Principles and Ethics of Cosmetic Surgery

These are principles that guide us.

1. Make no change that is not an improvement in appearance.

2. Make no change that is not agreed upon by the patient.

3. Rewards must far outweigh risks.

4. Normal or natural is more desirable than attractive or beautiful.

5. There must be no unnaturalness or abnormality in the post-surgery appearance.

6. There must be no visible scars.

7. The overall aim is to look the best we can with the least amount of surgery.

8. The objective of surgery is to obtain the best possible result with the least ill effects.

9. If on the fence (undecided), stay on the fence

10. More can always be done later.

11. Less cannot be done once it has been done.

12. What is done often cannot be undone.

13. It is better to wish more were done than to wish less had been done.

14. It is better to regret not having done it than regret having done it.

15. The surgery must be safe.

16. For safety, local anesthesia is preferred.

17. The patient should be comfortable at all times.

18. There should be no pain with surgery.

19. There should be no surprises.

20. The only acceptable surprises are that it was so easy or that the results are so good.

21. Recovery should be rapid.

22. Bruising and swelling should be minimal.

23. Problems and complications should be kept to a minimum.

24. The patient is the most important person to please.

25. It is more importantto please the patient than the surgeon.

26. Cosmetic surgery is a trade of the risks, discomfort, and the process of having surgery for looking better.

27. Before surgery is done the subject and the surgeon should know, not only in the mind, but in the heart and soul, that it is worthwhile.

28. The goal chosen should be some form of visual representation such as a drawing, picture or sculpture of the subjects face rather than a description in words.

29. The more precise and attractive the chosen goal drawing, the better the result.

30. Surgery should only be done if there is a clear goal drawing showing indisputable benefit.

31. The goal drawings that are to be followed must be the patients choice.

32. The patients choice and opinion is ofhighest priority.

33. The goal drawings chosen should be of both front and side views.

34. The goal drawings represent the after appearance of the side and front views.

35. The chosen goal drawing should be so attractive that it cannot be improved upon.

36. It should not be possible to improve on the chosen goal.

37. There should be close to 100% agreement that the goal is the most attractive possible.

38. Everyone who sees the goal drawing and all the alternative drawings should agree that the chosen goal drawing looks the best.

39. The choice of goal should be what will be most pleasing and look the best to all people for all eternity.

40. The side-by-side comparison of the before pictures with the chosen goal drawings should be an improvement in appearance to all humankind.

41. There should be almost 100% agreement of all observers that the goal drawing chosen is clearly, in every change that is made, an improvement in appearance over the before.

42. Only the opinions of observers who are unable to see, to perceive or may have impairment of judgment because of drugs, who are in a jesting mood or who object on a religious or cultural basis such as the Amish or because of personal envy should be discounted.

43. Fads, fashion, the in thing, what is in vogue, chic, or in style are to be avoided.

44. With cosmetic surgery, the appearance is usually worse before it is better.

45. Even when very successful and beautiful, the area on which work is done may not feel the same as before.

46. The beauty of the chosen goal should appeal to all people of all ages and cultures.

47. Our chosen goal should be the most pleasing and the most beautiful possible to the human genes or human genome.

48. We want to appeal to the natural appreciation of beauty with which we are born, just as humans and many other animals appreciate the beauty of flowers.

49. The final ethic of all of medicine and surgery is that everything that is done must be to, of, and for the benefit of the patient totally and completely without reservation or compromise.