Selection of Patients

(1)

Clínica Médica Dr Mauricio de Maio, São Paulo, São Paulo, Brazil

2.1 Introduction

2.2 General Rules

2.3 The First Consultation

2.4 The Facial Thirds System

2.5 The Ideal Patient

2.6 The Aging Patient

2.7 The Patient with Facial Imperfections

2.8 The Patient You Do Not Want to Treat

2.9 The Dysmorphic Patient

References

Abstract

Patients’ perception of their needs and medical diagnosis differs much more than we imagine. One important reason is that patients usually look at themselves at the mirror in frontal view while the observers (including the doctor) look at them mainly in the oblique view. Differences in position and angles result in differences in prioritization of aesthetic needs for both patients and doctors. We also find differences in treatment planning among doctors which may lead to confusion to patients if they happen to consult more than one injector for the same indication. Differences in experience, problems in communication, and to a large extent limitation in injector’s technical skills represent the main reasons for discrepancy in treatment planning among different doctors. For example, the reasons that some injectors will not suggest volume replacement in a patient with severe sunken temples include (a) the unawareness of the patient of this indication which therefore remains unrequested and/or (b) the doctor’s inability to give a proper diagnosis, technical deficiency, and lack of experience to predict whether the diagnosis, technique, and product will lead to a result that will finally make the patient happy! Cultural aspects, poor training in medical/patient communication, and lack of time or patience to educate patients are further barriers to obtain more efficient results (see also Chap. 4).

2.1 Introduction

Technical ability is fundamental for good medical practice, but the correct selection of patients is mandatory. Physicians who would like to successfully practice aesthetic medicine must understand that the vast majority of patients are unaware of what they really need (see above). They know (hopefully) what they want; however, it is the physician who has the knowledge of the anatomical base and the aging process and who has to find a compromise between the expectations of the patient and what is feasible.

Patients are prone to ask for procedures that they have heard of or read about in lay magazines. For example, it is quite common for patients to request treatment of nasolabial folds with botulinum toxin A (BoNT-A) only because this product is widely advertised. In most cases, however, injection of BoNT-A into the nasolabial fold would result in an unhappy patient because this would have little effect on the depth of the fold. Understanding patients’ complaints and educating them according to their needs will minimize patient dissatisfaction and increase patient retention.

Patients with multiple needs and requesting immediate results are legendary. The first consultation is very important, as it gives the physician the opportunity to establish the kind of patient he will be treating. Uncompromising patients, for example, are best avoided. Dissatisfaction with prior aesthetic procedures is one of the most important points to be evaluated. It is therefore mandatory to conduct a thorough examination of their past history, which should include any prior cosmetic procedure, and how the result was perceived by the patient. Depending on the answer, the practitioner can evaluate the patient’s perception. Unrealistic expectations are another important factor to be analyzed before starting with any treatment. Experience shows that sometimes it is preferable not to treat a specific patient because, whatever is done, dissatisfaction will invariably result.

Do’s

Do take time to educate your patient about the benefits of the treatments that you believe are important to them.
Do try to overcome the barriers that block you to obtain more efficient treatments. Long-term patient retention will depend on that.

Don’ts

Do not automatically deliver what the patients are asking for. They may have a wrong perception of their needs.

Key Points

All injectors will sooner or later be able to deliver a satisfactory technical result. Long-term patient retention does not rely on delivering patients’ request only.

FAQs

Why are some doctors reluctant to be more active in indicating a procedure that the patient is unaware of?

Cultural aspects, problems in communication, lack of time or patience to educate patients, the inability to perform proper diagnosis, technical deficiency, and lack of experience to predict whether the diagnosis, technique, and product are the main reasons that prevent injectors from being more active and efficient in treating cosmetic patients.

2.2 General Rules

As mentioned before, the first consultation is very important for both the patient and the physician. Before the advent of the digital camera, the physician would make a communicative effort to make the patient understand the limits of treatments and, in particular, the limits of a specific treatment for a specific patient. The lack of knowledge of the vast majority of patients would often make it difficult for them to truly understand what the physician is telling them. Showing some before and after pictures could be useful in some cases but may be disastrous in others. Only the best cases would be shown, and patients may gain an unreasonably positive impression of the results, since these results may not be achievable in their case.

Without the digital camera, it is particularly hard to make patients understand the physical limitations of certain procedures. Patients often do not look at themselves in the mirror in the proper way (they perceive themselves in a more frontal view). Patients unconsciously correct any defects by smiling or changing the angle when facing the mirror. It is quite difficult for human beings to face differences in beauty and accept the aging process. If a woman was quite beautiful when she was young, it is even harder to accept that she cannot become that beautiful again, even after an invasive cosmetic procedure.

After many years working with cosmetic patients and also teaching injectors worldwide, it became evident that there is a “blind spot” for both patients and injectors when it comes to the evaluation of facial features. Basically, cosmetic practitioners aim to beautify, correct, or prevent aging signs. When assessing a patient, we may use a simple quantitative scale that almost everybody in the world is familiar with: 0–10. We may deliberately say that 0 (zero) is the worst that someone may look at that specific age, ethnicity, and gender and 10 (ten) is the top, the most desirable, and perfect human being that exists on the planet. We dare say that no one will be a zero or 10! But we can exercise and assess a patient and roughly and subjectively give a grading in this scale. Even more interesting is to evaluate what upgrades and downgrades the overall grading. For instance, a 50-year-old woman may have a beautiful nose according to the beauty pattern of that specific community but may have an unfavorable lip. We may then say that her nose upgrades her but her lips downgrades her. Facial shape, proportion, eyebrows, cheekbones, and so forth should receive the same rule.

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