Last Tuesday’s episode of ‘Botched’ featured Carmen, a transgender woman whose pursuit of surgery led her to Mexico. In this somewhat tragic tale, Carmen was drawn to an offer of “buy three surgeries, get the fourth one free”.
As Carmen herself said, “it was like going to a fast food restaurant and you’re going to the menu board and picking what you want”. As you can by now imagine (and as suggested by the name of the television series), the surgeries were all botched procedures. Carmen now has drooping ear cartilage and her new nose leaves her struggling to breathe, even after several attempts to fix the poor work by other plastic surgeons.
“it was like going to a fast food restaurant and you’re going to the menu board and picking what you want”
The clear lesson from this case is that patients should never order a nose job off a menu. However, what many people still do not realise is that the same principle also applies to minimally invasive (non-surgical) cosmetic treatments, including Botox and dermal fillers.
Why is this bad if the procedure isn’t even surgical?
For example, a patient might believe that they want dermal filler to the tear trough area, but the trained eye of an experienced clinician can identify no justifiable indication to treat. Periorbital dark circles can have a number of causes, including thinning skin around the eyes alongside interaction with the venous circulation. Such a patient would not only not be indicated for tear troughs, but even contraindicated as the risks posed by surface veins would be hugely increased. The patient might instead benefit from cheek augmentation, or a procedure in an area close by that can produce a similar aesthetic improvement in a different way.
These kinds of realisations come from the careful and thorough examination and quizzing of a patient on factors such as their hydration, salt intake, and so forth. The indiscriminate delivery of a chosen procedure that has been selected from a ‘catalogue’ (as found, for example, on some ‘cosmetic models’ advertising sites), is to entirely miss the point and importance of the cosmetic consultation.
Patient-centred care is integral to aesthetic medicine of all kinds. The professional aesthetic practitioner does not offer a number of generic procedures, but an in-depth, individualised consultation where a treatment plan is agreed upon based on myriad factors. TV shows like ‘Botched’ might be helping to raise awareness of the dangers of menu-style selections in plastic surgery, but we need to also focus how this applies to non-surgical aesthetics. Poor results from a procedure unsuited to the individual represent our specialty badly in the public sphere. This is evidenced daily by countless celebrity images and ‘botox horror stories’. Yet risking your patient’s self-esteem, sense of personal identity, or even their eyesight will be the death of aesthetic medicine’s reputation and
popularity (as well as your own).
What You Can Do
As aesthetic medical professionals, we can help patients to avoid these risks. Educate your patients on the procedures that would and would not be suited to their individual facial features, and advise them on the fact that clinics or individuals that offer menu-selection style procedures are risking their safety as well as their money. The route to a safer aesthetics specialty will be paved with patient empowerment.
If you are not confident in the patient consultation and how to individualise treatment plans, deepen your training with a higher education level course in aesthetic medicine.