PAKISTAN seems to be quietly sliding into a preventable public health crisis, one that is unfolding not in emergency wards, but behind the glossy facades of the so-called aesthetic clinics across our cities. What began as a specialised medical discipline has now been overtaken by beauty salons and parlours rebranding themselves as clinical establishments, often operating beyond the reach, or perhaps the attention, of regulators.

The demand for aesthetic procedures has surged globally, with over 38 million treatments performed in 2024 alone. Pakistan is no exception, with some studies indicating that nearly 69 per cent of healthcare professionals report a sharp rise in patient demand for such procedures. Yet, this demand has been met not with a proportional expansion of trained specialists or regulatory oversight, but with an influx of unqualified operators filling the vacuum.

At the heart of the issue lies a dangerous regulatory gap. Authorities, such as the Pakistan Medical and Dental Council (PMDC) and provincial healthcare commissions, have established frameworks for licensing and oversight. However, enforcement appears, at best, inconsistent. The result is an expanding parallel industry where invasive and semi-medical procedures are performed in environments that lack even the most basic of clinical safeguards.

A particularly troubling manifestation of this trend is the misuse of branded medical technologies. The globally recognised HydraFacial treatment, a trademarked, standardised procedure, is routinely replaced in local markets with generic ‘aqua facial’ machines, often imported from unregulated manufacturers. These devices, along with their associated serums and boosters, frequently bypass scrutiny of the Drug Regulatory Authority of Pakistan (Drap) by being ambiguously declared as cosmetic or dermatological consumables. In reality, many of these substances have never undergone rigorous safety evaluation.

The situation is further exacerbated by the proliferation of substandard laser devices. Unlike globally approved systems that operate within precisely defined energy parameters, many of the machines currently in use here lack validated output controls. This raises the very real risk of burns, scarring, pigmentation disorders, and long-term dermal damage. Equally alarming is the widespread absence of infection control protocols. Procedures such as microneedling and hydrader-mabrasion require strict adherence to single-use consumables and sterilisation standards. Yet, reports of reusable tips and cartridges, driven by cost-cutting practices, point to a looming risk of cross-infection. These are not hypothetical concerns; they are predictable outcomes of systemic negligence.

Adding to this is the critical shortage of trained professionals. Pakistan lacks structured, accredited training pathways in aesthetic medicine, creating a vacuum that is increasingly filled by non-technical staff having little to no clinical background. This is not merely a professional lapse; it is a direct threat to patient safety.

It is worth noting that enforcement actions have already revealed the scale of the issue, with provincial authorities sealing multiple illegal clinics in recent crackdowns. However, such measures appear reactive rather than preventive, and the unchecked proliferation continues unabated. The situation demands more than sporadic enforcement; it requires a coordinated national response.

The PMDC must urgently take the lead in formalising aesthetic medicine as a recognised subspecialty. Simultaneously, healthcare commissions must intensify inspections, enforce licensing requirements, and establish umabiguous guidelines for equipment certification and consumable approval. The Drap must also tighten control on the import and distribution of all dermatological products used in clinical settings. If left unchecked, this burgeoning industry risks evolving into a silent epidemic of dermatological compli-cations, infections and irreversible harm.

Dr Shafee Khorasanee
Peshawar

Published in Dawn, May 11th, 2026