Cosmetic surgery for aging skin is a rapidly growing field within dermatology. Whereas formal instruction in cosmetic surgery was uncommon for the dermatologist 20 years ago, cosmetic procedures are now an integral part of dermatologic practice. Training in cosmetic surgery is standard in most residency programs, with at least 12% of course offerings at the annual meeting of the American Academy of Dermatology in 1997 including instruction in cosmetic techniques. Biotechnological advances in areas such as laser surgery, chemical peeling, liposuction, and phlebology have made it possible to erase signs of aging that previously were considered indelible. But while the technology of "skin rejuvenation" is readily accessible, its intrinsic value and ethical implications have gone largely unquestioned by the dermatologic community. Why are we performing these procedures? What goals are we trying to achieve? Are these goals worthwhile? What is their impact on our patients? On the profession? On society? A situation has developed in which there has been ample investigation into what physicians can do, but far less examination of what they should do. Cosmetic procedures are invasive, potentially morbid techniques that have implications far beyond their value as "practice builders." As dermatologists enter the realm of cosmetic surgery, they have a responsibility to explore the moral and psychosocial as well as the scientific and technical implications of the procedures they perform.
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