THE HISTORY OF AESTHETIC MEDICINE

The history of aesthetic medicine by Doctor Jean-Jacques DEUTSCH

Today, aesthetic medicine is well established, both in France and abroad. Its existence and effectiveness are no longer disputed, and an official diploma was introduced in 2025. But what seems obvious today was not so for decades. It took a long and determined fight so that now, more than 50 years after its beginnings, thousands of doctors in France and worldwide practice recognized medical treatments with aesthetic purposes, allowing their patients to achieve physical and mental well-being by reducing unaesthetic aspects related to aging, aftereffects of illness or accidents, as well as morphology and heredity.

From the outset, aesthetic medicine also integrated a strong focus on “aging well,” through the prevention of the harmful consequences of aging. It has therefore always been holistic in its approach, firmly based on science and validated techniques.

In a forthcoming memoir, “A History of Aesthetic Medicine,” I wanted to recount my personal journey through the epic story of aesthetic medicine—so that senior colleagues may revisit their memories, and new generations may understand the efforts required to pave the way to today’s success. I was, in fact, among the first doctors in France to practice aesthetic medicine exclusively.

I witnessed all its developments, participated in all its evolutions, and met all its main actors in France and the many countries where I was invited to speak at congresses. I kept notes, preserved documents, and recall numerous anecdotes. Very early, I also embraced the necessity for French doctors to unite around the French Society of Aesthetic Medicine founded by Dr. Jean-Jacques Legrand, so that together we could fight with a shared vision. My personal path has thus been deeply intertwined with the recent history of aesthetic medicine.

The brand-new magazine (H)éritage was enthusiastic about this project and proposed to collaborate with me, in line with its DNA, by dedicating in each issue a special section on the History of Aesthetic Medicine. I will invite many friends and colleagues to share their memories as well. We hope you will find this history inspiring.

We will start with a historical reminder: “The pursuit of Beauty, from Antiquity to modern times.” Then I will recount how I became an “aesthetic doctor.” On this point, the timing is striking: in 1973, when Dr. Jean-Jacques Legrand—the true “Father” of Aesthetic Medicine—created the French Society of Aesthetic Medicine (SFME), I was setting up as a general practitioner that very same year. By founding this learned society, known for its annual congresses and its “Journal of Aesthetic Medicine and Dermatologic Surgery,” Legrand, together with Dr. Patrick Rabineau, used for the first time the term “aesthetic medicine,” without imagining how widely this medical field would later expand.

I am certain many of you will be interested to discover—or, for senior colleagues, to relive—the rise of Aesthetic and Anti-Aging Medicine, particularly from 1973, the year of SFME’s creation, until around 1982, when bovine collagen injectable first arrived in France. At that time, only a few isolated doctors were practicing embryonic techniques, and a few dermatologists like Patrick Rabineau were performing what was then called “dermatologic surgery.” Yet, all this was discreet, partly to preserve a certain monopoly, but also because the broader medical community was not ready to accept this new field, seen as minor and purely lucrative. Surgeons, in particular, looked unfavorably at non-surgeons performing minor surgical procedures. Their frustration only grew as general practitioners began to train for these acts.

Unaware at first of the SFME’s existence, I was quickly overwhelmed by patient demand when I reestablished my practice in Paris, and quite naturally came to be called an “aesthetic doctor.” My practice rapidly became almost exclusively aesthetic, driven simply by patient demand.

By the late 1970s, I already sensed the huge potential of what I too began calling “aesthetic medicine,” as it clearly had a role alongside cosmetic surgery.

Like every specialty, it would have its medical and its surgical side. Through enriching encounters and constant research, I broadened my own techniques.

We will then see that, from 1985, with the creation of the Research and Application Group for Aesthetic Medicine (GRAME), of which I later became President, the first hands-on training workshops were developed for doctors, dermatologists, and surgeons alike.

It was thanks to this dual training effort—practical through GRAME workshops, and theoretical through SFME’s congresses, journal, and publications—that the first qualified aesthetic doctors were born, listed annually in updated directories.

Other associations soon followed, creating a true nationwide network of continuous education: notably AFME, still led by its President Dr. Jean-Luc Morel, which also turned toward informing the public and interacting with doctors. Later, other associations emerged, often linked to University Diplomas in aesthetic medicine. Alongside general practitioners, these associations always included dermatologists and aesthetic surgeons, as scientific advisors, trainers, or members.

As for the techniques adopted by aesthetic medicine, several landmark dates stand out: 1982, with the arrival in France of bovine collagen injections to effectively treat wrinkles; 1985, with the remarkable courses of the inventive surgeon Pierre Fournier, who taught us liposuction of small fat volumes under local anesthesia, followed by lipofilling (later known as lipostructure). Thanks to his mentorship, some of us also adopted deep phenol chemical peels and mechanical dermabrasion.

From 1990 onwards, pioneering dermatologists spread micro hair grafting techniques among doctors, along with the use of lasers—vascular, then ablative, then pigmentary—with exponential growth.

In 1992, at the American Academy of Dermatology (AAD) congress, I discovered fruit acid peels, particularly glycolic acid, and above all, injectable hyaluronan, which soon evolved into cross-linked hyaluronic acid, and finally botulinum toxin to treat dynamic wrinkles of the glabella and forehead. This marked a true “explosion” of medico-surgical techniques for doctors, benefitting patients—though some, like permanent non-resorbable fillers, were short-lived.

Soon, to protect doctors practicing these acts without formal diplomas, leaders of various associations founded the National Union of Aesthetic Medicine (SNME).

I was its first Secretary General. It is now chaired by Dr. François Turmel. While today it fights “fake injectors,” its ultimate goal has always been official recognition of aesthetic medicine. But one essential condition existed from the start: aesthetic medicine had to define its place between surgery and dermatology, and set its limits.

This was a long battle, as each specialty jealously guarded its prerogatives, while successive governments postponed a lasting solution. Public health concerns grew: too many doctors were abandoning general practice (already weakened by an unreasonable numerus clausus) in favor of aesthetic practice, often without standardized or mandatory training.

Many of us believed early on that aesthetic medicine must become noble, visible, and credible. Noble, because it answers the natural human need to feel well in both mind and body. Visible, by raising awareness through media and offering quality care by well-trained, sufficiently numerous doctors. Credible, by building its foundations on strict scientific standards, eventually leading to a state diploma.

The path, however, proved harder than expected. In France, academic and medical institutions are slow to change, and unethical practices by a few tarnished the field’s image. It took constant fighting for what I still consider a noble cause, overcoming egos, lobbying, and skepticism from authorities. Unfortunately, dissension within the field itself—multiple unions, rival societies—too often meant doctors were their own worst enemies.

During this long institutional deadlock, practices shifted. From 2002, experienced doctors like myself who had performed minor surgical acts had to stop liposuctions under local anesthesia, and thus lipofillings too, due to a late amendment in the “Kouchner law” which barred non-surgeons from operating in clinics.

Meanwhile, many plastic surgeons, once hostile to non-surgeons, gradually embraced aesthetic medicine as part of their own practice—sometimes making up to 80% of their activity. Dermatologists, too, increasingly adopted aesthetic acts. Other specialties followed suit, such as gynecology, ophthalmology, and angiology aesthetics. A consensus slowly emerged: aesthetic medicine had become a necessity, relevant to generalists and specialists alike, demanded by patients seeking to maintain an acceptable image.

Driven by pioneers like Dr. J.-J. Legrand in France and Prof. C.A. Bartoletti in Italy, aesthetic medicine internationalized quickly, under the aegis of the International Union of Aesthetic Medicine. National and international congresses multiplied, and I personally took part actively. This global expansion also brought competition for influence, as non-European countries joined the field.

Still, the thorny issue remained: official recognition through a national diploma, endorsed by professional, academic, and governmental bodies. Together, we will revisit the difficult milestones that finally led to the Inter-University Diploma introduced in 2025.

It will then be valuable to assess today’s state of aesthetic medicine: advances in sciences related to aesthetics, aging prevention, and regenerative approaches; the progress of techniques and studies; industry contributions; and patient safety, including ethical concerns. The field faces challenges such as the proliferation of low-cost chains, non-doctor “experts,” fake injectors on social media, and home devices of questionable value. We will also examine the global beauty market, its segmentation, and the place of doctors within Western, Eastern, and African societies.

Finally, I hope to address broader questions of interest to professionals: the body and its aesthetics, health and beauty, aging and appearance, the meaning of human beauty, its link with identity, happiness, seduction, and even its negative aspects—such as objectification.

Héritage has thus given me both a challenge and an opportunity. As I announced earlier, this regular section will also feature contributions from colleagues in France and abroad, enriching it with diverse perspectives. Of course, not everything from my upcoming book “A History of Aesthetic Medicine” can be included here, especially anecdotes. But thanks to my colleagues’ input, I am convinced this column will be both insightful and captivating. I wish you all a pleasant read.

Jean-Jacques Deutsch