Dr Louay Azoo, MMBS, MRCPsych
Psychological aspects of aesthetic medicine
Understanding the psychological drivers that lead a patient to seek aesthetic treatments is a vital element in providing that patient with the correct medical advice and intervention. A good psychological formulation will strengthen the professional-patient relationship, reduce dissatisfaction and lead to a better prognosis. It a skill required of all aesthetic professionals.
The pursuit of improved physical appearance is simply a means to a psychological end. The relevance of psychology to the aesthetic patient and clinician is therefore clear.
Reasons for seeking aesthetic treatment vary between individuals but are often linked by recurrent negative feelings, thoughts, or experiences. The psychosocial goals for patients can be broadly summarised as a positive change in emotional state, raised self-esteem, improved interpersonal relationships and more positive reactions from society in general.
Patients seeking aesthetic treatments may be less physically vulnerable but are very often more psychologically vulnerable, it is the aesthetic clinicians job to assess psychological vulnerability before offering treatment.
The degree of importance a person places on body image along with the amount of dissatisfaction around specific features contribute to their decision to seek aesthetic treatment. Vulnerability is often linked to body image relative to self-esteem and the importance placed on one relative to the other. Patients who have extreme dissatisfaction with their appearance leading to significant distress, impairment and preoccupation may not be suitable candidates for cosmetic treatments. Assessing for and understanding underlying conditions such as Body Dysmorphic Disorder (BDD) and other mental disorders is essential. BDD is the persistent preoccupation with a slight or imagined defect in appearance that leads to significant distress and impairment in daily functioning.
Applying BDD diagnostic criteria to modern-day patients interested in aesthetic treatments can be difficult. The first part of the diagnostic criteria concerning preoccupation with a “slight” or “imagined” defect in appearance, could be used to describe most aesthetic patients. Patients seeking aesthetic treatments can often report being preoccupied with slight imperfections of “normal” features. Describing features as “normal” or a defect as “slight” is also highly subjective and can be assessed differently by the patient and the clinician. A certain amount of body image dissatisfaction is typical among most patients, those who report extreme dissatisfaction with a specific feature may be suffering from BDD. The degree of dissatisfaction with the specific feature should therefore be thoroughly assessed with an emphasis on any resulting social or functional impairment.
Apart from identifying significant psychopathology that may indicate against offering aesthetic treatment, a good psychological understanding of the patient is essential for any successful aesthetic clinic. Aesthetic medicine is based on long term management of client’s aesthetic goals and the nature of most treatments means that repeat business is invariably required. Patient retention is a critical indicator of clinical performance in this field. Psychological benefit leads to patient satisfaction which leads to patient retention, when an aesthetic professional understands this dynamic they also understand the importance of psychology in their clinical practice.
Patients who feel understood will be more likely to follow treatment recommendations and less likely to use any other aesthetic practitioner.
So what is a successful treatment outcome?
Outcomes are highly subjective in aesthetic medicine. An appendectomy is successful if the appendix is removed and there is a return to normal functioning, a dermal filler treatment is successful if there is a subjective feeling of improved appearance and to put it bluntly – if the patient says it is successful. The true aim of most aesthetic treatments is psychological benefit and a subjective improvement in emotional state, self-esteem and relationships as previously stated. It is therefore also true that it is the patients own view of what they consider to be a good outcome that determines this rather than any objective measure. The subjective nature of aesthetic treatment success can leave the unprepared clinician on shaky ground.
A failure to manage patient expectations will frequently lead to dissatisfaction, a thorough assessment of patient goals, motivation and expectations is essential.
Client motivation will include an aesthetic goal and a psychological goal (whether this is a conscious influencing factor or not). Aesthetic goals include enhancing physical appearance, maintaining appearance or delaying the ageing process. From a psychological viewpoint it is better to direct the consultation towards positive outcomes “reducing wrinkles” instead of negative self-assessment, “I can’t stand my wrinkles”. “What would you like to achieve?” instead of “What do you not like about yourself?”. Asking a patient to point out all the things they do not like about themselves can be emotionally exhausting and reinforce the negative emotions associated with their self-image. A better psychological approach would be to focus on positive changes they would like, they will have a better experience of the consultation and therefore be more likely to want to use your clinic.
Psychological goals can be explored by asking how they think a treatment will make them feel, and what would change in their life. Do they think lip enhancement will lead to increased self-esteem or infuse her marriage with passion? It is the clinician’s job to assess if the client expectations are realistic. If the patient states, “I won’t be depressed,” or “People will love me,” this should raise a red flag – that is not to say that this may not be the outcome, it just should not be the expectation and primary motivator for treatment.
Unrealistic or excessive expectations would include the assumption of significantly enhanced self-esteem, enhanced physical appearance beyond possibility, unrealistic duration of effect, increased social standing, improvement in lifestyle, relationships and career or a reversal of the aging process.
Suitable clients are well informed and realistic. Patients should be educated towards taking their own informed, realistic, and “eyes-wide-open” decision. They should be encouraged to research any possible treatment options and be aware of differences in treatment outcome between individuals. As part of the informed consent process the patient’s understanding of all aspects of the treatment should be verbalised and documented.
The message is clear, an understood and informed patient with realistic expectations usually means a happy patient, which makes a happy doctor, and that is good for everyone.
Dr Louay Azoo MBBS, MRCPsych
Dr Azoo qualified as a medical doctor from Kings College London in 2000, he has been a full member of the Royal College of Psychiatrists since 2005 and is also a practicing aesthetic doctor. He currently works as an NHS Psychiatrist in West London and has his own aesthetic clinic in Ealing called Dr Azoo Cosmetic Clinic www.drazoo.com