A Modified Delphi Study on the Ethics and Governance of Live Injecting at Aesthetic Conferences. Is There a Better and Safer Alternative?

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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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