Plastic surgery business: Need strict but scientific management

Plastic surgery is a field that combines medicine and beauty services, requiring both medical safety and flexibility to serve the needs of services in the market. However, in the current practice of Vietnamese law, the management framework is being designed in a tight but unscientific direction, leading to some difficulties in business activities and potential risks of increasing activities outside the control of the law.

Identifying plastic surgery facilities with medical examination and treatment facilities causes many consequences

According to current regulations, establishments providing plastic surgery services, that is, using medical techniques for surgery (anatomy) to change the shape and characteristics of human identity are required to be organized in one of three forms: hospitals, general clinics or specialized clinics[1]. This regulation in fact places a plastic surgery facility similar to a conventional medical examination and treatment facility, although the operational goals of these two groups are completely different.

Plastic surgery, in essence, does not aim to treat pathologies or restore biological functions, but mainly serves aesthetic needs, improving appearance according to personal wishes. The application of the same set of organizational standards, human resources, and facilities such as hospitals or disease treatment clinics has made the regulations unscientific, leading to a number of negative impacts in practice, which can be mentioned as follows:

Compliance costs exceed the capacity of the business.

For example, Decree 96/2023/ND-CP requires plastic surgery hospitals to have a minimum construction floor area of 50m²/bed, a façade at least 10m wide, a path for ambulances to enter and exit the emergency area, and a full range of specialized departments and practicing personnel[2]. However, for plastic surgery activities where the majority of surgeries are minor surgeries or do not require a long-term hospital stay, these conditions are somewhat unsuitable for the professional nature.

These requirements may be reasonable for general hospitals or pathological specialties, but they far exceed the actual needs of plastic surgery facilities. In order to be licensed to operate, the facility must invest a lot of resources to build standard premises, purchase medical equipment, arrange the department system and arrange personnel. Such high compliance costs can create a barrier to market entry for many investors, leading to the market being narrowed down to a few large investors, while the aesthetic needs of society are increasingly diverse and highly personalized.

In addition, with the cost of compliance being pushed up unreasonably, the price of plastic surgery services will also increase at the same time and customers will also be the subject of these additional costs. Therefore, in many cases, businesses have had to calculate to tighten costs to be able to "pull" customers, maintain invisible operations, and reduce service quality.

It can be said that the management approach in the form of organization instead of management according to the level of expertise can lead to administrative burden and lack of flexibility with the peculiarities of the field of modern aesthetics. Strict management is not effective management if regulations do not reflect the true nature of activities and the subject's ability to comply.

The rise of unauthorized aesthetic services and risks for customers.

Another worrying thing is that excessive tightening of input conditions can contribute to the situation that facility owners deliberately violate regulations because they cannot meet strict standards and still earn a significant profit every year. Some establishments register in the form of non-invasive spas and beauty salons but still perform surgeries that interfere with body tissue. When an accident occurs, the prosecution of legal liability becomes complicated because the establishment is not licensed for the right scope of operation.

As a result, the goal of ensuring consumer safety of the original policy may be counterproductive when service users become the subject of the highest risk of health and life. In fact, many serious accidents in recent years have come from unauthorized establishments or illegal activities, showing that without scientific management can lead to negative consequences instead of the original user protection policy[3].

Source: VTV

Need a more flexible and scientific management framework

To mitigate difficulties for establishments in the business of plastic surgery services and potential risks to consumers, it is important to establish a more flexible regulatory framework that balances safety requirements and market accessibility,  attracting the participation of individuals and organizations that are good at expertise and operating in this very specific field.

Firstly, it is necessary to clearly separate plastic surgery and traditional medical examination and treatment

As mentioned above, the majority of plastic surgery activities are not for the treatment of pathologies but rather surgical interventions to improve aesthetics according to personal wishes. Meanwhile, the regulations on business establishments operating this activity are being equated with other ordinary medical examination and treatment establishments.

Therefore, there should be an amendment and supplementation of separate regulations as in Decree 96/2023/ND-CP related to conditions and management for plastic surgery facilities in order to shift from "preventing risks by comprehensively tightening" to "controlling risks by classification and standardization". Separate regulations will create a clear legal corridor for establishments with professional capacity to expand their scope of operation, encourage legal investment and professionalize the beauty industry, avoid the situation of establishments "hiding" the law because the licensing conditions are too high and ensure the safety of service users.

Second, refer to the promulgation of regulations based on level and risk in plastic surgery

State agencies can refer to the promulgation of regulations regulating plastic surgery activities based on invasive characteristics, anesthesia methods and the ability to affect the physiological function of the person being operated on. Each level corresponds to its own legal requirements in terms of facilities, personnel and professional authority.

For example, three basic levels of management can be developed as follows, in which, specific requirements and criteria require further consultation from experts in the medical field:

Level 1 – Low risk: includes simple procedures that require local anesthesia and do not significantly alter the body structure, such as blepharoplasty and lipoplasty. These procedures can be performed in a specialized procedure room, meet sterile standards and have basic emergency equipment available.

Level 2 – Medium risk: includes surgeries with mild anesthesia or changes in body structure to a certain extent, such as structural rhinoplasty. These procedures should be limited to intensive surgical clinics, which have standard operating rooms, primary care units, and dedicated anesthesiologists.

Level 3 – High risk: including surgeries that require general anesthesia or have the potential to greatly affect physiology such as chin trimming, cheekbone reduction. These surgeries are only allowed in specialized hospitals or independent surgical facilities with intensive care units, inpatient treatment, and a 24/7 on-call team.

This classification not only helps regulators strengthen medical safety controls, but also avoids the application of a rigid framework of conditions to all facilities, limiting the business rights of legitimate clinics. At the same time, clearly defining the boundaries between levels also creates conditions for a more transparent licensing mechanism, helping practitioners and consumers easily identify which services are performed in accordance with authority. In the long term, this model also opens up the possibility of standardizing the training of aesthetic doctors according to each level of practice, thereby improving professionalism and minimizing legal risks in the field of plastic surgery in Vietnam.

In conclusion, in the context that plastic surgery is both a medical field and a beauty service, it is essential to have a modern legal framework that goes hand in hand with strict management of professional risks and flexibility in practice conditions.  based on the principle of classification and control according to the level of medical risk. When standards are designed to be reasonable and feasible, the law will not only protect public health but also promote the methodical development of an industry that is bringing significant economic value to society.