Journal of Clinical and Aesthetic Dermatology

APR 2017

An evidence-based, peer-reviewed journal for practicing clinicians in the field of dermatology

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Managing Expectations Associated with Cosmetic Interventions An Aesthetic Complications Expert Group Consensus Paper JCAD JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY April 2017 • Volume 10 • Number 4 E 7 Minimizing the Risk Patient factors . It is important to appreciate that patients' expectations and motives for seeking treatment are thoroughly complex and diverse. Some relevant factors are mentioned b elow: • Age: Younger patients can be particularly sensitive to the opinions of their peers and to images on social media. Especially in this group, however, correction of a truly unattractive feature can prove enormously therapeutic. 6 • Media: Television, magazines, films, and the internet can all give rise to unrealistic expectations of an idealized appearance. 7 Social media, such as Instagram, which encourages users to take the perfect "selfie," has led to high levels of dissatisfaction with body image and appearance. Not only has this negativity impacted interpersonal relationships, 8 but it has also dramatically increased demand for cosmetic treatments. 9 • Partners, families, and friends: May exert strong influences and it may be helpful to tease out and differentiate the patient's expectations from those of others. 10 • Indirect effects: Expectations of secondary effects the physical changes may have on a patient's life should be considered. Unrealistic expectations (e.g., that their partner will love them more) require discussion. 3 • Psychopathology: Low self-esteem may lead to unrealistic goals and expectations. High neuroticism and/or anxiety may influence expectations, and outcomes tend to be poorer. Body dysmorphic disorder may be a contraindication to treatment and can be associated with "doctor shopping." Appropriate onward referral may be required when psychopathology is severe. 11 • Educational level: Expectations tend to be higher among more educated patients. 12 • Knowledge level: Education about the details of the treatment may modify expectations, and good information is associated with better outcomes. Sometimes hearing these details may lead to the patient preferring a different course of treatment than that proposed. Providing the patient is aware of the limitations imposed by his/her disinclination to follow the practitioner's advice, proceeding with an agreed alternative plan may be more likely to achieve a satisfactory result in that expectations have been matched. 13,14 • Cost: It is essential to clarify the cost of the intervention and that of other treatment modalities that may be required in addition to achieve the desired outcome. Practitioner factors. All practitioners have a duty to work within the limits of their competence and experience and, by so d oing, should have appropriate expectations as to what can be achieved for each patient. 15 With some patients, there will be a considerable range of treatment options, especially when several different aspects of the patient's appearance could be addressed. The practitioner will then need to know what is realistic and feasible to expect, and prioritize accordingly. Particularly in this context, expectations of timescale may be important,especially when desired effects are a requirement before an important event (e.g., a family wedding). On occasion, it will be appropriate to turn down a patient's request for a particular treatment. It is essential to explain the reasons why (to avoid them being treated unnecessarily by a less scrupulous practitioner through "doctor shopping"). This discussion would also provide the opportunity to advise on which other treatment options may be appropriate. The practitioner needs a thorough knowledge base on each product she/he uses in order to know what outcome to expect. This knowledge should not derive solely from the manufacturer, and this emphasizes the need for regular educational updating in a variety of settings. 16 A full range of treatment options should be presented to each patient. Practitioners need to know, and need to explain to their patients, the likely "downtime" or potential adverse effects of any treatments undertaken. Forewarning of patients is likely to reduce dissatisfaction; for example, a patient knowing that sagging abdominal skin is likely after bariatric surgery. 17 Ongoing advice and support can be important in modifying a patient's unfulfilled expectations. Ideally, all patients would have a follow-up appointment to determine whether expectations have been met; this will also be educational for the practitioner. Informed Consent Informed consent is an essential prerequisite to any treatment. As may clearly be evident, informed consent cannot be acquired without an exploration of the factors mentioned above. An understanding of what the patient wants and expects, along with an educated understanding of the patient's condition

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