest of Europe, French doctors must be up to date with their CPD. Doctors will therefore have to prove that they have a certain number of CME/CPD continuing education points. The SAMBA Diploma provides 24.5 points.

For the time being, it would appear that France’s Conseil national de l’ordre des médecins (CNOM) is not in a position to clearly set out the conditions for validation of acquired experience. It will therefore be several years before this is put in place.

Mixed activity mandatory!

In my opinion, one of the crucial elements of this new DIU, which is not much mentioned, is the obligation to carry out a mixed activity. Indeed, it would seem that, in order to retain the title of medical doctor and specialist, aesthetic medicine can only be a partial activity.

The avowed aim is to limit the conversion of general practitioners and other specialists to aesthetic medicine. A doctor wishing to devote himself or herself full-time to the practice of aesthetic medicine could find his or her medical degree and specialist diploma invalidated, and thus invalidate his or her overall practice of medicine, including aesthetic medicine. Miscalculation …

Toxin vagueness

Botulinum toxin has always been a controversial subject, because beyond its use for aesthetic purposes, it is a drug with a strict marketing authorization (AMM). In terms of aesthetic indications on the French market, only Vistabel, Azzalure and BoCouture have received marketing authorization for indications starting with the glabella (inter-brow area, frown lines), followed by crow’s feet and the forehead.

Only doctors qualified in plastic, reconstructive and aesthetic surgery; dermatology; face and neck surgery; maxillo-facial surgery and ophthalmology (since 2004) are authorized to prescribe and inject Vistabel, Azzalure or BoCouture.

Despite the qualification linked to the DIU in aesthetic medicine, the prescription and use of botulinum toxin in France does not concern all holders of this DIU.

What I like

Generally speaking, regulating the practice of aesthetic medicine and making training compulsory is bound to be a step in the right direction in terms of the safety of aesthetic medicine treatments for the benefit of patients.

Alternating a theoretical phase with practical training seems to me to be a good thing. In any case, regulation in favor of qualified professionals, i.e. medical doctors, to practice aesthetic medicine is always a good thing when we know the scourge represented by illegal injections perpetrated by unqualified people, with hygiene rules not respected, endangering the physical integrity of sometimes gullible and ill-informed patients.

The limits I see

First limit:

The number of doctors trained each year is derisory compared to the demand for aesthetic medicine. One wonders whether this is not an attempt to restrict the practice of aesthetic medicine within the corporation of medical doctors.

Rather than supporting conversion to a safer, more responsible practice. In my opinion, limiting so drastically the number of annual places for properly training doctors in the practice of aesthetic medicine risks further reinforcing the emergence of the illegal practice of aesthetic medicine by people without any qualifications.

Second limit:

Mandatory mixed activity. While this may sound attractive in theory, we know that in aesthetic medicine, as in surgery, it’s the repetition of the procedure that determines the quality of the practitioner. Even if this is not the only variable, it is one of the most important. Without exhaustive practice being an obligation, it seems to me to be a mistake to impose a mixed activity.

From this point of view, it seems clear that boosting the attractiveness of initial specialties such as general medicine, pediatrics, gynecology, occupational medicine and psychiatry, and overall the attractiveness of all specialties in France, should be an absolute priority.

Third limit:

Validation of acquired experience (VAE). The criteria are still vague, so it’s going to be very difficult to define the right criteria that will enable the doctor who presents a work ethic and a scientific and safe approach to aesthetic medicine to stand out from the rest.

Fourth limit:

The content of this DIU. Indeed, having been through it all, putting together a coherent, comprehensive training course delivering all the fundamentals of evidence-based aesthetic medicine is a difficult exercise, costing both time and money.

We now know which recommendations of good practice should be shared by all medical doctors practicing aesthetic medicine. What about this DIU in aesthetic medicine and its compliance with the recommendations of good practice?

The most important

The most important thing, as always, is to get the right training if you want to practice medical procedures with an aesthetic aim. Time will tell what our colleagues in France think of this new DIU in aesthetic medicine.

Whatever the case, the intention is good. What now remains is implementation to meet the growing demand for aesthetic medical care in modern society.

 

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