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Aging may be one of the most foreseeable facts of life. As aesthetic providers, we routinely hear concerns about facial aging, and it is important that we address these concerns by consistently delivering the best care possible while managing our clients' expectations.
How do we set our clients and ourselves up for success by providing superb aesthetic solutions to the age-old challenges we are faced with every day? A thorough Aesthetic Analysis of the clients' needs and an Aesthetic Plan to their specific needs ensure success. An Aesthetic Plan requires a shift from a two-dimensional approach to a three-dimensional approach. Providing safe treatments, establishing trust, producing positive outcomes, and creating engaging experiences will ensure loyalty, future treatments, and continued maintenance.
We hear it every day, "I want to look as good as I feel! I hate sounding so vain, but I'm competing with women/men half my age; I don't want my years of experience to show on my face!" As aesthetic providers, we routinely hear these concerns about facial aging, and it is important that we consistently deliver the best care possible while managing our clients' expectations. Vivian Diller, PhD, describes the psychology of our obsession with youth-young, clear, unblemished skin and strong, beautiful bodies-as the "beauty paradox" (Diller, 2010). On one hand, looks are not supposed to matter, but on the other hand, they clearly do. Given that this is the psyche we have to deal with in our busy practices, how do we set our clients and ourselves up for success by providing superb aesthetic solutions to the age-old challenges we are faced with every day?
The objectives of this article are as follows:
1. Describe "beauty" and its importance in the aesthetic industry.
2. Recognize the importance of the Aesthetic Analysis.
3. Describe how to develop an Aesthetic Plan.
What is Beauty? The Webster dictionary defines Beauty as "A quality present in a person that gives intense pleasure or deep satisfaction to the mind. A meaningful design or pattern."
Beauty can be consoling, disturbing, sacred, and profane; it can be exhilarating, appealing, inspiring, and chilling. It can affect us in an unlimited variety of ways, yet, it is never viewed with indifference. Beauty demands to be noticed; it speaks to us directly like the voice of an intimate friend. If there are people who are indifferent to beauty, then it is surely because they do not perceive it (Scruton, 2009).
"Some women are born beautiful, others achieve beauty, and still others are on good terms with the society editors" (Gonzales, 2009). Facial beauty correlates with symmetry (proportions) and harmony (balance) of facial elements.
We are women/men of a generation who are unrealistic. We are expected to have it all and do it all, and then we are supposed to show little wear and tear on our faces. Looks are important. Today, our physical ideal of beauty holds greater contradictions than ever before. Yet among all of these new variations, there remains one constant that does not fluctuate in our culture or in our minds... that is YOUTH! (Diller, 2010).
The "Attractive Peak" is age 14-24 years (Marquart, 2001). As an individual matures, the face ages. Beyond the age of about 24 years, the face begins to see physiological changes that occur with time. In general, a full and wide mid face represents youth and beauty. Characteristics associated with female facial beauty are large, smooth forehead, well-proportioned nose, round and big eyes set wide apart, full lashes, heart-shaped jaw, and fuller lips with a plump vermilion border. Male facial characteristics associated with beauty are deep set eyes, overhanging brow, well-proportioned nose, wider mouth, and squared lower face and jaw.
We have all heard the saying, "Beauty is in the eye of the beholder," yet today, that doesn't seem to entirely reign true. This battle is secretly waged within our own minds.
Beauty can therefore be a daunting equation. If Beauty = Youth and Aging = Loss of Youth.... This is a new mathematics that cannot be mastered (Marquart, 2001). There is good news and bad news associated with this. The good news is that we have created a society where, as successful women/men, we are admired for our years of hard work. The bad news is that we are often marginalized if our experience shows on our faces, as in aging (e.g., friends may whisper "he/she needs some work"...).
Aging may be one of the most foreseeable facts of life-every person at some point will lose his or her youthful appearance-yet this sends most of us into some level of concern. The enemy we face at midlife is not aging itself; it is the confusion and anxiety we feel about aging and how it will affect us emotionally and physically.
Knowledge is power! We have the ability to educate and advocate for our clients. We are in the happiness business! We need to create a positive experience for our patients. We know that our interactions count as much as transactions. Rather than just recognizing the economic value of a patient, we also recognize the value of every interaction of that patient-whether it's over the phone, discussions in the clinic, enrolling in different loyalty programs, and so forth. There is inherent value in the activities that increase the level of client involvement with the clinic as this ultimately deepens the relationship with the client (i.e., it takes a lot more energy and expense to acquire a new customer than to keep an existing one).
There are four emotional needs that meet patients' basic requirements for good service and medical care (Gallup, 2010).
1. Confidence reflects the belief that patients can always trust you to deliver on its promises.
2. Integrity reflects the belief that you always treat them fairly and will satisfactorily resolve any problems that might occur.
3. Pride reflects the degree to which a patient feels good about using your services and about how using your services reflects on them.
4. Passion reflects the belief that your practice is irreplaceable and an integral part of your patients' lives.
Health care organizations that can fulfill these four emotional needs will engage their patients. They also create optimal patient experiences. Engaged patients are the kind of patients that health care organizations want. Research shows that patient engagement consistently predicts health care organizations' performance on an array of crucial business outcomes, including Earnings Before Interest, Taxes, Depreciation, and Amortization per adjusted admission and net revenue per adjusted admission (Gallup, 2010).
Today's challenges include the following:
1. Economic: Clients are attuned to calculating the value of price and quickly size up alternative selection offers.
2. Functional: Clients' desire for instant results.
3. Emotional: Low client loyalty, low switching costs (we need to build exclusivity into the client experience).
"It is important for all types of women to know that you don't have to fit a prototype of what one person thinks is beautiful in order to be beautiful or feel beautiful..." (Davidson, 2003).
We understand the importance of beauty and "Looking your best" as Aesthetic Health Care Providers. This drives the magnitude of properly performing an Aesthetic Analysis for our clients. The dual focus then assists us in developing an Aesthetic Plan that is ideal for each individual client's need.
The most important part of the Aesthetic Analysis is the Patient Interview.
The Assessment should include the following:
* Patient desires
* Medical history
* Skin color/ethnicity
* Wrinkles in repose/animation
* Volume loss
* Prior treatments
* Pain tolerance
* Social plans for week after treatment
* Realistic expectations
During the interview process, look at patients while focusing on their physical signs of aging. Take a thorough medical history (e.g., are they a smoker, how much time they spend in the sun and elements, medical conditions, medications) and assess the condition of their skin. Pay particular attention to the extent of aging of their facial fat pads. Recall that the malar region is composed of three separate compartments: medial, middle, and lateral temporal cheek fat. Remember that these discrete facial fat compartments are subject to individual rates of absorption.
Evaluation of medications:
* Blood thinners
* Acetylsalicylic acid
* Nonsteroidal anti-inflammatory drugs
* Vitamin E
* Warfarin (Coumadin), clopidogrel (Plavix), and aspirin and dipyridamole (Aggrenox)
* Fish oil/flaxseed oil
* Herbal medications
* Wrinkle Assessment Scale (Glogau, 1996)
* Facial Aesthetic Scales (Carruthers et al., 2008a, 2008b, 2008c, 2008d, 2010)
* 5-Point Photographic Wrinkle Severity Rating Scale (Day, 2004)
* How do they feel about themselves?
* Understanding that your patient's goals will determine the treatment plan
* Guide toward the best use of their money
* "Best bang for their buck"
* What does their budget deliver?
* Full versus partial correction
* Meeting/exceeding expectations at given price points
Red Flags-Be aware of:
* The patient who has been to many practices with no satisfaction
* Expectation of perfection versus improvement
* The patient who is there for the wrong reason
* The patient who does not smile or make eye contact
Photos/pictures. "A picture is worth a thousand words." Before and after photos are essential. These allow us to document and track the progress of our patients. If they say, "I don't see a difference," a before photograph will provide them with a more objective assessment of the result.
The photos allow us to reinforce the perception of success in addition to heightening the patient satisfaction when they see their progress. The ability to market yourself and your abilities with photos that show great outcomes also builds trust for clients desiring future treatments.
According to Doris Day, MD, the idea is that at the end of the day, women want to look natural and they want to look beautiful-ageless beauty (Day, 2011). Our responsibility and goals are to help them be realistic in what they can accomplish so they can look their best. It's not about getting rid of every line and wrinkle. It's about helping women look their best at any age.
The American Society for Aesthetic Plastic Surgery determined that the 2010 top-five minimally invasive cosmetic procedures are (1) botulinum toxin type A, (2) hyaluronic acid (HA) dermal fillers, (3) laser hair removal, (4) laser skin resurfacing, and (5) chemical peel (Babbitt, 2011).
In order to develop an Aesthetic Plan, we have to shift from a two-dimensional focus (immobilizing hyper dynamic facial lines, filling lines, and wrinkles) to a three-dimensional focus (recontouring and volume restoration). It is important to tailor to individual needs. Combination treatments may increase longevity of outcomes.
The Aesthetic Continuum of Care representation on page 15 depicts a multifaceted approach to facial rejuvenation. The continuum involves all areas in aesthetic medicine and encourages us to think about the integral relationship between them:
* Skin care (products/facials/makeup)
* Injectables (neuromodulators and dermal fillers)
* Surgery (facial/body/dermatological)
As we develop the Aesthetic Plan for patients, we first look at all the factors that might affect that plan (as determined during our assessment) and then discuss these findings with the client. We then want to discuss the product selection, areas of injection, and so forth, on the basis of our clinical expertise. A facial assessment form that looks almost like a construction bid with a face on it may be used to draw or hand write names of products, placement concepts, and pricing so that the patient can understand how/where these products will be placed to benefit them. The aesthetic provider is responsible for educating the client and providing safe outcomes even though the variables are great. The provider is also responsible for discussing any possible adverse events at this time so that clients are aware of any risks involved in their treatment.
Factors affecting the outcomes are as follows:
1. Patient-physical characteristics and emotional expectations
c. Dermal health
d. Movement pattern
2. Product-chemical and physical properties
a. Chemical properties
1. Source-US products-bacterial origin
2. HA concentration-percent of cross-linked versus uncross-linked
3. Amount of free HA
b. Physical properties
1. Gel versus particle
2. Rheology (i.e., flow characteristics)
3. Provider-aesthetic eye and knowledge and injection technique.
b. Choice of injectable
c. Individual patient
d. Desired application
Provider factors affecting outcomes: What is the patient looking to achieve? The provider is responsible for discussing the treatment goals for the injectable agents.
* Effacement of hyperfunctional rhytides
* Volume restoration
* Periorbital volume
* Malar projection/submalar
* Buccal fat pads
* Recontour facial proportions and achieve symmetry
* Brow shaping/repositioning
* Facial dimension and definition
* Jaw line shaping
* Masseter reduction
* Improved outward projection of lips
Consistent and thorough client education ensures realistic expectations. Remind your clients that undertreatment is likely to lead to unsatisfactory outcomes. Educate your clients about both surgical and nonsurgical procedures (including all product choices); they deserve to know their treatment options. Take time to discuss the differences between products and how these differences could potentially influence how they will be used and what the likely clinical outcomes will be. It is especially important to discuss potential adverse events associated with injectable products and communicate what pre- and poststeps the clients should take to minimize them. It is your responsibility to address any anxieties or distress or uncover possible misinformation that could influence your clients' perceptions. And finally, gauge their commitment to long-term maintenance. Time, effort and education will go a long way toward managing your clients' expectations and increasing their livelihood of success.
As aesthetic providers, our goal is to provide safe treatments that establish trust, produce positive outcomes, and create engaging experiences. Achieving this goal will ensure that clients return for future treatment needs and continued maintenance. There is a possibility that your satisfied clients will refer their friends and family due to their exceptional experience! The key to retaining your clients is STAY: Set realistic expectations for treatment; Treatment assessment is necessary; Always make a follow-up appointment; and You are the reason patients return.
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Carruthers A., Carruthers J., Hardas B., Kaur M., Goertelmeyer R., Jones D., et al. (2008a). A validated grading scale for crow's feet. Dermatologic Surgery, 34 (Suppl 2), S173-S178. [Context Link]
Carruthers A., Carruthers J., Hardas B., Kaur M., Goertelmeyer R., Jones D., et al. (2008b). A validated grading scale for forehead lines. Dermatologic Surgery, 34 (Suppl 2), S155-S160. [Context Link]
Carruthers A. (2008c). A validated lip fullness scale. Dermatologic Surgery, 34 (Suppl 2), S161-S166. [Context Link]
Carruthers A., Carruthers J., Hardas B., Kaur M., Goertelmeyer R., Jones D., et al. (2008d). A validated brow positioning grading scale. Dermatologic Surgery; 34 (Suppl 2), S150-S154. [Context Link]
Carruthers A., Carruthers J. (2010). A validated facial grading scale: the future of facial ageing measurement tools? Journal of Cosmetic & Laser Therapy; 12 (5), 235-241. [Context Link]
Davidson S. (2003, ). Face to face with Jennifer Lopez: The Little Latina girl from the Bronx is all grown up. Reader's Digest. Retrieved November 24, 2011, from Retrieved November 24, 2011, from http://RD.com/content/interview-w-Jennifer-Lopez/[Context Link]
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Diller V. (2010). Face it: What women really feel as their looks change. Carlsbad: Hay House, Inc. [Context Link]
Gallup. (2010, ). Gallup 2009 HealthLeaders media patient experience leadership survey. Gallop.com. Retrieved November 24, 2011, from http://gmj.gallup.com/content/143258/patient-experience.aspx[Context Link]
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