Injectables are becoming increasingly common as a solution for the patient presenting with a variety of cosmetic concerns, from acne scars and hyperhidrosis to wrinkles and nonsurgical body sculpting. These experts shared a few clinical tips to keep in mind for your next cosmetic patient visit.
According to a membership survey of the American Society for Dermatologic Surgery,1 more than 2.1 million wrinkle-relaxing, 1.6 million soft-tissue filler, and 65,000 deoxycholic acid body sculpting procedures were performed in 2018 by its members alone. With an increase in the annual number of injections, the following dermatologists shared some tips and pearls to remember when performing and discussing these types of procedures in your aesthetics practice.
Show Patients Photos
When discussing cosmetic procedures, especially fillers for anti-aging and body contouring, I like to take several photos of the patient with a tablet or iPad. 
These photos should be captured at different angles, and be sure to have the patient with a relaxed, neutral face as well as make various facial expressions (smiling, frowning). I then review the photos with the patient, using the photos to discuss exactly what the patient can expect from each procedure. Using the photos during a discussion of a treatment can help manage unrealistic patient expectations and lead to better postprocedural satisfaction.
Gary Goldenberg, MD
New York, NY
Filler Isn’t for Everyone
I once had a new patient who had filler placed by another doctor. She was unhappy with the results, had it dissolved and replaced with a new filler. Still, she was unhappy, so she presented to my practice. The filler placement was not great, so I dissolved it, and at another appointment 2 weeks later, I put in more filler.
Two weeks later, this patient was back with complaints about an almost invisible bump at the base of one eyelid. I dissolved it. Another 2 weeks later, she was back, with complaint of an even less visible bump at the base of the other eyelid (not to mention an imperceptible hollow where I previously dissolved the bump on the other lid). I explained to the patient, as I learned at an educational conference: “The results of these fillers are not completely predictable, and some people have skin that does not behave particularly well with fillers. You are one of those people. I will dissolve this most recent bump, but because you are not a good candidate, I will no longer be able to give you filler.”
Realize that not every patient is a great candidate for fillers— and that patients may have unrealistic expectations of their treatment. You may need to find an alternative treatment to improve patient satisfaction.
Gerald Bock, MD
Germantown, TN
Be Transparent With Procedure Preparation
A patient recently told me that they like when I take out and prepare botulinum toxin in front of them in the appointment room. This patient had been to other clinics where the physician or nurse would “go to the back” and then magically return with syringes filled with “who knows what.” Preparing injections in the appointment room, within reason, can help ease any fears a patient may have with a potential procedure and allows them to ask questions to better understand their treatment.
Benjamin Barankin, MD
Toronto, Ontario, Canada
Botulinum Toxin Booking Pearl
For patients receiving botulinum toxin, I estimate the future date/time when the toxin will wear off. I tell the patients that if they come in at that time, they will get better long-term results and we will give them a 10% discount on their charge for the botulinum toxin at that visit. It’s better for the patients, maintains their treatment regimen, and enhances compliance.
Gerald Bock, MD
Germantown, TN
Reference
1. American Society for Dermatologic Surgery Survey on Dermatologic Procedures. ASDS. https://www.asds.net/medical-professionals/practice-resources/asds-survey-on-dermatologic-procedures. Accessed January 7, 2020.
