Cosmetic Foreplay and Getting “Lost in the Crease”

At the consultation stage, effective cosmetic clinicians excel at setting the emotional basics for patient satisfaction. These emotional basics may be conceptualized as “ethical seduction,” or “cosmetic foreplay.” Specifically, these are the ingredients that make our patients hungry and willing to embrace the cosmetic procedures that best suit their individual desires, physiologic endowment, and age. Cosmetic foreplay includes creating an uplifting and positive mood, fostering trust, and performing our due diligence of expectation management. This includes both what can be realistically achieved and how we go about doing it. Once in place, these ingredients usually lead to a state of receptivity. The reason for this is that the patient often comes in with a very different set of expectations than they will need in order for a given procedure to achieve the desired results. For example, take a patient who's coming to see you for a concern with their nasolabial folds. When talking with the patient, you can really see what's bothering her and causing her to look older is the elongation of her face.

Not only should the mood be uplifting, so too should be the procedure! Patients, and sometimes clinicians can find themselves “lost in the crease.” I often say to patients “Remember when we were kids there was an expression “Why the long face”? This was essentially asking, “Why so sad?” This colloquial expression was actually a profoundly astute recognition that a droopy, elongated, or deflated face gives an appearance of sadness and fatigue. Therefore, in the context of cosmetic correction, simply filling the nasolabial folds or prejowl sulci can actually accentuate the elongation and volume loss that characterize the older face, making them look smoother, but ultimately unnatural and older. This brief verbal illustration allows the patient to understand why you may be addressing their lower face concerns with an upper face intervention (or commonly both upper and lower). Helping them to grasp why the crease has formed in the first place—bone and volume loss in their upper face—can help them to avoid becoming “lost in the crease.” By restoring a more youthful lift in areas such as the upper cheeks and temples, we are able to make people look younger. Making patients attuned to this, showing them in the mirror both before and after the procedure, can train them to focus on and appreciate the pillars of a youthful face. “Wow, you look great!” An honest exclamation of an immediately brighter, happier, and perkier appearance. By doing this, we're both honestly and ethically helping patients to enjoy the true benefits of well-chosen cosmetic interventions. Led gracefully and delicately through the cosmetic performance, both patient and clinician can be well satisfied. Anyone for a hug?