Our patients seeking aesthetic services have an increasingly sophisticated array of noninvasive, minimally invasive, device-based and surgical choices to help us achieve the results they are looking for. At the same time, as health care providers, it is crucial we maintain professional vigilance to ensure patients' safety and well-being, understanding the importance of considering their health holistically.
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Our patients seeking aesthetic services have an increasingly sophisticated array of noninvasive, minimally invasive, device-based and surgical choices to help us achieve the results they are looking for. At the same time, as health care providers, it is crucial we maintain professional vigilance to ensure patients' safety and well-being, understanding the importance of considering their health holistically.
The concept of body image is multidimensional, encompassing thoughts, feelings and behaviors individuals have toward their overall appearance. These feelings are central to one's identity, whether that person is satisfied with or concerned about body image and appearance.1 Much attention and research has focused on the concept of body image as a deficit, i.e. negative body image as a risk factor for poor mental health and psychopathology like eating disorders. A positive body image, on the other hand, contributes to better mental and emotional health.2
LISTENING FOR RED FLAGS
When patients come to us for advice on their aesthetic needs, we need to be aware of these issues and, through our consultations, ensure they have realistic goals and expectations. I begin by listening carefully, keying into words that are red flags regarding one's mental and emotional state. For example, if a patient says, "I look in the mirror all day long and I can't stand my appearance" or they use the word "hate," I become concerned. I might tell this patient that I do not have the skill set to get to the root cause of their feelings, and I offer to get them aligned with someone who can better address their needs.
Another red flag for me is when patients say things like, "I've been to seven other injectors and none of them do it as well as you can." If someone is building you up while tearing others down, this may be a clue that there are other issues going on for that patient. We should be wary of individuals who might have jumped from provider to provider unable to find one that meets their needs.
ACCENTUATE THE POSITIVE
It is my job to find out what a patient is seeking, not to point out what I believe are flaws. A patient might ask me, "What do you see and what do you want to do to me?" Instead, I want to hear from them, finding out together what we should focus on. I don’t want to miss what the patient is feeling and jump to things that they never even thought about.
I try to understand what my patients like about themselves. I often ask them about their favorite features and develop a plan that enhances those areas. Maybe they love their smile, so that could be an excellent place to start with improvements that bring more attention to the beautiful parts of themselves.
HOW ARE YOU FEELING?
An important part of my holistic approach is finding out how my patients are feeling. Often my opening statement is, "Tell me what is going on in your life." I want to find out about their current state of mind and how they are feeling in general, not necessarily how they feel about the last treatment I gave them. If someone tells me they feel terrible, I want to know that and find out if I can help. Maybe they look tired because they are tired; I can help tease out what else might be going on.
Life can be fatiguing and stressful. Many times, I will discuss multivitamins, having blood drawn to check vitamin D levels or having them visit their family doctor. I love opening that door of, "tell me how you're feeling." I do want to know, and my patients understand that about me.
Many different kinds of life changes, from menopause to divorce, can put individuals into a place of struggle and they may be looking to aesthetic improvements for a boost. Whether it be neuromodulators to soften the face or widening and brightening the eyes for a more well rested appearance, those props are helpful tools for folks transitioning to a new stage of their lives.
HONEST ASSESSMENT
Take a female patient with heavy or droopy eyelids (ptosis) for example, who is concerned about age-related lines and wants a neuromodulator to stop wrinkling. Treating the patient with true ptosis could potentially cause the eyelids to droop more because of the relaxation that occurs in the muscle around the eyebrow and forehead area with neuromodulators. In this case, I need to be a detective and recognize that her lids are droopy to start, and if I do the treatment she demands, it could make her even more unhappy.
This requires an honest discussion of what it means to have lids that are a bit more lax, and explaining that, if I inject the forehead, I could be doing her a disservice. There are options for lifting the lids, from a topical pharmaceutical product to surgery. Ultimately, any given treatment should not worsen a different issue. I will discuss anatomy during the assessment to help patients understand their best options for achieving the outcomes they desire. This is a delicate conversation, which requires educating patients on what results I can achieve and setting realistic expectations versus what a patient might believe can be done.
EYE CONTACT
Our eyes are the first thing people notice about us, and when they look more open, brighter and wider, we look healthier and happier. Ptosis is caused by compromise to the levator and superior tarsal muscles that are responsible for upper eyelid resting position and elevation. A depressed eyelid position can reduce the amount of light entering the eye, thereby degrading visual acuity.3 Drooping of the upper eyelid due to ptosis can have an important impact on individuals' well-being. A UK study found that adults referred for ptosis surgery reported higher than normal levels of appearance-related distress, anxiety, and depression—similar to levels previously reported in patients with other appearance-altering ophthalmic conditions, such as strabismus.3
Oxymetazoline hydrochloride ophthalmic solution 0.1% is a prescription eyedrop that temporarily improves eyelid drooping by directly activating the alpha-adrenergic receptors in the superior tarsal muscle, stimulating contraction and elevation. In clinical trials of once-daily use, patients noticed an improvement in as little as 5 minutes, with full results in 2 hours and lasting for about 8 hours. My patients (and I am a user myself) have reported that in addition to the aesthetic improvement, they feel better when they are using the product. Some have even decided to forego surgery in favor of the drop and others have been so happy with the drop results that they pursued surgery for a more permanent solution.
MENTAL HEALTH BENEFITS
Aesthetic procedures have the potential to improve patients' mental outlook. Injectables such as hyaluronic acid fillers and botulinum toxin type A were associated with significant improvements in patient-reported psychological and social functioning and reductions in appearance-related distress. What we do is valuable, improving psychosocial health in well-selected patients.4 Patients having undergone cosmetic surgery in a 2-year multisite investigation reported high rates of satisfaction and improvements in body image within the first 3 months postoperatively, maintained through the first 2 months after surgery.5
Several meta-analyses have confirmed the antidepressant effect of botulinum toxin injected into the glabellar region with the safety and tolerability of the treatment found to be excellent in all studies.6 The muscles in the glabellar region of the face play a key role in the facial expression of negative emotions, such as anger, fear or sadness, which are highly prevalent in mental disorders like depression. According to the facial feedback hypothesis, the facial expression of emotions generates proprioceptive feedback signals that can maintain and reinforce the expressed emotions. Relaxing glabellar muscles with neuromodulator injections may not only give the face a less negative and more positive expression but may interrupt the feedback loop and lead to a less negative and more positive emotional state.6 Along with cosmetic benefits, injections seem to enhance emotional wellbeing, improve social and psychological behavior and reduce irritability, as well as depressed and anxious moods.6
CONCLUSION
The standard of beauty varies from culture to culture and evolves over time, and it can become skewed through constant exposure to images—particularly on social media. It is our job as aesthetic medical providers to be aware of this as a societal phenomenon and engage each and every one of our patients on a holistic level in order to provide services that are in their best interest and contribute to an overall positive self-image.
References
1. Rodgers R, Laveway K, Campos P, De Carvalho P. (2023). Body image as a global mental health concern. Cambridge Prisms: Global Mental Health, 10, E9. doi:10.1017/gmh.2023.2
2. Fostering a Positive Self-Image. Cleveland Clinic. https://my.clevelandclinic.org/health/articles/12942-fostering-a-positive-self-image. Accessed October 31, 2023.
3. Bacharach J, Lee WW, Harrison AR, Freddo TF. A review of acquired blepharoptosis: prevalence, diagnosis, and current treatment options. Eye (Lond). 2021;35(9):2468-2481. doi: 10.1038/s41433-021-01547-5
4. McKeown DJ. Impact of minimally invasive aesthetic procedures on the psychological and social dimensions of health. Plast Reconstr Surg Glob Open. 2021;9(4):e3578. doi: 10.1097/GOX.0000000000003578
5. Sarwer DB, Infield AL, Baker JL, et al. Two-year results of a prospective, multi-site investigation of patient satisfaction and psychosocial status following cosmetic surgery. Aesthet Surg J. 2008;28(3):245-50. doi: 10.1016/j.asj.2008.02.003.
6. Wollmer MA, Magid M, Kruger THC, Finzi E. Treatment of depression with botulinum toxin. Toxins (Basel). 2022;14(6):383. doi: 10.3390/toxins14060383
