At the risk of stating the obvious, a thriving and successful clinical-cosmetic practice requires satisfied and “happy” patients. In contrast, unsuccessful “struggling” practices often have dissatisfied and “unhappy” patients who will ultimately seek care and cosmetic intervention elsewhere. These “unhappy” patients often spew disparaging appraisals that can potentially diminish your reputation and success. Any honest and experienced clinician can relate to the scenario of the patient presenting on follow-up with objectively excellent clinical results offering at best blasé recognition of improvement — or at worst — anger and criticism of the procedure and clinician.
Why are these patients unable to “see” the true and obvious benefits of the intervention? Why wasn’t it enough to make them happy? Why weren’t the seven megapixel before-and-after photos convincing enough? Is it a problem with their vision or did we fail to perform adequate screening and vision correction before and during the cosmetic process?
In essence, it is really all about what they see. Can we help our patients to see their skin and cosmetic benefits through more positive and accepting eyes? Can we better see their skin through their eyes in order to make better pre-treatment choices? I believe we can.
In an ideal world, academic credentials, clinical competence and judgment, appropriate and up-to-date equipment, skilled surgical hands, and objective clinical outcomes should be the sole determinants of patient satisfaction.
Unfortunately, as illustrated above, a myriad of other less-tangible factors seem to factor into the equation. Included are patient-based factors such as their expectations regarding outcome, innate personality factors i.e., positivity, “pleasability,” general satisfaction with life, and associated psychopathology. Appropriate screening with a clinical interview and existing assessment tools such as the Cosmetic Procedure Screen-Derm (CPS-D), which was discussed in the article “The Key to Mastering Cosmetic Dermatology Patient Selection” (Fried R, and Werschler WP, Skin & Aging, October 2006), can help to screen for inappropriate candidates. Perhaps equally important are physician-based factors that can direct/correct patient vision and favorably affect the emotional aspects of the experience.
Refining the cosmetic process with appropriate focusing, direct and subliminal messaging, and ongoing reinforcement are the key ingredients for enhancing our patients’ vision of success.
The Process: Planting the Seed That “Less Can Be More”
The initial vision correction begins with effectively conveying to the patient the cosmetic fact that “less can be more.” Media claims of miraculous, overnight restorations of youth imbue patients with an unrealistic expectation that huge changes in appearance are easily attainable and desirable. Medical naiveté and magical-wishful thinking allow them to believe in these outlandish and absurd claims.
They are unaware that even if these miraculous transformations were possible, dramatic changes in appearance can alter self-identity and elicit unexpected and negative reactions from others. The depressing emotional sequelae reported by many of the participants from the reality T.V. show “Extreme Makeover” made it evident that dramatic changes in appearance can be disastrous.
In contrast, well-chosen procedures that yield even modest benefits can lead to dramatic improvements in mood and function. For example, previous studies have demonstrated that interventions as “superficial” as b.i.d. application of a 10% glycolic acid lotion for 12 weeks can lead to significant improvements in overall happiness, body image, and sexual satisfaction (Fried and Cash, 1998). Botox is another example that can help produce substantial emotional benefits and has even been shown to alleviate clinical depression. I have previously described the “Botox Loop,” a self-perpetuating positive circle of affirmation based upon subconscious interpretation of proprioceptive cues.
We are continually monitoring our muscle tension, heart rate, respiratory status, etc. When facial muscles tense, the message to the brain is that we are in a stressful situation. A “trickle down” begins from the cortex, through the limbic system, to the pituitary, on to the adrenals, gonads and the skin. This results in adrenergic stress sensations and the release of other pro-stress and pro-inflammatory substances i.e., neuropeptides. In contrast, after Botox treatment, there is a lack of muscle contraction in stressful situations. This leads to a subconscious “relaxation response” rather than a stress response. In fact, individuals often report that they feel less stressed in their day-to-day interactions and activities after receiving Botox. Therefore, we can legitimately plant the seeds of positive expectation.
I spend an extra minute or two and share these observations with all my cosmetic patients. I tell my filler patients how I am continually amazed at the positive emotional effects other patients experience and the way in which others seem to respond more favorably to them.
We begin here to focus their eyes and ears and improve their emotional-visual acuity, helping them to focus on the sometimes subtle positive cues and reactions that can enhance satisfaction and happiness.
Choose Procedures Well — S.T.E.P.
A well-chosen cosmetic procedure is often defined as one that leaves others guessing. They are aware that you look great, but they often can’t put their finger on why. The Botox, Restylane, Radiesse, Sculptra, intense pulsed light, pulsed dye laser, fractionated resurfacing, and more, have improved their appearance, leaving them with a more youthful, rested, and non-stressed appearance. However, they lack radical changes in appearance that elicit the unwanted responses such as “She’s had work.”
I encourage clinicians to consider utilizing the S.T.E.P. program to help patients and clinicians to choose procedures that will yield the greatest patient satisfaction.
The “STEP” acronym describes a conceptual framework and algorithm for clinicians and patients to identify appropriate cosmetic patients and: (S) Specify, (T) Target, (E) Envision, and (P) be Proactive. (See sidebar “Reviewing the S.T.E.P. Program” for more details.)
Defining Beauty
If we are to speak about visions of beauty, it certainly is desirable to help ourselves and our patients to define beauty. Beauty can be defined as a culturally determined prototypical “look” unmarred by imperfection. Aspiring to attain a “perfect appearance” is asking to be placed on a fragile pedestal from which one must ultimately fall. Flaws are inevitable with time, age, and exposure.
True beauty is not simply a lack of physical imperfection. It is a complex collage of physicality, personality, talent, and self-worth. How close to our ever-changing cultural norms need one be to be considered beautiful, attractive, desirable, or handsome enough?
How Much Is Enough?
Most of us know individuals who are objectively not that attractive but seem to always be successful in drawing others close to them. Conversely, there are those extremely pretty or handsome individuals who seem forever in search of a friend or companion.
What Is It That Defines These Different Individuals?
Much of it is about their vision. It is often a function of their personal vision regarding their attractiveness and self-worth.
I believe that there may be a “critical mass” of skin attractiveness that allows individuals to achieve a sufficient degree of self-acceptance that allows them to embrace their world in a more positive, confident, and proactive fashion. They begin to embrace an underlying belief system that validates a self-perception that they are attractive enough or free of enough imperfections that they can be accepted by the world around them.
I emphasize to all patients that beauty is not simply a physical state. Beauty is about finding and focusing on the things that are positive about them as individuals. Sometimes it is a smile, warmth, intellect, passion, curiosity, or acceptance. External attributes such as hair, smile, eyes, malar prominence, nose, breasts, or toes can also be part of the equation.
Help patients to expand their definition of beauty. In so doing, they can adjust and direct their vision in ways that can bring peace and acceptance.
Utilize Effective Messaging During the Procedure and on Follow-Up
The verbalizations and “incidental banter” that take place during cosmetic procedures can elicit strong effective responses and be powerful predictors of post-procedure satisfaction. Studies have shown that patients recall and respond to conversations that take place while they are under general anesthesia. You can only imagine how much more powerful the messages are when the patient is fully awake during the procedure.
There must be a smooth, natural, and ongoing dialogue between the physician and the assistant containing positive assessments regarding patient progress and outcome. Statements such as “yes,” “beautiful,” “impressive,” and even “wow” can powerfully direct the focus, expectation, and vision of the patient.
Let me be perfectly clear that I am not suggesting an insincere “emperor’s clothes” phenomenon. It is your obligation to do what you do well and to fairly assess the outcome.
Addressing Physician Insecurity
Many of us wonder whether we are the best, or even good enough, at what we do. We are all deeply immersed in an ongoing evolution of knowledge and technology, with most of us learning, assessing, and selectively incorporating new procedures and products into our practices. It is important to realize that we are not alone when experiencing those haunting waves of insecurity and are all perpetually somewhere on the learning curve.
No patient wants to feel that he or she is being treated by a tentative, unsure clinician. Patients want to feel as though they are being treated with state-of-the-art products and procedures by the best. Obtain appropriate training, read and study, practice on those that you can. Then, when you are with patients, be sure to behave “as if” you are an experienced master of your trade. Be positive, enthusiastic, and confident Try it, it may surprise you that you begin to believe that it is so!
Convey Positive Feedback on Follow-up
Touch, point, and convince. Help your patient to “see” the benefits that they have attained. Warn them of what I call the “pretty picture phenomenon.” This refers to the human tendency to focus on the newly evident imperfections and asymmetries that existed before treatment that were obscured by the more prominent, obvious, and distressing skin issues, such as telangiectasias, dyspigmentation, erythema, etc. Patients have a tendency to focus on the negative rather than experience the joy and relief that should accompany the benefits of dermatologic intervention.
Our job is to help them “see” the improvements while simultaneously conveying a sincere commitment to “make them happy.” Statements such as “we can do more” and “I am very committed to making you happy” can allay anxiety and keep patients hopeful and positive about their experiences and outcomes. Sometimes they simply need to “digest and incorporate” your assessment and feedback in order to be satisfied with their result.
Keep the Ball Rolling
At this point, you have a happy patient who has begun the process of rejuvenation and improvement. He or she should be commended for his or her courage and commitment to skin health and rejuvenation. The patient should be reminded that these interventions are not simply “vane and superficial strivings” but rather meaningful strategies and procedures that can substantially improve the appearance and function of his or her skin. You and your staff should convey that skin care and enhancement is not a “one-shot deal” but instead an ongoing process that will meaningfully change the aging process of the skin. Assure your patients that you will continue to be there to assist in their lifelong quest for healthy visions of beauty.
At the risk of stating the obvious, a thriving and successful clinical-cosmetic practice requires satisfied and “happy” patients. In contrast, unsuccessful “struggling” practices often have dissatisfied and “unhappy” patients who will ultimately seek care and cosmetic intervention elsewhere. These “unhappy” patients often spew disparaging appraisals that can potentially diminish your reputation and success. Any honest and experienced clinician can relate to the scenario of the patient presenting on follow-up with objectively excellent clinical results offering at best blasé recognition of improvement — or at worst — anger and criticism of the procedure and clinician.
Why are these patients unable to “see” the true and obvious benefits of the intervention? Why wasn’t it enough to make them happy? Why weren’t the seven megapixel before-and-after photos convincing enough? Is it a problem with their vision or did we fail to perform adequate screening and vision correction before and during the cosmetic process?
In essence, it is really all about what they see. Can we help our patients to see their skin and cosmetic benefits through more positive and accepting eyes? Can we better see their skin through their eyes in order to make better pre-treatment choices? I believe we can.
In an ideal world, academic credentials, clinical competence and judgment, appropriate and up-to-date equipment, skilled surgical hands, and objective clinical outcomes should be the sole determinants of patient satisfaction.
Unfortunately, as illustrated above, a myriad of other less-tangible factors seem to factor into the equation. Included are patient-based factors such as their expectations regarding outcome, innate personality factors i.e., positivity, “pleasability,” general satisfaction with life, and associated psychopathology. Appropriate screening with a clinical interview and existing assessment tools such as the Cosmetic Procedure Screen-Derm (CPS-D), which was discussed in the article “The Key to Mastering Cosmetic Dermatology Patient Selection” (Fried R, and Werschler WP, Skin & Aging, October 2006), can help to screen for inappropriate candidates. Perhaps equally important are physician-based factors that can direct/correct patient vision and favorably affect the emotional aspects of the experience.
Refining the cosmetic process with appropriate focusing, direct and subliminal messaging, and ongoing reinforcement are the key ingredients for enhancing our patients’ vision of success.
The Process: Planting the Seed That “Less Can Be More”
The initial vision correction begins with effectively conveying to the patient the cosmetic fact that “less can be more.” Media claims of miraculous, overnight restorations of youth imbue patients with an unrealistic expectation that huge changes in appearance are easily attainable and desirable. Medical naiveté and magical-wishful thinking allow them to believe in these outlandish and absurd claims.
They are unaware that even if these miraculous transformations were possible, dramatic changes in appearance can alter self-identity and elicit unexpected and negative reactions from others. The depressing emotional sequelae reported by many of the participants from the reality T.V. show “Extreme Makeover” made it evident that dramatic changes in appearance can be disastrous.
In contrast, well-chosen procedures that yield even modest benefits can lead to dramatic improvements in mood and function. For example, previous studies have demonstrated that interventions as “superficial” as b.i.d. application of a 10% glycolic acid lotion for 12 weeks can lead to significant improvements in overall happiness, body image, and sexual satisfaction (Fried and Cash, 1998). Botox is another example that can help produce substantial emotional benefits and has even been shown to alleviate clinical depression. I have previously described the “Botox Loop,” a self-perpetuating positive circle of affirmation based upon subconscious interpretation of proprioceptive cues.
We are continually monitoring our muscle tension, heart rate, respiratory status, etc. When facial muscles tense, the message to the brain is that we are in a stressful situation. A “trickle down” begins from the cortex, through the limbic system, to the pituitary, on to the adrenals, gonads and the skin. This results in adrenergic stress sensations and the release of other pro-stress and pro-inflammatory substances i.e., neuropeptides. In contrast, after Botox treatment, there is a lack of muscle contraction in stressful situations. This leads to a subconscious “relaxation response” rather than a stress response. In fact, individuals often report that they feel less stressed in their day-to-day interactions and activities after receiving Botox. Therefore, we can legitimately plant the seeds of positive expectation.
I spend an extra minute or two and share these observations with all my cosmetic patients. I tell my filler patients how I am continually amazed at the positive emotional effects other patients experience and the way in which others seem to respond more favorably to them.
We begin here to focus their eyes and ears and improve their emotional-visual acuity, helping them to focus on the sometimes subtle positive cues and reactions that can enhance satisfaction and happiness.
Choose Procedures Well — S.T.E.P.
A well-chosen cosmetic procedure is often defined as one that leaves others guessing. They are aware that you look great, but they often can’t put their finger on why. The Botox, Restylane, Radiesse, Sculptra, intense pulsed light, pulsed dye laser, fractionated resurfacing, and more, have improved their appearance, leaving them with a more youthful, rested, and non-stressed appearance. However, they lack radical changes in appearance that elicit the unwanted responses such as “She’s had work.”
I encourage clinicians to consider utilizing the S.T.E.P. program to help patients and clinicians to choose procedures that will yield the greatest patient satisfaction.
The “STEP” acronym describes a conceptual framework and algorithm for clinicians and patients to identify appropriate cosmetic patients and: (S) Specify, (T) Target, (E) Envision, and (P) be Proactive. (See sidebar “Reviewing the S.T.E.P. Program” for more details.)
Defining Beauty
If we are to speak about visions of beauty, it certainly is desirable to help ourselves and our patients to define beauty. Beauty can be defined as a culturally determined prototypical “look” unmarred by imperfection. Aspiring to attain a “perfect appearance” is asking to be placed on a fragile pedestal from which one must ultimately fall. Flaws are inevitable with time, age, and exposure.
True beauty is not simply a lack of physical imperfection. It is a complex collage of physicality, personality, talent, and self-worth. How close to our ever-changing cultural norms need one be to be considered beautiful, attractive, desirable, or handsome enough?
How Much Is Enough?
Most of us know individuals who are objectively not that attractive but seem to always be successful in drawing others close to them. Conversely, there are those extremely pretty or handsome individuals who seem forever in search of a friend or companion.
What Is It That Defines These Different Individuals?
Much of it is about their vision. It is often a function of their personal vision regarding their attractiveness and self-worth.
I believe that there may be a “critical mass” of skin attractiveness that allows individuals to achieve a sufficient degree of self-acceptance that allows them to embrace their world in a more positive, confident, and proactive fashion. They begin to embrace an underlying belief system that validates a self-perception that they are attractive enough or free of enough imperfections that they can be accepted by the world around them.
I emphasize to all patients that beauty is not simply a physical state. Beauty is about finding and focusing on the things that are positive about them as individuals. Sometimes it is a smile, warmth, intellect, passion, curiosity, or acceptance. External attributes such as hair, smile, eyes, malar prominence, nose, breasts, or toes can also be part of the equation.
Help patients to expand their definition of beauty. In so doing, they can adjust and direct their vision in ways that can bring peace and acceptance.
Utilize Effective Messaging During the Procedure and on Follow-Up
The verbalizations and “incidental banter” that take place during cosmetic procedures can elicit strong effective responses and be powerful predictors of post-procedure satisfaction. Studies have shown that patients recall and respond to conversations that take place while they are under general anesthesia. You can only imagine how much more powerful the messages are when the patient is fully awake during the procedure.
There must be a smooth, natural, and ongoing dialogue between the physician and the assistant containing positive assessments regarding patient progress and outcome. Statements such as “yes,” “beautiful,” “impressive,” and even “wow” can powerfully direct the focus, expectation, and vision of the patient.
Let me be perfectly clear that I am not suggesting an insincere “emperor’s clothes” phenomenon. It is your obligation to do what you do well and to fairly assess the outcome.
Addressing Physician Insecurity
Many of us wonder whether we are the best, or even good enough, at what we do. We are all deeply immersed in an ongoing evolution of knowledge and technology, with most of us learning, assessing, and selectively incorporating new procedures and products into our practices. It is important to realize that we are not alone when experiencing those haunting waves of insecurity and are all perpetually somewhere on the learning curve.
No patient wants to feel that he or she is being treated by a tentative, unsure clinician. Patients want to feel as though they are being treated with state-of-the-art products and procedures by the best. Obtain appropriate training, read and study, practice on those that you can. Then, when you are with patients, be sure to behave “as if” you are an experienced master of your trade. Be positive, enthusiastic, and confident Try it, it may surprise you that you begin to believe that it is so!
Convey Positive Feedback on Follow-up
Touch, point, and convince. Help your patient to “see” the benefits that they have attained. Warn them of what I call the “pretty picture phenomenon.” This refers to the human tendency to focus on the newly evident imperfections and asymmetries that existed before treatment that were obscured by the more prominent, obvious, and distressing skin issues, such as telangiectasias, dyspigmentation, erythema, etc. Patients have a tendency to focus on the negative rather than experience the joy and relief that should accompany the benefits of dermatologic intervention.
Our job is to help them “see” the improvements while simultaneously conveying a sincere commitment to “make them happy.” Statements such as “we can do more” and “I am very committed to making you happy” can allay anxiety and keep patients hopeful and positive about their experiences and outcomes. Sometimes they simply need to “digest and incorporate” your assessment and feedback in order to be satisfied with their result.
Keep the Ball Rolling
At this point, you have a happy patient who has begun the process of rejuvenation and improvement. He or she should be commended for his or her courage and commitment to skin health and rejuvenation. The patient should be reminded that these interventions are not simply “vane and superficial strivings” but rather meaningful strategies and procedures that can substantially improve the appearance and function of his or her skin. You and your staff should convey that skin care and enhancement is not a “one-shot deal” but instead an ongoing process that will meaningfully change the aging process of the skin. Assure your patients that you will continue to be there to assist in their lifelong quest for healthy visions of beauty.
At the risk of stating the obvious, a thriving and successful clinical-cosmetic practice requires satisfied and “happy” patients. In contrast, unsuccessful “struggling” practices often have dissatisfied and “unhappy” patients who will ultimately seek care and cosmetic intervention elsewhere. These “unhappy” patients often spew disparaging appraisals that can potentially diminish your reputation and success. Any honest and experienced clinician can relate to the scenario of the patient presenting on follow-up with objectively excellent clinical results offering at best blasé recognition of improvement — or at worst — anger and criticism of the procedure and clinician.
Why are these patients unable to “see” the true and obvious benefits of the intervention? Why wasn’t it enough to make them happy? Why weren’t the seven megapixel before-and-after photos convincing enough? Is it a problem with their vision or did we fail to perform adequate screening and vision correction before and during the cosmetic process?
In essence, it is really all about what they see. Can we help our patients to see their skin and cosmetic benefits through more positive and accepting eyes? Can we better see their skin through their eyes in order to make better pre-treatment choices? I believe we can.
In an ideal world, academic credentials, clinical competence and judgment, appropriate and up-to-date equipment, skilled surgical hands, and objective clinical outcomes should be the sole determinants of patient satisfaction.
Unfortunately, as illustrated above, a myriad of other less-tangible factors seem to factor into the equation. Included are patient-based factors such as their expectations regarding outcome, innate personality factors i.e., positivity, “pleasability,” general satisfaction with life, and associated psychopathology. Appropriate screening with a clinical interview and existing assessment tools such as the Cosmetic Procedure Screen-Derm (CPS-D), which was discussed in the article “The Key to Mastering Cosmetic Dermatology Patient Selection” (Fried R, and Werschler WP, Skin & Aging, October 2006), can help to screen for inappropriate candidates. Perhaps equally important are physician-based factors that can direct/correct patient vision and favorably affect the emotional aspects of the experience.
Refining the cosmetic process with appropriate focusing, direct and subliminal messaging, and ongoing reinforcement are the key ingredients for enhancing our patients’ vision of success.
The Process: Planting the Seed That “Less Can Be More”
The initial vision correction begins with effectively conveying to the patient the cosmetic fact that “less can be more.” Media claims of miraculous, overnight restorations of youth imbue patients with an unrealistic expectation that huge changes in appearance are easily attainable and desirable. Medical naiveté and magical-wishful thinking allow them to believe in these outlandish and absurd claims.
They are unaware that even if these miraculous transformations were possible, dramatic changes in appearance can alter self-identity and elicit unexpected and negative reactions from others. The depressing emotional sequelae reported by many of the participants from the reality T.V. show “Extreme Makeover” made it evident that dramatic changes in appearance can be disastrous.
In contrast, well-chosen procedures that yield even modest benefits can lead to dramatic improvements in mood and function. For example, previous studies have demonstrated that interventions as “superficial” as b.i.d. application of a 10% glycolic acid lotion for 12 weeks can lead to significant improvements in overall happiness, body image, and sexual satisfaction (Fried and Cash, 1998). Botox is another example that can help produce substantial emotional benefits and has even been shown to alleviate clinical depression. I have previously described the “Botox Loop,” a self-perpetuating positive circle of affirmation based upon subconscious interpretation of proprioceptive cues.
We are continually monitoring our muscle tension, heart rate, respiratory status, etc. When facial muscles tense, the message to the brain is that we are in a stressful situation. A “trickle down” begins from the cortex, through the limbic system, to the pituitary, on to the adrenals, gonads and the skin. This results in adrenergic stress sensations and the release of other pro-stress and pro-inflammatory substances i.e., neuropeptides. In contrast, after Botox treatment, there is a lack of muscle contraction in stressful situations. This leads to a subconscious “relaxation response” rather than a stress response. In fact, individuals often report that they feel less stressed in their day-to-day interactions and activities after receiving Botox. Therefore, we can legitimately plant the seeds of positive expectation.
I spend an extra minute or two and share these observations with all my cosmetic patients. I tell my filler patients how I am continually amazed at the positive emotional effects other patients experience and the way in which others seem to respond more favorably to them.
We begin here to focus their eyes and ears and improve their emotional-visual acuity, helping them to focus on the sometimes subtle positive cues and reactions that can enhance satisfaction and happiness.
Choose Procedures Well — S.T.E.P.
A well-chosen cosmetic procedure is often defined as one that leaves others guessing. They are aware that you look great, but they often can’t put their finger on why. The Botox, Restylane, Radiesse, Sculptra, intense pulsed light, pulsed dye laser, fractionated resurfacing, and more, have improved their appearance, leaving them with a more youthful, rested, and non-stressed appearance. However, they lack radical changes in appearance that elicit the unwanted responses such as “She’s had work.”
I encourage clinicians to consider utilizing the S.T.E.P. program to help patients and clinicians to choose procedures that will yield the greatest patient satisfaction.
The “STEP” acronym describes a conceptual framework and algorithm for clinicians and patients to identify appropriate cosmetic patients and: (S) Specify, (T) Target, (E) Envision, and (P) be Proactive. (See sidebar “Reviewing the S.T.E.P. Program” for more details.)
Defining Beauty
If we are to speak about visions of beauty, it certainly is desirable to help ourselves and our patients to define beauty. Beauty can be defined as a culturally determined prototypical “look” unmarred by imperfection. Aspiring to attain a “perfect appearance” is asking to be placed on a fragile pedestal from which one must ultimately fall. Flaws are inevitable with time, age, and exposure.
True beauty is not simply a lack of physical imperfection. It is a complex collage of physicality, personality, talent, and self-worth. How close to our ever-changing cultural norms need one be to be considered beautiful, attractive, desirable, or handsome enough?
How Much Is Enough?
Most of us know individuals who are objectively not that attractive but seem to always be successful in drawing others close to them. Conversely, there are those extremely pretty or handsome individuals who seem forever in search of a friend or companion.
What Is It That Defines These Different Individuals?
Much of it is about their vision. It is often a function of their personal vision regarding their attractiveness and self-worth.
I believe that there may be a “critical mass” of skin attractiveness that allows individuals to achieve a sufficient degree of self-acceptance that allows them to embrace their world in a more positive, confident, and proactive fashion. They begin to embrace an underlying belief system that validates a self-perception that they are attractive enough or free of enough imperfections that they can be accepted by the world around them.
I emphasize to all patients that beauty is not simply a physical state. Beauty is about finding and focusing on the things that are positive about them as individuals. Sometimes it is a smile, warmth, intellect, passion, curiosity, or acceptance. External attributes such as hair, smile, eyes, malar prominence, nose, breasts, or toes can also be part of the equation.
Help patients to expand their definition of beauty. In so doing, they can adjust and direct their vision in ways that can bring peace and acceptance.
Utilize Effective Messaging During the Procedure and on Follow-Up
The verbalizations and “incidental banter” that take place during cosmetic procedures can elicit strong effective responses and be powerful predictors of post-procedure satisfaction. Studies have shown that patients recall and respond to conversations that take place while they are under general anesthesia. You can only imagine how much more powerful the messages are when the patient is fully awake during the procedure.
There must be a smooth, natural, and ongoing dialogue between the physician and the assistant containing positive assessments regarding patient progress and outcome. Statements such as “yes,” “beautiful,” “impressive,” and even “wow” can powerfully direct the focus, expectation, and vision of the patient.
Let me be perfectly clear that I am not suggesting an insincere “emperor’s clothes” phenomenon. It is your obligation to do what you do well and to fairly assess the outcome.
Addressing Physician Insecurity
Many of us wonder whether we are the best, or even good enough, at what we do. We are all deeply immersed in an ongoing evolution of knowledge and technology, with most of us learning, assessing, and selectively incorporating new procedures and products into our practices. It is important to realize that we are not alone when experiencing those haunting waves of insecurity and are all perpetually somewhere on the learning curve.
No patient wants to feel that he or she is being treated by a tentative, unsure clinician. Patients want to feel as though they are being treated with state-of-the-art products and procedures by the best. Obtain appropriate training, read and study, practice on those that you can. Then, when you are with patients, be sure to behave “as if” you are an experienced master of your trade. Be positive, enthusiastic, and confident Try it, it may surprise you that you begin to believe that it is so!
Convey Positive Feedback on Follow-up
Touch, point, and convince. Help your patient to “see” the benefits that they have attained. Warn them of what I call the “pretty picture phenomenon.” This refers to the human tendency to focus on the newly evident imperfections and asymmetries that existed before treatment that were obscured by the more prominent, obvious, and distressing skin issues, such as telangiectasias, dyspigmentation, erythema, etc. Patients have a tendency to focus on the negative rather than experience the joy and relief that should accompany the benefits of dermatologic intervention.
Our job is to help them “see” the improvements while simultaneously conveying a sincere commitment to “make them happy.” Statements such as “we can do more” and “I am very committed to making you happy” can allay anxiety and keep patients hopeful and positive about their experiences and outcomes. Sometimes they simply need to “digest and incorporate” your assessment and feedback in order to be satisfied with their result.
Keep the Ball Rolling
At this point, you have a happy patient who has begun the process of rejuvenation and improvement. He or she should be commended for his or her courage and commitment to skin health and rejuvenation. The patient should be reminded that these interventions are not simply “vane and superficial strivings” but rather meaningful strategies and procedures that can substantially improve the appearance and function of his or her skin. You and your staff should convey that skin care and enhancement is not a “one-shot deal” but instead an ongoing process that will meaningfully change the aging process of the skin. Assure your patients that you will continue to be there to assist in their lifelong quest for healthy visions of beauty.
