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According to a rapidly growing body of evidence on TikTok, brought to my attention by some inquisitive teenagers, most men of a certain age start to think about the Roman Empire more than would otherwise be considered ‘normal’. But what do teenagers today know about me, a 41-year-old Aesthetics Doctor?
Well, to be fair, those teens are right about that one: I do watch a lot of documentaries about Rome and I do read books where the Roman Empire is typically referred to several times. And, I suppose I do think about the Roman Empire at least once per day. But they don’t know everything, do they?
Now for the serious part.
Having practised as an Aesthetics Doctor for the past 16 years, I'm repeatedly asked if a client who has had cancer can safely receive aesthetic treatments. There was never really any evidence available as to whether or not these treatments would cause any harm to cancer survivors. The best answer from doctors over that timeframe has always been to avoid treating this ‘demographic’ in case their cancer comes back, which cancer sadly tends to do. Lose sight of that, the advice goes, and you will be sued, lose your business, your reputation and your home. So I’ve told countless would-be aesthetic clients that, unfortunately, ‘we’ can’t help.
But recently I decided to review and update this decision, if at all possible. Because, as I get older, I realise that life isn’t black and white. And cancer is common. And, as if having cancer wasn't bad enough already, having cancer attracts manifold treatments that can bring about even more suffering. Some spiritual devotees might consider that this can have positive effects if this suffering is transmuted into spiritual growth and the development of a deeper empathy and wisdom. As Emperor Marcus Aurelius (here I go again) said:
“It will suffice thee to remember as concerning pain . . . that the mind may, by stopping all manner of commerce and sympathy with the body, still retain its own tranquility.”
But we all know that cancer certainly isn’t a good thing. To be superficial for just a second - I am an Aesthetician after all - cancer doesn’t do much for your appearance. And once the treatment is finished, many of the changes in appearance from cancer and cancer treatment act as constant reminders of the whole ordeal. The body gets stressed, dehydrated, tired, and ageing is accelerated. These also are the exact same reasons however for regular clients to visit my Aesthetics clinics.
My insurer advises now that clients can have aesthetic treatments as long as they can provide a letter from their cancer specialist giving them permission to do so. In my opinion, looking at this with the fresh perspective of someone who has himself entered middle age, this is a cruel and short-sighted tick-box exercise to get Insurers off the hook. In medical school, we were taught to put our patients first. I know from the many face-to-face discussions I’ve had with cancer survivors that they often feel embarrassed to ask for this permission slip from their busy cancer specialist. And I know from various exchanges with doctors who don’t themselves practise Aesthetics that the service I offer is not ‘real’ medicine. I have seen in writing, one doctor write demeaningly of Aesthetic Medicine to another doctor, referring to it as “some beauty thing or something”.
A quick Google search reveals just one medical journal publication on this topic. The 2021 publication in Clinical, Cosmetic and Investigational Dermatology, written by cancer researchers in Rome, explores this issue.
So here I go again, thinking about Rome.
The Italians have a National Health Service, just like us in the United Kingdom. I’m not saying the Romans gave us the NHS; ours was founded in 1948 and the Italians’ followed 30 years later. But although Italians may speak a different language and raise their voice more in casual conversation than the average Brit, their culture surrounding healthcare is similar to ours in the U.K. And what are they saying regarding aesthetics in cancer patients?
“Maintaining patients’ quality of life is of paramount importance and this can be accomplished by a multidisciplinary treatment approach, including aesthetic treatments to improve patients’ body image and positively impact their quality of life.”
Maybe it’s just because they like making everything aesthetically pleasing over there. Or maybe it’s because they enjoy fussing about things like art and fashion, is that it? Well, The American Society of Clinical Oncology (ASCO) and the European Society for Medical Oncology (ESMO) also recommend approaching cancer patients from biological, psychological and sociological perspectives but neither Society seems to specifically refer to aesthetics as part of this. This publication from the Romans of today may be just a well-dressed opinion piece.
But even cancer specialists don’t have access to data if it does not exist. The truth is, we don’t know if there are any harmful effects of anti-wrinkle injections or dermal filler but equally, there is no reason to think that there would be as long as we aren’t administering anti-wrinkle injections to patients with neuromuscular problems or dermal filler to those with neutropenia. I am not aware therefore of any good medical reason why we should be withholding aesthetic treatments from cancer survivors. Like with any new medicine or medical device, patients should be encouraged to share any side effects and complications they experience with their relevant doctors. A side note here is that side effects and complications of cancer treatments are, in the U.S., recorded in the “Registry Operations and Data Standards” or “ROADS” for short.
But maybe we shouldn’t be embarrassed any longer to ask our cancer specialists, whose remit includes our psychological well-being, for that letter. Even if the letter is only to satisfy insurance companies. And if we start doing that more often, maybe this issue will become destigmatized sooner rather than later?
To conclude, and to answer the question posed to me by the teenagers mentioned at the beginning, my favourite Roman Emperor is Marcus Aurelius, because of his contribution to Philosophy. It is merely coincidental that it happens to have been his own physician, Galen, who first coined the phrase “cancer”.
So, should we offer aesthetic procedures to cancer survivors? All roads lead to Rome.
Post by Dr Michael David Aicken
Astral Skin Clinic, Visage Academy
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