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LIVE BLOG: Selecting the Right Patient for a Cosmetic Procedure

In this live blog Martha Sikes, MS, RPh, PA-C, lectures on Selecting the Right Patient for a Cosmetic Procedure. This is from the Fall SDPA 2013 Conference in Atlanta, GA.

Facial rejuvination is “in,” and the trend is here to stay. According to the ASPS both surgical & minimally invasive facial rejuvenation procedures experienced most growth in 2012, with a 8% increase in botox and 5% increase in soft tissue fillers.  Other procedures that have grown in popularity include chemical peels, laser hair removal and microdermadasions.  With the help of the acronym SAGA, PAs can assess the red flags of a risky patient before proceeding.  “It’s your license on the line,” so it’s very important to be diligent.

How do I select the right patient for a cosmetic procedure? 

+ Reference with plastic surgeons

+ Take the time to listen to your patients

+ Ask open ended questions as to not offend them or put new ideas in their head: “What brings you in today?” & “What can I do for you?”

+ Address patient’s desires not just physical deformity

+ Motivation: Is it something that they see in themselves, or is it what someone else sees in them? Was there a precipitating factor initiating the consult (divorce, work-place)?


+ Does the patient understand the risks and implications of the procedure?

+ Has the patient done their homework?

+ Have you provided enough information so that the patient can make an informed decision about the procedure?


Do they appear to have some apprehension about the procedure?  If they do, then it may be a good thing.  If they are anxious, they’ve been thinking about the procedure.  They’ll then really listen to you when you run through options and risks.


SAGA: Sensitization, Aesthetic Self-Assessment, Peer Group Comparison, Avoidance behavior


+ Is this self-induced or extraneous?

+ If the patient is not sensitized & is requesting procedure to please someone else – this may be a big factor in how they want things to look.

Aesthetic self assessment

+ Consider the patient’s own private evaluation of the complaint.

+ “I know that you’ve looked at this issue from many angles…”

+ Allows you to provide empathy to the patient.

+ Patient gives “clear” idea of improvements they want & expectations they have for the procedure.

Peer Group Comparison

+ Has the patient analyzed their complaint on everyone around them?

+ This is NORMAL and provides insight into the patient’s behavior.

+ If this behavior is not there, it may be a procedure that they’re doing to please someone else.

+ Minor red flag: Denial of this behavior.

Avoidance behavior

+ Strategies patients used to camouflage or avoid feature of complaint.

+ Record behavior as it is useful for comparison, post procedure.



+ When patient is pushy or impatient.

+ Solicitous, seductive or flattering behavior.

+ When patient is rude to office staff.

+ Patient appears depressed or to have low self esteem.

+ Asks numerous questions without listening to replies.

+ Patient is clearly trying to please someone else.


Setting Reasonable Expectations

+ What is the patient’s desired outcome?

+ Is the desired outcome reasonable/realistic?

+ Is the desired outcome achievable?

+ Is the patient willing or able to endure post procedure pain/healing time?

+ Is the patient willing to accept the risks of the cosmetic procedure?

+ Do you have the necessary tools/skills to reach that outcome?


Ego-Aside: Know Your Limitations

+ What do you consider “vanity”?  Where does your vanity show itself in your life?

+ Would you have any of these procedures done to yourself?

+ Would you recommend any of these procedures to your mother?

+ Do you understand the pathophysiologic reasoning for utilizing various cosmetic procedures?

+ Do you have the necessary tools/skills to reach that outcome?

+ Are you comfortable with performing the cosmetic procedure?

+ Is your supervising physician available/approachable for consultation or aid?

+ Do you feel the patient needs a psych consult?


Do you like the patient?

R.K. Daniel said “Never operate on a patient one does not like as an individual – the pre-op course is finite, but the post operative course is infinite.


Know when to say “no”

It’s your license on the line:

* Deliver the “no” with empathy and openness


SIDE EFFECTS: Expected and Unexpected


Commonly reported:

+ Erythema

+ Pruritis

+ Acne




Commonly reported:

+ Bleeding

+ Ecchymosis

+ Injection site pain

+ Headache

+ Lack of effect

+ Ptosis



Commonly reported:

+ Swelling

+ Bruising

+ Pain

+ Pruritis


+ Vascular occlusion

+ Infection



Commonly reported:

+ Purpura

+ Crusting

+ Edema

+ Dyschromia

+ Infection



+ Be sure patient has a way to reach you with ANY question

+ Lay eyes on the patient… photos are fine in some cases

+ Trust your instincts….. If it sounds off, it probably is


Common adverse effects that seem out of proportion:

+ Delayed wound healing

+ Serious infection

+ Persistent common adverse effects

+ Non-compliance: Ask for honesty in what they have been doing post-procedure



+ Ancillary help can be your most valuable resource

+ Make sure they understand the procedures/complications

+ Perform the procedures on them…. They will be your best referral and can handle the minor complaint telephone calls from patients having side effects

+ Trust their judgment about the patient!


Setting Reasonable Expectations While Establishing a Patient Base

+ Talk candidly with patient regarding realistic outcome and possible complications

+ This is where the “art of medicine” comes into play

+ Show before and after photos of your work

+ Don’t be afraid to refer patients to other providers

+ Don’t let your bottom line affect your judgment

+ …And do it all with an enthusiastic smile!


AND SO!  In conclusion:

1. Get a History

2. Do an Examination

3. Move to Conclusions

4. Make a Final Choice




Image: Thinkpanama

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