Home' Clinical Aesthetics : CA issue 4 Contents BEST PRACTICE
and wrinkles and leave it at that, even if their face was falling
down around their knees. After all, there was really no other
option but scientifically unsophisticated (by today’s standards)
skincare and surgery to address the rest.
But now w ith advanced cosmeceuticals, va stly improved
formulas and techniques for injectable fillers and a plethora of
non-surgical device technology you are effectively short-changing
your patients – and your business – by offering a one-hit, one-
dimensional ser v ice.
You are literally letting business walk out the door, and
potentially leaving a patient vulnerable.
Perhaps they won’t fully appreciate that non-surgical cosmetic
enhancement is always a work in progress; results are not
permanent and they will continue to age.
Or they may start cherry-picking providers for further
enhancements or corrections, having a “bit of this” here and a “bit
of that” elsewhere, which can lead to disappointing, damaging or
downright bizarre results.
You know better than anyone that a patient needs to be
considered as a whole, their features and concerns seen in
synergy; also that the treatments they are receiving work together
for maximising beauty, not negating or actively working against
Patients will benefit from an ongoing program of enhancement
and maintenance incorporating a number of modalities, and
including attention to integrative heath, as explained in It Takes
Two – Or Three, Or Four! (see Page 8).
CONSULTATION IS KEY
The initial consultation is one of the most important steps
of any successful treatment program, the doctors all tell
“It’s not uncommon for a patient to have a ver y fixed idea of
what they need and want done,” says Dr Irene Kushelew (see Page
9). “Even if I don’t agree with them, it is my responsibility to hear
them out and respect what they are saying.
“However, part of an aesthetics doctor’s responsibility is also
to be to be as diplomatically honest with the patient as possible re
whether the requested treatment is suitable/will make the desired
improvements for that individual and intuit whether the patient is
open to other suggestions.
“For instance, a patient may be focused on having neurotoxins
to reduce lines on their forehead but I observe that the lower half
of their face is sagging and jowling.
“By correcting the lines on the forehead and doing nothing
about the lower half of the face, it will create disharmony of the
facial features and likely look strange, or at least strangely out
“So my protocol is to gently guide the conversation to how they
feel about their appearance generally, to unearth what other –
and perhaps more pressing – concerns they may actually have.
“ This creates the opportunity to suggest the treatment they
are requesting may not be the right one for them and offer
“It is essential to choose your language carefully in these
situations, so the patient doesn’t go away feeling they are more
` flawed’ than they thought, deflated or angry, or that you are
trying to do a `hard sell’ on them just to make more money.
“If the patient doesn’t want to hear other options and I am
convinced the requested treatment won’t be of any real benefit to
them – indeed, could create a new set of problems – I may decline
to perform it.
“Similarly, when patients come to me with a limited budget, I
won’t always agree to provide the treatment that they can afford at
the time if I believe it won’t make any significant difference; that in
effect, it would be a waste of their money and they will inevitably be
disappointed – and likely upset with me.
“I will either suggest they wait until they can afford what will
give them the desired outcome, or that they have treatments spaced
at intervals to suit their budgeting. In the latter scenarios, they must
be educated to expect that results, therefore, will be gradual.”
Dr Cath Porter (see Page 9) says once patients are educated to
understand the anatomical and physiological basis of what they are
seeing in their face, they are far more likely to come on board with
a range of treatments.
“ When my patients are just embarking upon cosmetic
rejuvenation, I may start with confidence-building simple treatments
before embarking upon the 3D full ser vice approach,” she says.
“It might go something like this ... if the skin looks good with
even colour tone and texture everything else looks good.
“For treating discolouration I use IPL or broadband light
(Sciton BBL and Cutera limelight) in combination w ith a vascular
laser for capillaries (Candela VBeam and Cutera xcel V) over two
treaments. Longterm, this also rejuvenates with new Collagen 1 and
“I will then put a patient on a maintenance regime of one light
based treatment once or twice yearly, or on a needs basis. These
results are best maintained with treatment skin care – AHAs,
BHAs, retinols vitamin C and peptides, combined with peels and
microdermabrasion performed by our dermal therapists.
“Melasma will obviously need more specific treatments – peels
and low level YAG laser performed by a dermal therapist.
“For deep lines around the eyes and mouth I will use ablative
resurfacing (Sciton erbium and pro -fractional or Cutera Pearl and
Pearl fractional), and muscle relaxants for crows feet and lines on
the forehead and neck.
“I will use longterm fillers to address volume loss in the mid-
face, temples and chin to create structural 3D support, and finer
fillers for lines on forehead and lips and for recontouring lips.
“ When a patient’s skin elasticity is an issue, this is often this is
where we need to refer to our surgical colleagues, especially where
there is significant loss of elasticity in the neck area
“I find the energy based devices such as RF (we have Pelleve)
and ultrasound (Ulthera) are effective for moderate to minor
elasticity changes. They are a good preventative in a person of good
health. Smokers forget it!”
Dr Joseph Hkeik (see Page 9) reinforces the importance of
consultation: “At first consultation we take the opportunity to
discuss with each patient their proposed journey at All Saints.
“ We seek permission to take a general look at their health and
wellbeing, with their skin being the main focus.
“ This is where the sensitive quality of staff is needed in order not
to offend any patients.”
CUTERA.COM; CYNOSUREAUSTRALIA.COM (FOR PELLEVE);
IONIAMEDICAL.COM.AU (FOR SCITON); MERZAESTHETICS.COM
(FOR ULTHERA); SYNERON-CANDELA.COM (FOR VBEAM)
CLINICAL AESTHETICS | 15
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