Patient red flags with Dr. Rupert Critchley - Hamilton Fraser


In our latest guest blog from Dr Rupert Critchley, Director and Founder of VIVA Skin Clinics, highlights the importance of patient selection and the red flags to be aware of.

As practitioners, we often talk about the importance of a thorough consultation before any treatment from the perspective of the patient. This is of course an invaluable step in the patient journey for them; but it is also essential for you as injector. Although non-surgical treatments are largely elective from a client stand point, the truth is that that we have a moral responsibility to select our clients carefully. Considering certain red flags and having protocols in place before treatment even begins is therefore paramount.

Of course, it is imperative to look out for signs of body dysmorphic disorder (BDD) during the early stages of consultation as this is a direct contraindication to aesthetic treatment. The mental health of patients and the responsibility to protect vulnerable clients ultimately lies with the practitioner, so we have a duty of care to assess this before we inject. The social media and Photoshop age in which we live continuously bombards vulnerable minds and breeds feelings of anxiety and the need to attain perfection. Easy to access procedures you can have done in your lunch break only makes this problem worse, so for us it’s all about ensuring treatment is genuinely in the best interests of the client before going ahead. The difficulty is that spotting red flag signs isn’t straightforward and there are multiple points to consider.

Beautiful and happy blonde woman at beauty medical clinic. She is sitting and talking with female doctor about face esthetics treatment.

Unrealistic expectations: During consultation you will start to build a picture of what the patient wants to achieve. In some cases, results don’t marry up with expectations. It’s not unusual for clients who are considering treatment to have unrealistic expectations, but striving for perfection can lead to more treatment, an unnatural finish and a continuous cycle of dissatisfaction. It’s important for every client to understand that, as practitioners, we still want them to look like themselves and that aesthetic treatment is there to enhance what they already have.

Requesting dramatic results: Similarly, some clients simply ask for too much product to be injected. They want ‘barbie doll’ lips or over-contoured cheekbones, but from both a moral and safety standpoint this is not the purpose of aesthetic procedures. Client education here is key – explaining that a more holistic, natural looking approach can be built upon over time if necessary is often enough to dissuade those eager for a dramatic change.

Budget vs. desired results: This is a tough one. It’s important to be wary of clients who require 5ml of filler to achieve their optimal results but don’t have the budget to accommodate this. This can be an awkward situation, but if you choose to continue with treatment with the budget they have in mind, disappointment is almost certain.

So, what can we do if these situations arise and how can we limit them in the first place?

Consultation: In truth, the process starts before the consultation – a questionnaire to gauge what they want to achieve and why can help you prepare before you even meet a client in clinic. Including questions such as ‘How often do you compare your appearance to others?’ and ‘How often do you think about how to camouflage or alter your appearance?’ can help to flag up red flag signs of BDD immediately. The consultation is the next step and a chance to discuss potential treatment and decide if it is in their best aesthetic interests. It’s important to remember to discuss alternative options too – we need clients to see the whole picture and this should always include the option to have no treatment at all. A consultation also allows for a cooling off period, giving them sufficient time to make an informed decision.

Education: As practitioners, we must remember that our clients may know nothing about the treatment they are proposing before they walk through the clinic doors. Basing their hopes on social media and celebrity culture, their expectations may be askew. Educating clients is the key to helping them understand what treatment can do for them and how the process will work. Explain where you will be injecting, what product you will be using, expected results and likely side effects to avoid any confusion down the road.

Aesthetics / Cosmetic Surgeon Examines Beautiful Woman's Face, Touches it with Gloved Hands, Inspecting Healed Face after aesthetic treatment with Amazing Results.

Consent: Nothing is more important than treatment consent from a client. What’s more, consent needs to be clearly informed, with any conversations documented. Ensure you include the possible side effects discussed, the expected outcomes and how long results are likely to last. It’s always a good idea to ask them to confirm each point that has been discussed individually so you know they have read and understood everything and so they can flag any questions or concerns.

Before and after snaps: Before and after photos are the only way you can definitively evidence positive results, so they are essential. If clients come back to clinic dissatisfied with treatment, these are often the best way of showing exactly what has been achieved. It also acts as a baseline; before any work is carried out to help keep clients grounded.

Refusing treatment: Refusing to carry out a procedure can be tough, but occasionally it is necessary. Luckily, so long as you are honest and provide reasoning, generally clients are respectful of your professional opinion. Clients who are displaying signs of body dysmorphia or are adamant about a treatment can, however, find refusal particularly hard to take; they may even try to persuade you to go ahead and may continue to try to rebook. In these situations, it is so important to remain firm with your final decision. Treatment and any problems that arise down the line are your responsibility so you simply can’t succumb to pressure, no matter how challenging.

About the author

Dr Rupert Critchley

Dr Rupert Critchley is the lead clinician, founder and director of VIVA Skin Clinics. Since beginning his medical career at Kings College more than a decade ago, he has since developed a passion for aesthetics and established a industry-leading practice. Now dedicated to the artistry of working with dermal fillers, developing his own particular techniques and consultation methodology, Dr Rupert takes the time to train up and coming aesthetic practitioners personally.

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