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Conflicts of interest: none declared.

Sir, The fourth International Academy of Cosmetic Dermatology (IACD) was held in Paris, 3–5 July 2005. As Honorary President, I gave a short talk which might interest some readers of this journal.

IACD was born 15 years ago and held its first meeting in Malta in 1997. In the early years, cosmetic procedures fell within the province of dermatological surgeons and this (soon) engendered criticism from cosmetic surgeons. The development of less invasive procedures such as the use of injected fillers for wrinkles, botulinum toxin, chemical peels and laser treatments enabled the field of cosmetic surgery to expand rapidly over recent years and in many countries. This has produced a dramatic schism (especially in the U.S.A.) between dermatologists, whose approach is medically orientated and those primarily involved with surgical procedures. Of course, the field of science related to cosmetic dermatology falls into both of these unequal categories and this has resulted in a shortage of qualified doctors in both the U.S.A. and the European Union.

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