Essential Psychiatry for the Aesthetic Provider

From the moment we enter an examination room, the psychotherapeutic dance begins. But who’s leading the dance?

Aesthetic patients are seekers, but they come with different prerogatives. Concrete seekers know what bothers them, whether it is skin tone, texture, dyspigmentation, wrinkles, laxity, fat deposition, pore size, asymmetry, size, or perkiness.

The vague seekers want to look better, younger, less stressed or distressed, or less angry. Other seekers want to look vital, fertile, desirable, or marketable. Some are dealing with misery and unhappiness—searching to have all their life problems solved. Some want to be made into movie stars or saved from killing themselves, and some want you to do it better than the previous 10 providers.

While moving down that list, the dynamics of the relationship change and the danger of engaging the patients changes.

Cosmetic patients want acceptance and marketability; whether it’s in the workplace, social networks, family rooms, or the bedroom. They want less stress or distress, more pleasure, more satisfaction, a better vision or vision correction, to feel more attractive, and a happy, engaged, vibrant, and fulfilling life.

Providers should never underestimate the impact of minimal imperfection. There’s a tendency to say the patient could benefit from several treatments to optimize their appearance, but mainly, the owner has a single imperfection that has an enormous symbolic meaning. Connecting an imperfection to a family member is the first sign of psychosis. It’s the beginning sign of a patient feeling deterioration and decline.

These imperfections can be daunting, larger than life, emotionally handicapping, and functionally handicapping.

Providers should never think they can understand the emotional and functional impact based on quantity in terms of the number of imperfections or disease severity scores.

Never underestimate the benefit of well-chosen cosmetic treatments. It could be liberating, anxiety reducing, emotionally and functionally beneficial, and that single lesion may be an entry point for many more cosmetic procedures moving forward.

Patients turn to providers when they begin to feel they’re no longer bright-eyed and bushy-tailed and are showing signs of being tired and drained—long face, temporal wasting, dull appearance, downward turn of oral commissures, etc. These things all make us look mean, unhappy, and judgmental.

Patients are vulnerable, confused, and overwhelmed when they enter the examination room. A cacophony of information sources make exaggerated claims that patients indulge in prior to their appointment, leading them to come in with pseudo degrees based on what they’ve read online.

We can be the person they are seeking to trust.

TRIANGLE OF INTIMACY

The key to cosmetic patient satisfaction encompasses the forehead at its base and the glabella, periorbital region, eyes, infraorbital area, cheeks, nose, mouth, and the chin at the apex.

It is what defines us—where we give and receive nourishment, pleasure, praise, critique acceptance, love, friendship, beauty, and knowledge. Within the triangle, everything of real meaning takes place.

When talking about botulinum toxin and untreated glabellar tension, proprioceptive interpretation “stress” leads to increased tension in the glabella and elsewhere. When the glabella is treated, it can’t contract. Proprioceptive interpretation of “no stress” leads to decreased tension at the glabella and elsewhere.

Inevitable volume loss and proportional redistribution of volume happens with age. Change or redirection of the social-visual focus point moves away from the eyes to beneath the tear trough. Filler cheeks elevate the cheek unit, brightening and redirecting light reflection to promote a perkier, more rested appearance.

The top results from a study using calcium hydroxyapatite found 96% were more pleased with their reflection in the mirror and 80% felt more attractive.

THE S.T.E.P. PROGRAM

The S.T.E.P. program encompasses medical, surgical, and psychodermatological aspects: specify, target, envision, and be proactive.

You or your staff can help patients to specify the area/areas that cause stress, making sure to evaluate the realistic basis of the stressor. Help patients target specific areas for intervention/amelioration. Be sure to avoid phrases such as “getting older” and “unhappy with my skin” and make sure the goals and ideas are realistic and attainable. Help the patient envision how their perceptions, emotions, and life would be different or better after the intervention. Be proactive by offering a concrete plan for treatment, whether it’s laser, filler, botulinum neurotoxin, liposuction, or surgery. Review risks, benefits and alternatives for the treatment and make sure the patient makes an appointment before leaving the office if necessary.

Providers can offer legitimate and efficacious treatments gaining control over the daunting dread of deterioration and decline. As a psychologist, I want to sell control and slowly halt, even reverse, some of the stigmata of deterioration and decline.