American jurisprudence has strongly supported the concept of patient autonomy. There is a strong judicial belief that a patient has a right to be free from nonconsensual touching or interference. As stated by Justice Cardozo, “Every human being of adult years and sound mind has a right to determine what shall be done with his own body.”¹

The doctrine of informed consent protects the patient from unwanted contacts. A patient need only demonstrate that he or she was not properly informed of the nature of touching or treatment to prevail in such an action.

Violation of the duty to obtain informed consent from the patient constitutes a battery. The burden of proof is far simpler than that of a negligence action, for which a plaintiff needs to prove a breach of a duty that caused harm. In an action based on battery, physical injury or harm need not be shown to prevail. All that needs to be shown is a nonconsensual touching or treatment. The focus of a battery action is always on whether the touching was consensual. Thus, there is no need for expert witnesses or learned medical treatises in these cases. Indeed, one does not even need to establish a doctor–patient relationship. All that is at issue is whether the patient was informed sufficiently before the physician’s treatment.

There are several factors that must be included in a valid patient consent. The first factor is that the patient must have capacity to make a decision regarding his or her health care.² Dermatologists may encounter situations in which capacity is in question. For example, minors lack capacity to consent for many medical procedures. The cosmetic dermatologist therefore should see minors with their parents present, and the physician should determine which, if any, procedures are appropriate for young skin. Similarly, the cosmetic dermatologist may encounter patients with mental illnesses, such as body dysmorphic disorder (BDD), who look to cosmetic procedures as a way to fix their perceived imperfections.³ Given their underlying pathology, such patients are often not satisfied with even the best results and may sue.³ The cosmetic dermatologist should have a low threshold to seek appropriate psychiatric consultations before any procedure on a patient suspected of having BDD or other mental illness.

The second factor is that consent must contain adequate information.² Most jurisdictions use the “reasonable person” standard to determine what is adequate.² The consent must contain the information that a reasonable person requires to make a health care decision.² The consent must describe the diagnosis as well as the nature and purpose of the treatment. Furthermore, it must explain the risks and side effects of the procedure, as well as alternatives. For medications, side effects must be described even when there is only a small risk.

In assessing whether to describe each risk, it is important to consider any potentially severe side effects. Thus, even a small risk of serious morbidity or death should be disclosed. One must also consider the particular susceptibilities of the patient. In a patient with a higher Fitzpatrick skin phototype, the risk of pigmentary changes is higher than that of a skin phototype I or II. This should be emphasized both in the patient consultation as well as a proper written consent. For example, there is a higher risk of obvious hypopigmentation in a Fitzpatrick skin phototype VI

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