An aesthetic treatment creates a distinct information and decision structure. The treating physician assesses the patient, develops the treatment concept, explains its benefits and risks, justifies the choice of procedure and may ultimately perform the treatment. The same professional side therefore designs the proposal, explains its clinical rationale and may then execute it. This is consistent with ordinary medical care. For the principal, however, a decision of considerable personal significance must be made on the basis of information selected, interpreted and communicated predominantly by the party that may later perform the procedure.

Good governance does not arise from distrust, but from recognising that executive responsibility and independent challenge are different functions. A physician may be exceptionally qualified, conscientious and experienced, yet will necessarily assess a procedure from a particular professional perspective. That perspective is shaped by preferred techniques, established operating concepts, available clinical structures and personal experience. It is legitimate, but it does not replace an independent assessment of whether this procedure, in this facility, with this practitioner and under these conditions represents the most appropriate decision for the principal.