title: The Ethics of Stem Cell-Based Aesthetic Surgery: Attitudes and Perceptions of the Plastic Surgery Community.
abstract: BACKGROUND
  The emerging field of stem cell-based aesthetics has raised ethical concerns related to advertising campaigns and standards for safety and efficacy.
  
  
  OBJECTIVE
  The authors sought to characterize the attitudes of plastic surgeons regarding the ethics of stem cell-based aesthetics.
  
  
  METHODS
  A cross-sectional electronic survey was distributed to 4592 members of the American Society for Aesthetic Plastic Surgery and the American Society of Plastic Surgeons. Statements addressed ethical concerns about informed consent, conflicts of interest, advertising, regulation, and stem cell tourism. An agreement score (AS) from 0 to 100 was calculated for each statement. Majority agreement was designated as ≥60 and majority disagreement as ≤40.
  
  
  RESULTS
  A total of 770 questionnaires were received (16.7%). The majority of respondents indicated that knowledge regarding the risks and benefits of stem cell procedures is insufficient to obtain valid informed consent (AS, 29) and that direct-to-consumer advertising for these technologies is inappropriate and unethical (AS, 23). Most respondents reported that patients should be actively warned against traveling abroad to receive aesthetic cell therapies (AS, 86) and that registries and evaluations of these clinics should be made publicly available (AS, 71). Even more respondents noted that financial conflicts of interest should be disclosed to patients (AS, 96) and that professional societies should participate in establishing regulatory standards (AS, 93).
  
  
  CONCLUSIONS
  The plastic surgeons surveyed in this study support a well-regulated, evidence-based approach to aesthetic procedures involving stem cells.
authors.affiliation: Dr Nayar is a resident in the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Wisconsin in Madison, Wisconsin.
authors.forename: Harry S
authors.initials: HS
authors.lastname: Nayar
authors.affiliation: Dr Caplan is Chair of the Division of Medical Ethics at New York University Langone Medical Center in New York, New York.
authors.forename: Arthur L
authors.initials: AL
authors.lastname: Caplan
authors.affiliation: Dr Eaves is a Professor of Surgery in the Division of Plastic and Reconstructive Surgery, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Felmont F
authors.initials: FF
authors.lastname: Eaves
authors.affiliation: Dr Rubin is Chair of the Department of Plastic Surgery at the University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania rubinjp@upmc.edu.
authors.forename: J Peter
authors.initials: JP
authors.lastname: Rubin
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D003357:Cosmetic Techniques / Q000009:adverse effects / Q000941:ethics*; D003430:Cross-Sectional Studies; D000067088:Direct-to-Consumer Advertising / Q000941:ethics; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007258:Informed Consent / Q000941:ethics; D008389:Marketing of Health Services / Q000941:ethics; D057193:Medical Tourism / Q000941:ethics; D008875:Middle Aged; D061214:Patient Safety; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000941:ethics*; D012307:Risk Factors; D033581:Stem Cell Transplantation / Q000009:adverse effects / Q000941:ethics*; D066231:Surgeons / Q000941:ethics* / Q000523:psychology
keywords: cell-assisted lipotransfer; ethics; informed consent; stem cell breast augmentation; stem cell facelift