In October 2013, the late Senator Miriam Defensor Santiago filed a bill limiting the practice of cosmetic dermatology to licensed and qualified physicians with residency training in dermatology. The bill is in legislative purgatory and, as of writing, has had no update in the last decade.
But perhaps the reason for this standstill is as pragmatic as it is bureaucratic. It doesn’t take much research to conclude that the Philippine Dermatological Society has not managed to gatekeep the practice of dermatology—or, specifically, aesthetic medicine. The Yellow Pages reports over 300 skin and body clinics in Metro Manila alone. In a country that boasts a beauty and personal care market size of $3.3 billion, the demand for cosmetic services may just be too high for the 1,275 PDS dermatologists who also have to juggle the country’s high acne, skin asthma, psoriasis rates.
So, the question becomes: Is that cosmetic pie big enough for aesthetic physicians and licensed dermatologists to share? Has the term dermatologist been coopted? And does it even matter to consumers?
Dermatologists vs. Aesthetic Doctors
To be a board-certified dermatologist in the Philippines, licensed doctors must undergo a three-year residency program in a certified institution. While some sources consider aesthetic medicine a sub-genre of dermatology, in the Philippines, aesthetic MDs usually refer to doctors who did not undergo the required training but are practicing medical cosmetic methods. They could be GPs or even other specialists who are trained in aesthetics.
In other countries like Singapore, this distinction is quite clear-cut. Aesthetic doctors are usually general practitioners who deal with cosmetic issues. Dermatology, on the other hand, is purely a clinical practice.
“To be honest, the line has become very blurred,” observes Dr. Stephanie, a PDS board-certified dermatologist who requested anonymity. “You can expect plastic surgeons to do cosmetic procedures, sure, but there are also ENTs (Ear, Nose, Throat) who do rhinoplasty. Both ophthalmologists and plastic surgeons can do blepharoplasty (eyelid surgery).”
There is, of course, still a difference in the standard of board-certified dermatologists. Dr. Giselle Lazaro-Maceda of NU.U Asia believes the PDS makes its members more cautious. “Those who aren’t PDS usually take more risks because they don’t know the side effects. They don’t care if it’s evidence-based or if there’s a study behind it,” she says, adding, “People say we are slow in introducing these new procedures but only because we wait and see if there will be consequences.”
In the early ’90s, Dr. Vicki Belo, perhaps the most famous dermatologist in the Philippines to not be a PDS member, drew flak in the medical community for bringing lasers and injecting Botulinum toxins into her patients.
Simply being a member of the PDS is also a factor, according to Dr. Lazaro-Maceda. They have an ethics committee that keeps them in check, and they have their society’s name to protect.
High Demand, Low Supply
Currently, the PDS has accredited 15 institutions for their residency training program – each accepting around two to eight doctors annually. Some centers even require a tuition fee that ranges in the tens of thousands. The competition for these slots is immense, admits Dr. Stephanie. Dermatology is a popular specialty for various reasons, from its profitability to the fact that it offers a much more pronounced work-life balance compared to, say, obstetrics or internal medicine.
“So, imagine that you’ve been dreaming all your life to be a dermatologist then you didn’t get into the training program,” explains Dr. Jayce, a board-certified dermatologist who declined to reveal her real name. “Will you just suddenly drop that dream, especially if you wanted to focus on aesthetics anyway?”
Other reasons are more economic. Dr. Windie Hayano, medical director of The Skin Inc. Dermatology and Laser Center, adds that local residents and fellows don’t get paid much. “You are also prohibited from working in clinics when you are under the [program]. That’s no income for at least three years!” With a family to raise, this was a non-negotiable for her.
While there are other dermatological societies in the Philippines, only the PDS certification allows doctors to use the DPDS or FPDS post-nominals. It is also the only group recognized by both the Philippine Medical Association and the Philippine College of Physicians.
Dr. Vicki Belo, perhaps the most famous dermatologist in the Philippines to not be a PDS member, reveals that she begged off from her residency in Makati after a year because she didn’t want to focus on clinical work.
“I became frustrated because the diseases in dermatology all look alike. They’re all red, they’re all itchy. And maybe 50% of them don’t really have a cure. My vision of a doctor is to cure,” she says, recalling her initiation to the field. “Like I don’t want to have an eczema patient, tell him to adjust his diet and give him steroids, then he’ll come back when it flares up again.”
After some confusion, a bit of a career crisis, and an introduction to laser technology in 1989, Dr. Belo found her resolve: “I decided I would be niche and just do [aesthetics] instead, I was not going to even touch clinical dermatology at all. I mean, there’s so many of them already.”
A Matter of Training?
Though the PDS does not officially recognize Dr. Belo as a dermatologist, she is a member of the American Society of Dermatologic Surgery, American Academy of Cosmetic Surgery, American Society for Laser Medicine and Surgery, American Academy of Anti-Aging Medicine, International Society of Cosmetic Laser Surgeons, International Society of Dermatologic Surgery, and Philippine Society of Liposuction Surgery. The latter of which she is a founding officer.
The Belo Medical Group honcho trained at London’s St John’s Institute of Dermatology but left to study in Thailand which she believed would teach conditions more relatable to Filipinos. She also took courses at Harvard Medical School, St. Francis Memorial Hospital, and more. In the early ’90s, she drew flak in the medical community for bringing lasers and injecting Botulinum toxins into her patients.
“And now look, everyone’s doing it!” she says matter-of-factly.
Despite this background, official recognition still eludes the celebrity doctor to the stars. But Dr. Belo shrugs it off, letting her reputation and over 33 years of experience speak for her.
Any monkey can do aesthetic – that’s what our mentor said. You just have to follow the steps. But to know what you’re injecting, to know the reaction of the skin? That’s different.
—Dr. Giselle Lazaro-Maceda
Like Dr. Belo, Dr. Jayce also believes that the divide between aesthetic doctors and dermatologists shouldn’t be a big deal. “They are still real doctors,” she maintains. “They know what they’re doing.” Moreover, many of them – she hesitates to say all – also do intensive and continued study before and during their practice.
“You still need to train to do these aesthetic procedures – real training and not those three-day, long-weekend type workshops,” Dr. Jayce clarifies. “But for me, I don’t think the boards are necessary if you want to go into aesthetics.”
However, Dr. Lazaro-Maceda takes a more measured approach. She recalls that she was not allowed to do aesthetic work until she was in her third year of residency. Dermas-in-training had to study basic anatomy, physiology, and about 3,000 diseases related to skin, hair, and nails before they could practice. “Any monkey can do aesthetic – that’s what our mentor said. You just have to follow the steps. But to know what you’re injecting, to know the reaction of the skin? That’s different,” she asserts.
Dr. Hayano agrees. She studied at Bangkok’s Institute of Dermatology – the same as Dr. Belo – and is therefore not a member of the PDS. However, she says: “I would still advise doctors to undergo residency training and fellowship because that is a complete training.” Although she admits to doing the reverse, the self-confessed “traditionalist” believes there are perks to the program, including finding mentors and building a network.
“Also, your peers might not acknowledge you the same way if you don’t [become board-certified]. This is just how it is, and to a certain extent, rightly so,” adds Dr. Hayano.
That said, Dr. Hayano believes that medical learning has evolved. Where there were limited opportunities to train before, there are now so many courses one can take locally and abroad to earn competency. “After all, just because you did residency doesn’t mean you’ll know how to do it perfectly,” she explains, adding that most cosmetic procedures, such as Botox and filler injections, aren’t even taught during the three-year program.
The Problem With Business
“Here in the Philippines, dermatology has become a bastardized specialty,” says Dr. Lazaro-Maceda. “Anybody can put up a clinic and hire a doctor. For many businessmen, they think it’s a money-generating specialty.” She mentions a time when pharmacies and machine companies could only sell to dermatologists, but the PDS was unable to sustain the restriction. “We can’t blame them. We decide slowly and we don’t have as many resources as these businessmen.”
I draw the line on non-medical people doing fillers or threads. Even in the hands of expert doctors, complications can happen. Social media posts make it look trivial, fashionable, and fun, but it can be very disastrous.
—Dr. Windie Hayano
For Drs. Jayce, Stephanie, and Hayano, the proliferation of such face and body clinics should be the reason the PDS must readjust its focus – from policing aesthetic doctors to lobbying against unsavory opportunists. In separate interviews for The Beauty Edit, the three strongly spoke against institutions that offer medical aesthetic tuition pretty much to anyone who signs up whether they have medical qualifications or not.
“I draw the line on non-medical people doing fillers or threads,” Dr. Hayano declares. “Even in the hands of expert doctors, complications can happen. Social media posts make it look trivial, fashionable, and fun, but it can be very disastrous. Some people do a two-hour course and call themselves masters. Twenty years on, and I don’t have the ego to say that about myself.”
Dr. Stephanie, on the other hand, speaks of treatments that require a doctor or at least a nurse present. For example, beauty IV drips, which have become vogue in the last five years, have neither been FDA-approved nor proven effective for skin whitening. According to a post by the PDS, evidence has shown adverse effects in high doses. Worse, this procedure is performed by non-medical practitioners.
Aestheticians should only do treatments that happen on the surface of the skin, like facials, manual extractions, or even radio-frequency skin tightening, clarifies Dr. Jayce.
Unfortunately, the PDS’ jurisdiction is limited to its member doctors. To combat the propagation of bogus aesthetic centers, the body started displaying a Seal of Excellence in clinics run by its members in 2005. The validation lasts two years, and any violation warrants its removal. In 2008, they also launched the Skin Safety campaign, which encouraged patients to consult only with board-certified dermatologists.
And, while there are laws, such as the 64-year-old R.A. 2382 or the Medical Act of 1959, that sanction non-medical people from executing medical work, no legislation currently qualifies what constitutes a medical service, particularly in the fields of dermatology and aesthetics where the boundaries are so often arbitrary.
In August 2023, the House of Representatives approved a bill to replace the ailing Medical Act of 1959. However, its specifics do not cover the scope of medical specializations. Sen. Defensor-Santiago’s Senate Bill 1850, while in some ways prohibitive, is the closest attempt to regulate the medical aesthetic industry – if it could get approved.
A Patient First Policy
Dr. Belo, who says she doesn’t “get” the emphasis on labels, shares that she hires both dermatologists and aesthetic GPs. “Whenever someone has a clinical issue, we always refer to our PDS doctors because, like I said, I’m not very patient with psoriasis. I know I’m not good at those things, so I won’t even touch them.”
She adds: “What makes me happy is making patients the best versions of themselves. And that’s all the certification that I need.”
Drs. Jayce and Hayano confess that not all their patients ask whether they’re board-certified or not. However, their goal is to put their patients’ best interests at the forefront.
“Fortunately, I do have the training and the years to back up what I do and say. Plus, I genuinely love my patients. I really care for them and want them to be happy. I would never do anything to deliberately put them at risk,” explains Dr. Hayano.
Dr. Jayce warns people, however, to do their due diligence when it comes to choosing a clinic or beauty center. “Read reviews, check their credentials, look at equipment.” Whether they’re aesthetic doctors or certified dermatologists, patients need to know that they’re in the hands of someone competent, trustworthy, and accountable.
The scope between aesthetic doctors and dermatologists may still be hazy, but one thing that can’t be denied is how fast the medical aesthetic market is growing. And, as with any progressing industry, there will always be disruptors – like Dr. Belo in the early ‘90s – that could be considered either a trailblazer or a troublemaker depending on where you stand. But only time will tell whether these distinctions will continue to matter or if new, updated safeguards should take place.
Additional sources:
Swain, R. (2023). Aesthetic Medicine Market – By Type (Surgical Procedures, Non-surgical Procedures) By Product (Energy-based, Non Energy-based), By Gender (Male, Female), By End-use (Hospitals, Beauty Centers & Medical Spas, Dermatology Clinics, Home Settings) & Forecast, 2023 – 2032. In Global Market Insights Inc.
Al Jazeera English. (2023, June 7). Inside Miami’s deadly plastic surgery industry | Fault Lines Documentary [Video]. YouTube.
