A Modified Delphi Study on the Ethics and Governance of Live Injecting at Aesthetic Conferences. Is There a Better and Safer Alternative?
Abstract
BACKGROUND: Live clinical demonstrations at aesthetic medicine conferences is common, yet concerns regarding patient safety, commercial influence, and ethical governance. This study established a consensus-based governance framework for live injecting and compared expert and attendee perspectives. METHODS: A two-stage modified Delphi process involved an international expert panel (n=31) alongside a cross-sectional attendee survey of conference (n=218). Round 1 included 46 statements addressing clinical safety, ethics, educational value, commercial influence, and governance, with consensus predefined as ≥70% agreement. Unresolved statements were refined in Round 2. A 23-item modified survey assessed attendee views on live injecting and alternative educational formats. RESULTS: Experts demonstrated strong consensus on key governance requirements. A voluntary code of conduct was supported by 96.6% of experts and that formal tripartite agreements between injector, host clinician, and organiser be required (93.1%) and that the practitioner assuming medico-legal responsibility must be physically present during demonstrations (89.7%). Experts identified performance pressure (95.7%) and unsafe modelling for less experienced practitioners (91.3%) as significant risks. Attendees favoured alternatives: 74% preferred small-group teaching over auditorium demonstrations, and 82% would still attend conferences if live injecting were replaced by high-quality recorded demonstrations. CONCLUSION: Live injecting demonstrations retain conditional support but require stronger clinical governance to ensure patient safety and ethical practice. Findings support standardised oversight mechanisms, including in-person clinical supervision, defined medico-legal accountability, and a formal code of conduct. Small-group teaching and high-definition recorded demonstrations, may offer safer, equally effective alternatives for procedural education.
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Authors: Greg Goodman, Mark Magnusson, Eqram Rahman, Sarah Boxley, Narendra Kumar, Andrew Clark, Hema Sundaram, Frank Lin, Michael Clague, Niamh Corduff, Sarah Hart, Peter Callan, Stefania Roberts, Cara McDonald, Alice Rudd, Katy Wallace, Antoinette Ciconte, Anita Patel, Sean Arendse, Aakriti Gupta, Terence Poon, Catherine E Porter, Philip Bekhor, Lee‐Mei Yap, Firas Al-Niaimi, Adrian Lim, Howard M Studniberg, Maeve A Ahern, Angelo Tsirbas, Richard Webb William, Zallmann Michaela, Somia Naveen
Institutions: Box Hill Hospital, The University of Sydney, Royal Adelaide Hospital, University of Manchester, The London College, Monash University, Royal North Shore Hospital, Oldham Council, Monash Health, Royal Children's Hospital, Griffith University, Bond University, St Vincent's Hospital Melbourne, Eastern Health, Aalborg University, St Vincent’s Private Hospital Sydney, IS practice, The Alfred Hospital, Cosmetics Europe, Aesthetic Surgery Center, Advanced Laser Technology (United Kingdom), American Academy of Cosmetic Surgery, Geelong Hospital, Unisys (United States), Dermatology Institute of Victoria, Institute of Dermatology