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 E 8 JCAD JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY April 2017 • Volume 10 • Number 4 and an explanation of what the practitioner hopes to achieve, are central to the principles of informed consent. The process of eliciting consent should be recorded as should the explanation of possible adverse effects. Providing written information to the patient may augment the process of consent to treatment. 1 8 Recent Good Medical Practice guidelines on cosmetic interventions stress the importance of giving patients time to reflect on all the information that they have been given. The duration of this "cooling off" period has not been specified. 19 Discussion and Conclusion More people consider cosmetic intervention than actually proceed with treatment. Trust in one's practitioner can be vital to the decision to proceed. A full discussion of the expectations of the patient and the practitioner can help to generate this trust and may help to ensure a successful outcome. Successful outcomes lead to successful clinics. Reviewing patients after treatment is very important. If expectations have not been met then, depending on the reasons for this, further treatment could be contemplated. This consultation also provides essential feedback for the practitioner. There are screening instruments that investigate patients' expectations of cosmetic treatments (e.g., how they expect their appearance and quality of life to change following treatment). 20 There is also now patient-reported outcome measures (PROMs) that can be used with patients before and after treatments to measure change, for example, in facial lines. 21 Such tools are being increasingly used to improve quality in clinical practice. For example, the FACE-Q 22 PROM is now being used nationally in the United Kingdom to evaluate outcomes of patients undergoing facelifts, blepharoplasty, and rhinoplasty as part of the Royal College of Surgeons cosmetic surgery PROM initiative. 23 Perhaps in due course, such scales will be used routinely to evaluate outcomes of cosmetic treatments as a way to augment, but not replace, patient-practitioner discussions of all the various factors that influence expectations of cosmetic treatments. References 1. Burrowes N. Body image—a rapid evidence assessment of the literature. Government Equalities Office (May 2013). 2. Gubbins S. Popularity of non-surgical cosmetic procedures soars as demand for cosmetic surgery falls (2015). http://www.penningtons.co.uk/news-publications/latest- news/popularity-of-non-surgical-cosmetic-procedures-soars-as- demand-for-cosmetic-surgery-falls [Accessed on 19 May 2016]. 3. Honigman R, Phillips KA, Castle D. A Review of psychosocial outcomes for patients seeking cosmetic surgery. Plast Reconstr Surg. 2004;113(4):1229–1237. 4. Oxford Dictionaries. Oxford University Press. http://www.oxforddictionaries.com/definition/english/manage- expectations [Accessed on 23 June 2016]. 5. Svider PF, Blake DM, Husain Q, et al. In the eyes of the law: malpractice litigation in oculoplastic surgery. Ophthal Plast Reconstr Surg. 2014;30(2):119–123. 6. Niamtu J III. Complications in fillers and Botox. Oral Maxillofac Surg Clin North Am. 2009;21(1):13–21. 7. Herren C, Armentrout T, Higgins M. Body dysmorphic disorder: diagnosis and treatment. General Dentistry. 2003;51(2):164–166. 8. Ridgway J, Clayton R. Instagram unfiltered: exploring associations of body image satisfaction, Instagram #selfie posting, and negative romantic relationships outcomes. Cyberpscyhology, Behaviour and Social Networking. 2016;19(1):2–7. 9. Mintz Z. Selfies And Plastic Surgery: How Social Media Is Causing More People To Go Under The Knife For Cosmetic Purposes. International Business Times. http://www.ibtimes.com/selfies-plastic-surgery-how-social-media- causing-more-people-go-under-knife-cosmetic-1616916 [Accessed on 4 July 2016]. 10. Solvi AS, Foss K, von Soest T, et al. Motivational factors and psychological processes in cosmetic breast augmentation surgery. J Plast Reconstr Aesthet Surg. 2010;63(4):673–680. 11. Castle DJ, Phillips KA, Dufresne RG. Body dysmorphic disorder and cosmetic dermatology: more than skin deep. J Cosmet Dermatol. 2004;3(2):99–103. 12. Medina-Franco H, Rojas-García P, Suárez-Bobadilla YL, Sánchez-Ramón A. Factors associated with breast symmetry after breast conserving surgery for cancer. Rev Invest Clin. 2013;65(5):379–383. 13. Bezzon OL, Gonçalves M, Pagnano VO. T-Bar clasp-retained removable partial denture as an alternative to implant-based prosthetic treatment. Brazilian Dental Journal. 2008;19(3):257–262. 14. Crawford MJ, Thana L, Farquharson L, et al. Patient experience of negative effects of psychological treatment: results of a national survey. Br J of Psych. 2016;208(3):260–265. 15. Klein A, Rittmann I, Hiller KA, et al. An Internet-based survey on characteristics of laser tattoo removal and associated side effects. Lasers Med Sci. 2014;29(2):729–738. 16. Gentile RD. Multimodality aesthetic skin rejuvenation. Facial Plast Surg. 2005;21(2):120–130. 17. Lanthaler M, Mattesich M, Nehoda H, Puelzl P, Matiasek J, Nitto A, Pierer G, Kinzl J. Long-term quality-of-life improvement in

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