The "medical beauty" service is fast proliferating in recent years despite the incidence of injuries and fatalities, problematic sales practices and service quality. The beauty-conscious are undeterred and splurging freely in their quest for the perfect body shape and looks. A Consumer Council's in-depth study has revealed a host of problems besetting the industry due to the absence of a clear definition of what constitutes a "medical beauty" service and a comprehensive system of regulatory oversight. (Source: Consumer Protection of Medical Beauty Services - A New Regulatory Regime)
Potential problems spread over a wide spectrum ranging from the risks involved in products and services to control over medical devices; qualifications accreditation to sales practices; and information disclosure to complaints resolution mechanism. Confused and incapable of assessment, consumers would invariably underestimate the risks they have to undertake let alone protecting their own interests.
The report studies the regulatory frameworks in 7 jurisdictions. In comparison, regulation of the "medical beauty" service in Hong Kong is clearly lagging behind the overseas. The Council has proposed a package of 9 recommendations urging the Government to consider a clear definition of "medical beauty", introduce certification and accreditation of qualifications for different "medical beauty" treatments, regulation of related medical devices, and urgently establish a clearly licensing scheme for risk management. In addition, the Government should set guidelines for information disclosure of related advertisements, bring in cooling-off period and redress mechanism, to further strengthen consumer safeguard.
The Council's research covered three major areas. First, through consultation with stakeholders in the beauty service sector, Government departments, medical professions and experts from the academia to seek their views and advice on the industry; and examining relevant legislations and regulatory frameworks in the 7 jurisdictions to assess the approach best suitable for Hong Kong. Second, through consumer opinion surveys to evaluate the level of consumer perception and understanding of "medical beauty" service and issues of consumer concern. Consumer opinions were canvassed via telephone interviews (1,004 respondents), street interviews targeting users (602 users) and focus group discussions (72 participants). Third, through market enquiry visits by posing as consumers to 30 premises (including beauty salons, "medical beauty" centres, "medical beauty" clinics and private hospitals) to collect first-hand experience of trade practices.
The opinion survey via telephone showed that 1 in every 5 in the age range of 15 – 64 years, of both men and women with predominantly the latter (82.6%), has subscribed "medical beauty" service. "Laser treatment" topped as the most popularly used service (61.8%).
According to the survey targeting users of "medical beauty" service, the great majority of consumers (98.8%) had their treatment performed in Hong Kong with nearly 90% (89.3%) in beauty centres and some half of them (52.5%) regularly used the service at least once a month. When purchase the service, the average cost incurred is about $6,600, mostly by pre-payment in one sum (65.6%).
Among users of "medical beauty" service, more than half of them professed to understand the terms and conditions in service contract (66.5%) and the potential risk involved (62.8%). The overall satisfaction rate reached a high 70% with over 90% (97.2%) of consumers regarded the service met their expected effect.
Of great concern to the Council is that the general consumer perception of the term "medical beauty" was not in line with the current regulated practice. The majority of users (81.3%) mistook "medical beauty" service as "ordinary" beauty service on the assumption that service offered to be conducted by "beauticians" or "therapists" at beauty centres were "common" and "non-invasive" treatment, overlooking the potential safety hazard.
Based on the feedback of those users who might have undergone what have been classified as high-risk "medical beauty" treatments that should be performed by a doctor or dentist, these treatments were claimed to be conducted by "beauticians", "therapists" or "beauty consultants" at beauty centres with "beauticians" took up a high proportion of 91.3%. In contrast, only 3.2% were claimed to be conducted by registered medical doctors.
The Council believes that in the absence of a clear definition of "medical beauty" in Hong Kong, different treatment procedures could be performed by various industry practitioners. The lack of clear differentiation of service responsibilities is most baffling and hence adversely affect the judgement of consumers. Should anything go wrong in the course of the treatment, consumers are left to their own to bear the risk. In more minor cases, they may stand to suffer financial loss or defect to the appearance. Or, in the more severe cases, permanent damage to the body or health or even life-threatening. In the Council's research, it was shown that although consumers were generally satisfied with the service efficacy, over 90% of users are firmly supportive of the Government in enhancing its regulatory oversight in respect of the usage of the medical devices, qualifications of the industry practitioners and the sales practices, etc. Clearly consumers have a strong desire and expectation of improvement in both the quality and safety of "medical beauty" service.
The rapid proliferation of "medical beauty" products and services in the market and the divergence of users' reports on them by consumers and commentators alike have brought on even more market information confusion. The experience of the Council's market enquiry visits has revealed that the information given by different service providers offering the same "medical beauty" service were sometimes at odds with each other, leaving the baffled consumers in limbo. In any case it is difficult to assess if the information provided is exaggerated or misleading. What is worrisome is that nearly 80% of user took such information to be trustworthy. The truth is only after problems have emerged will consumers then be able to ascertain the pros and cons of a product or service.
The Council also found that except for medical clinics and hospitals, beauty centres/salons offered little or insufficient explanation about the associated risks of undergoing "medical beauty" treatment such as the possibility of complications and side effects. Instead the sales personnel would focus on the efficacy of the beauty treatment with enticements of "limited privilege", "trial price" or "special discount" to prospective consumers. They appeared also to deliberately use psychological tactics to push the emotive consumers into a rush decision – by critical remarks on their appearance and typical hard sell practices. Over 70% of women users (72.4%) have recounted different experiences while receiving beauty treatment. For instance, demands were made on them to make purchase of upgraded services or other extra products and services at a time when they were unable to give careful thoughts to the potential risk of the products/services or whether they were really necessary.
Further, the Council's market enquiry visits observed that beauty centres/salons were often decorated or furnished to resemble medical clinics, the staff there were dressed in white robes like medical practitioners; the promotional and advertising materials frequently contained professional jargons such as "therapy", "specialist", and "science". The practitioners would claim to possess different professional qualifications or titles like "therapist", "consultant" to sell products and services but never disclosed their qualifications or experience. A common promotional tactic is to display before-and-after photos to show treatment efficacy but some of the photos could have been computer-processed to highlight the desired effect. The Council deems such practice questionable and undesirable as the industry should not create false vision and promote unrealistic consumer expectation, which is disadvantageous to consumers with unsubstantiated claims.
The Government should clearly define "medical beauty" service and design a comprehensive regulatory system.
At present, Hong Kong has no specific legislation governing the "medical beauty" service, nor a clear definition of the relevant services; high-risk procedures are covered and restricted by the issue of "administrative directive". The Council's research has shown that both consumers and industry practitioners have only a very vague idea of what constitute the scope of beauty service and that of "medical beauty". Overseas experience shows that although "medical beauty" is not necessarily defined officially they all have a clear consensus with regards to such medical treatment as surgery, drugs, medical devices or invasive technology to improve the effect of appearance. They all have their own unique regulatory framework including registration and licensing systems, competency standards and other consumer safeguard measures.
The Consumer Council has recommended that the Government should give consideration to the necessity of bringing in legislation to clearly define the elements that constitute a "medical beauty" service, and a licensing system to strengthen the regulation of service standard, use of treatment devices and facilities at beauty premises, together with oversight on marketing practices, information disclosure, cooling-off period and redress mechanism etc. to uphold consumer safety and interests. The research report has put forward a package of 9 recommendations in total for the consideration of the Government, industry practitioners and stakeholders.
(1) A clear definition of "medical beauty" service as the legal foundation for consumer safeguard – through legislation to clearly define what constitutes a "medical beauty" service covering lists of procedures, types of surgeries, drugs and medical devices or invasive techniques used in providing a medical service for cosmetic purposes, so as to regulate the behavior of service providers of both medical professionals and beauty sector personnel.
(2) Licensing requirement to oversee service quality – rather than the current piecemeal approach, the establishment of a clear licensing framework coupled with existing regulatory instruments to ensure effective risk management, quality control and compliance checks which will help not only strengthening consumer protection but also the healthy development of the industry to create economic benefits to Hong Kong.
(3) Competency requirements to ensure professional standard – all "medical beauty" service providers, whether registered doctors or beauticians, are required to possess the necessary professional skills and experience, and to attain the recognized competency standards needed specifically for the types and levels of risk of "medical beauty" services. Arrangements should be made for appropriate certification or accredited qualifications of providers made with reference to training and experience, such information to be regularly updated and made readily accessible by the public.
(4) Registries and incident reporting mechanisms to monitor product safety – under a licensing framework, operators of "medical beauty" devices will be required to be registered and report adverse reactions caused by the use of the related devices. The information will be made available for public scrutiny enabling consumers to gain a comprehensive understanding and evaluation of the risk involved before their decision to undergo "medical beauty" treatment.
(5) Independent, evidence-based information/advice to facilitate consumers to make informed choice – to ensure impartiality and convenience of use, it is necessary to develop an information platform for reference of consumers in respect of standards on "medical beauty" services, drugs and devices. The information should ideally be disseminated by the Government or through an industry licensing body to ensure the content is up-to-date and accurate.
(6) Acquiring written consent to safeguard consumer confidence – prior to undertaking a specified "medical beauty" service, practitioners must give a full explanation of the details of the procedures, and acquire a written consent of the consumers in acknowledgement of their understanding of the potential risk involved or any remedial action that might arise. It should also prohibit the service providers from marketing services to consumers while they are receiving treatment, that are not stipulated within the written consent.
(7) Regulating misleading advertising – under a licensing regime, a code of practice on "medical beauty" advertisement should be issued to regulate the way in which the services are promoted, especially in restricting the manner in which some advertising claims are made in the "medical beauty" service market.
(8) Mandatory cooling-off period to deter undesirable sales practices – the potential risk in "medical beauty" service could bring severe consequences. Therefore a reasonable period of time should be allowed so that the consumers could reconsider and, if necessary, rescind from the transaction. This is particularly important to consumers who have been unfairly lured or intimidated into the purchase, and help curb undesirable sales practices.
(9) Mediation and arbitration in dispute resolution and redress mechanism – as an alternative to the current channels of dispute resolution, the "medical beauty" service industry is recommended to collectively develop a specialist mediation agency to give consumers a feasible and practical way to resolve disputes.
To strengthen consumer protection, the Consumer Council emphasized the urgency of introducing a new regulatory regime with a licensing mechanism to prevent incidents involving undesirable medical beauty service. The Council urges the Government, the beauty sector, the medical profession and other related stakeholders to give these recommendations their most careful consideration, closely examining and taking heed of the legislative models and regulatory frameworks being put into force in the various jurisdictions in order to introduce in a regulatory regime that is stringent and professional for Hong Kong. Apart from safeguarding the consumer safety and interests, such move would also help a healthy development of the industry, beneficial to both consumer welfare and the economy.