Medical Aesthetics: Definition, Procedures and Regulation in Quebec

• Definition: in Quebec, medical aesthetics is a non-surgical procedure involving a medical technique that aims mainly to change appearance, without a therapeutic purpose.
• On the face: a laser acts through light, microneedling through small punctures; injections relax a muscle or add volume. Intense pulsed light and focused ultrasound are also among the options offered by CARE MD, to be discussed with the doctor before any choice.
• Who does what: the doctor assesses, makes a diagnosis and establishes the treatment plan; the doctor may perform the procedure or entrust it to an authorized professional, including a nurse who performs injections under an individual prescription.
• Regulation: professional regulatory bodies regulate individuals, Health Canada regulates devices and products; the RAMQ (Quebec’s public health insurance agency) does not cover any service provided solely for aesthetic reasons.
• Before deciding: an assessment, consent that you understand, not just a signature, the right to do nothing and enough time to think.

You saw “medical aesthetics” on a clinic sign or in an advertisement, and you want to know what the term covers before going further. It aims to change appearance, not to treat a disease. In Quebec, it is part of medicine: the doctor assesses the person and establishes the treatment plan before the procedure.

You therefore do not have to choose a device before meeting the doctor. The assessment is an opportunity to understand what suits you, and you can decide to do nothing.

In Quebec, medical aesthetics refers to any non-surgical procedure involving a medical technique whose main aim is to change a person’s appearance for aesthetic purposes. The procedure may involve an instrument, a substance, an injectable product or a device that uses a form of energy, a laser for example. What defines it is therefore not the technique but the purpose: changing appearance, with no therapeutic or reconstructive aim.

A procedure performed to treat a disease or for a reconstructive purpose belongs to another field of medicine. In medical aesthetics too, the doctor must assess each person, make a diagnosis and establish the appropriate treatment plan before proposing an intervention.

Signs of aging, often grouped under the word “anti-aging”, lead both women and men to seek a consultation. Added to these are acne scars, pigmented spots or small visible vessels. A laser that acts on the skin does not work like an injection that relaxes a muscle or adds volume. These options are not chosen based on the name of your concern alone.

Energy-based devices. Lasers, intense pulsed light and radiofrequency belong to this group. A laser sends light of a specific wavelength onto a tissue; the absorbed energy turns into heat and acts on the targeted area, with no marked effect on the rest when the procedure is carried out properly. Lasers are generally used to resurface the skin to soften certain wrinkles and acne scars, to remove pigmented spots and to treat superficial vascular lesions. Intense pulsed light is used in particular for rejuvenation or depigmentation.

CARE MD, a medical aesthetic clinic in Sainte-Thérèse, offers fractional CO2 laser, ablative CO2 laser resurfacing, intense pulsed light and focused ultrasound, also called facial HIFU. This range of services does not mean that each of these options is appropriate for your skin.

For a laser treatment, effectiveness and risks depend in particular on the device, the settings, the training of the person using it and skin colour. Even when it is the right choice, a laser can cause pain, redness, bruising and swelling, and sometimes blisters, burns, infection, or a lightening or darkening of the skin.

Here, intense pulsed light and focused ultrasound are options to discuss, not treatments recommended for a specific concern. Their names alone do not tell you how they will act on your skin or which risks you would face. Before considering them, ask the doctor to explain how the proposed device works, what it can change and the possible complications. The risks of lasers cannot be used to judge the safety of these two other options.

Needles. Microneedling creates many small punctures in the skin by passing needles through it repeatedly. In the United States, some devices are authorized to improve the appearance of acne scars and facial wrinkles in people aged 22 or older. That status is American: it says nothing about licensing in Canada.

Injections. An injection that relaxes a muscle blocks its ability to contract in order to reduce existing wrinkles. A filler injection adds volume. These two types of aesthetic injections therefore do not meet the same need. Before an injection, a diagnosis, a treatment plan and an individual prescription are required. A complication may require medical care: the responsible doctor must be reachable and available on site within 15 minutes of the procedure. Ask which risks the injection being considered carries; the distinction between muscle and volume is not enough to identify them.

Skin care. A cosmetic product belongs to a regulatory category distinct from medical devices and drugs. But not all skin care can be classified based on the product used: the procedure performed also has to be understood. The product category is not enough to determine whether the procedure is medical.

No result is guaranteed. During the assessment, ask what change you can reasonably expect, how many sessions would be needed and what maintenance to plan for the proposed procedure.

To understand what you are being offered, distinguish between the medical procedure, the surgical procedure and the cosmetic product: these words do not describe the same thing.

Medical aesthetics is the non-surgical procedure involving a medical technique, without a therapeutic purpose. Cosmetic surgery relies on a surgical procedure, such as liposuction, liposculpture, fat injections or hair transplants, which also aims to change appearance without a therapeutic purpose. Ablative techniques, lasers included, fall within this definition: the name of a device is therefore not enough to classify a procedure in one category or the other. CARE MD does not offer cosmetic surgery. Aesthetic care cannot always be classified by name or by the product used. A cosmetic is a product category, whereas medical aesthetics and cosmetic surgery are defined by the procedure performed and its purpose. For skin care, ask what will actually be done and whether it is a medical procedure. Not all skin care should therefore be excluded from medical aesthetics.

Medical responsibility applies to a medical aesthetic procedure: the doctor assesses the person, makes a diagnosis and establishes the treatment plan. The doctor may then perform the procedure or entrust it to another authorized professional.

For aesthetic injections, a diagnosis, a treatment plan and an individual prescription must come before the treatment; collective prescriptions are no longer authorized. The nurse may then administer the treatment under an individual prescription and a detailed plan specific to the person treated. The nurse assesses you before each treatment. The nurse can adjust the plan only if it includes a protocol for that purpose; if your condition does not allow you to receive the treatment, the nurse directs you to the prescriber. After injections, the doctor who wrote the prescription, or another responsible doctor on site, must be reachable and available within 15 minutes to manage a complication, and follow-up remains the responsibility of both the doctor and the people who performed the injections. These conditions concern aesthetic injections; they do not make it possible to deduce who can perform another procedure.

For CO2 laser as for injections, ask our professionals, the CARE MD team, who will assess you, who will perform the procedure and who will manage a complication. A general rule does not tell you who will be involved in your case. These are also concrete criteria for choosing a medical aesthetic clinic.

The regulation of professionals is separate from that of devices and products. Professional regulatory bodies—the Collège des médecins du Québec for doctors and the Ordre des infirmières et infirmiers du Québec for nurses—regulate individuals: their responsibilities, competencies and conditions of practice. Professionals must keep their knowledge up to date, in particular to manage complications, practise within the limits of their competencies and the means available to them, and ensure the safety of care.

Health Canada, for its part, regulates devices and products. Their category depends on the intended use: some are medical devices, others drugs, natural health products or cosmetics. For a laser, you can check that the device is licensed for the procedure being considered, then find out about its uses, benefits and risks, as described by the manufacturer in the device’s manual. Licensing is checked for the device and the procedure being considered; it does not guarantee your result.

The assessment comes before the choice of a device or product. In it, you describe your concern; the doctor assesses your situation, makes a diagnosis and establishes the treatment plan with you. The doctor presents the options, assesses your expectations and, if they are not realistic, should decide not to go ahead.

Ask what the procedure being considered can reasonably change, what it does not change, and what risks it carries. Ask about the risks of the specific procedure being proposed to you, rather than relying on those of another type of treatment.

For your consent to be informed, you must have received and understood the necessary information: your health condition, the possible options, the risks and the usual consequences of the proposed treatment. The doctor must present them in plain language, let you ask questions and answer them. A leaflet is not enough.

Signing a form is not enough: you must understand the information and decide freely, without pressure, threat, coercion or promise from the doctor or those around you.

The doctor must present all the options to you, including what could happen if you refused the proposed treatment. You can postpone your decision or decline the treatment: doing nothing is also a choice.

You must also have enough time to think in order to understand and decide. You should not feel rushed into this decision by a time-limited promotion or an add-on offered on the spot.

Before deciding, you can ask these questions:

• Who will assess me, and who will perform the procedure being considered?
• Is this device licensed for the procedure you are proposing to me?
• What are the risks of this specific procedure, and what can it reasonably change?
• What other options exist, including doing nothing?
• Who handles a complication, and how can I reach you afterwards?

If a question remains unanswered, you can send it to CARE MD, or come and ask it at an aesthetic consultation.

You can send your question to CARE MD.