PracticalDermatology

The demand for cosmetic dermatologic procedures—both invasive and minimally invasive—is on the rise. Laser and energy-based treatments, neurotoxin injections, and soft-tissue fillers continue to rank among the top cosmetic procedures. With recent advances in the use botulinum toxins and injectable fillers, dermatologists are better able to refine and customize their treatments to best meet the needs of individual patients.

One of the most important aspects of cosmetic procedures is delivering results that meet patient expectations. Cosmetic procedures are purely elective, after all, meaning that patient satisfaction is of the utmost importance. However, results are only part of the story. To enhance patient satisfaction, physicians should focus on optimizing the patient experience in all phases, including pre-, during, and post-procedure.

Patient Selection: Choose Wisely

The patient-physician encounter for aesthetic procedures is akin to the standard clinical encounter, though the symptoms of aging may not be as apparent to the patient. While the patient—male or female—may present for a specific facial cosmetic concern, it is important to assess the whole face and communicate your overall assessment to the patient. Allowing the patient to point out their main concerns is important, but adding a global physician perspective enhances this experience.

An important facet of the initial consultation is matching the appropriate procedure for each patient. While the patient may consider one treatment preferable over another, it is important to explain the potential benefits and shortcomings of neurotoxins and injectable fillers, as well as the benefits of combination therapy. Deep static rhytids may not fully correct with a neurotoxin alone; explaining this can help improve patient overall satisfaction.

Create a Treatment Plan and Treatment Goals: The Roadmap

In the larger scope of patient satisfaction, the consultation may be as important as the actual procedure. The aesthetic consultation is two fold. It allows the patient to voice her or his concern while becoming comfortable with the physician. Many patients may have a goal in mind or an upcoming engagement that may be prompting them to seek cosmetic procedures. As such, it is important for the physician to be in line with these motivations. Unrealistic expectations on the part of the patient will surely set up for patient dissatisfaction. Thus, frank discussions regarding realistic outcomes and the time course needed to complete such are often warranted and required. However, quoting the number of treatments needed may be precarious, as for some patients this can become a focus. Therefore, it is ideal to offer a range of treatments, so that patients can decide their own comfort level in terms of procedure as well as financially.

Combination treatments using fillers, neuromodulators, and lasers have become ideal practice to achieve desirable cosmetic results. However, many patients may not want to undergo all of the procedures at once. Therefore, it is important to create a solid treatment roadmap. Staging cosmetic procedures can be a great way to assess the satisfaction of patients and adjust the treatment plan as needed. This can be especially true for patients lacking experience with cosmetic procedures as well as for apprehensive patients. For the latter group, a “less is more” approach can help establish a strong patient-physician relationship and allow the patient to see natural aesthetically pleasing results with less apprehension.

The Male Patient: The New Frontier

The male cosmetic patient is a rapidly increasing demographic that the physician should be aware of. Regardless of their motivations for cosmetic procedures, an initial consultation is important to assess the patient’s desires. Some male patients will have specific concerns whereas others may not be aware of the various procedures available. Although procedures are often the same as in women, the techniques and treatment parameters required are different. It is important to recognize that men have different expectations, and their unique facial anatomy and aging characteristics are key factors to consider when performing cosmetic procedures.

Topical Talk

An adjunctive skin care regimen can significantly enhance the overall cosmetic result. Thus, creating a skin care plan for the patient with specific “dos” and “don’ts” will round out the cosmetic plan. Topical retinoids, pigment lighteners, and emollients can all have visible results when combined with aesthetic treatments. Having printed written instructions on how to care for skin after treatment will reinforce instructions given during the procedure, especially since patients may not retain all the information that was presented to them.

Baseline Photography; Scratch That Selfie

Baseline photography serves a multitude of uses and is important in the initial consultation. Patients are evaluating themselves in many different ways, including the use of mirrors, photographs, and “selfies.” It is important to explain to the patient that camera images such as “selfies” can be quite distorting due to camera lens and distance distortion, and therefore not suitable for cosmetic evaluation. Similarly, mirrors and lighting sources may provide different images than what the patient conceives. Therefore, using standard digital photography and lighting can document baseline anatomy and asymmetry. Highlighting this asymmetry to the patient is essential given that patients may not be attuned to this level of detail. The baseline photograph can be printed or used digitally to map out treatment strategies and highlight areas of concern or areas to be injected. Also, since many patients will scrutinize their face or body after the procedure, it is important to have a baseline record to alleviate any concerns post-procedure.

Baseline Video: Roll the Tape

With the advent of improved digital cameras and technology, video capture is easy. This can be of great utility when documenting patient animation before neuromodulation because static images may not portray the full effect. When considering neuromodulation of the upper and lower face, pre-treatment video can document different animation patterns. Also speaking patterns can be video-documented before neuromodulation of the perioral area, as a change in speech pattern may be observed.

Patient Satisfaction; Beyond the Lines

Patient satisfaction should be one of the main goals of a successful cosmetic dermatologic procedure. However, measures of satisfaction are not always quantifiable. That’s why health-related quality of life (QOL) based assessments are increasingly used to objectively demonstrate the impact of cosmetic dermatology procedures. Recent reviews of the literature have found that psychosocial QOL factors improve after facial cosmetic procedures.

One newer quality of life scale that may be useful is the FACE-Q, which measures outcomes for patients undergoing any type of surgical and/or non-surgical facial cosmetic procedure. The scales can be independently scored with pre-procedure and post-procedure versions. My colleagues and I have recently studied the utility of the FACE-Q scales in assessing the effectiveness of non-surgical facial cosmetic interventions including laser resurfacing, injectable neurotoxin, and injectable fillers (manuscript submitted). Comparing pre-procedure and post-procedure scores, we showed patient reported improvement for all three procedures.

Although objective measurements for patient satisfaction are still being refined, further analysis of how cosmetic interventions impact patient’s lives will hopefully better allow us to improve patient satisfaction. Moreover, it is important for all of us performing cosmetic procedures to give added consideration to patient satisfaction and how we can work toward increasing it throughout all stages of care. The more we are committed to increasing patient satisfaction, the more likely we can successfully use our expertise to deliver optimal results for individual patients. n

Anthony M. Rossi, MD, FAAD is Assistant Professor of Dermatology at Weill Cornell Medical College and an Assistant Attending Physician at Memorial Sloan Kettering Cancer Center in New York.