Patient consult crux of successful treatment
Source: Dermatology Times ©
By: Nancy A. Melville
Originally published: February 1, 2006

Las Vegas - While the marketplace is chock-full of fillers and is expanding every day, the greatest challenge dermatologists face is not necessarily in picking the right products, but in choosing the right patients ? and keeping those patients' expectations in check, says Ranella Hirsch, M.D., who spoke at the annual meeting of the American Society of Cosmetic Dermatology and Aesthetic Surgery (ASCDAS), here.

Collagen, hyaluronic acid, fat and poly-L-lactic acid and other fillers offer wide-ranging capabilities in a host of shapes and forms, but how, if and where they should be used all depend on the patient. The consultation is where the groundwork should be laid for patient and physician alike.

The basics
"It's important to go over all of the basic issues at the consult. Patients come in with lines and wrinkles and also, sometimes, unrealistic expectations and the most critical thing we provide them is a reality check," according to Dr. Hirsch, a dermatologist based in Cambridge, Mass., and the newly elected vice-president of the ASCDAS.

Essential information to gather at the consult includes possible medical limitations, such as allergies, medications the patient is taking and whether the patient has a history of oral herpes simplex.

Equally important are the patient's aesthetic concerns and the ability to communicate those wishes. When patients come in with a photo of a celebrity's lips, for instance, doctors need to convey what can really be accomplished.

"When they've chosen a single feature to highlight, it isn't always a realistic or appropriate thing to do...I explain to patients it would be the equivalent of dressing a window on a wall, without addressing the wall itself," Dr. Hirsch says. "I strongly encourage giving patients a hand mirror during the consult for use in the discussion so they can specifically point out the areas that concern them most and so that the physician can be certain that they are speaking about the same areas as the patient."

Doctors should be frank with themselves, as well, in considering whether the procedures suggested are really the best avenue for patients, or whether they would be better off, for instance, getting a face-lift. In addition, doctors should make sure patients understand that all of the treatments have fundamental limitations, Dr. Hirsch tells Dermatology Times.

Financial constraints
Assessment of financial constraints is critical, as inability to pay for the necessary degree of a treatment could undermine its efficacy.

"Volume is key and increased volume equals increased cost, so it's important to
be sensitive to that on the initial consult," Dr. Hirsch explains. "If someone needs three syringes and only wants to pay for one, you are much better off not performing the treatment, because the simple fact is, you are not going to make them better."

In addition to making sure patients are prepared to pay for treatments, dermatologists should make sure they are able to come in for the needed follow-up sessions. If patients are receiving Sculptra (Dermik), for example, they will need to know that this will involve several visits. It is important for the patients to understand this at the start.

Snapshots
Finally, it's essential to take photographs, and not just at the initial consult, but every time a patient comes in, Dr. Hirsch emphasizes.

"If you don't take photographs, you're making a very foolish mistake. It is
very difficult for patients to appreciate the before and after without (photos)
and it is critical for medical-legal reasons."

Once the preparations are complete and it's finally filler time, Dr. Hirsch suggests that with so many products hitting the market, picking the right one could often simply come down to personal preferences.

"You don't need to know all of the products," she says. "You're far better off picking one filler in each category (i.e. one hyaluronic acid and one collagen) and becoming its master. It will serve you well."

Disclosure: Dr. Hirsch reports no conflicts of interest of relevance to the
discussion.