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Dr Tim Pearce
Guest Blog
This guest blog is provided by an experienced Aesthetics Nurse who shares their unique experience of perceptions of beauty.
The article considers the difference in perspective from the patient to the practitioner. It also explores BDD (Body Dysmorphia Disorder)
There is a huge spectrum of what one would deem beautiful, and another person see as ugly.
There is no black and white just many variants of grey when we look at physical form and how we feel about it.
This is what you need to assess when choosing a practitioner for treatment or for us as practitioners to assess when correctly weighing up whether to treat a patient or not.
Not everyone will suit everyone and that is ok.
As a patient you must always feel comfortable in the presence of your practitioner, to really feel that they “get you”, that they “have your back and they have your best interest at heart, that they could make a positive impact on your wellbeing. You both need to sing from the same hymn sheet.
As a practitioner you must feel comfortable in the presence of your patient, to really feel that they reflect what you stand for. That they listen to you and ask appropriate questions, that you feel ultimately, you can make a positive impact on their wellbeing, you both need to sing from the same hymn sheet.
This, we as practitioners only get better at in time, with practice, from learning from previous mistakes, and when we reflect, often some of the red flags were there all along. That often these patients really didn’t reflect what you represented, but we as medics want to help everyone, to heal them, get them past this hurdle in their life to move on and be free.
The art of saying ‘No’
Its only with experience do we get better at saying “No”.
I know when I first started out, I’d have patients I wanted to do all the above for, the advice I had received or the papers I had read say don’t treat a patient displaying this type of behaviour and with me being me I wanted to help them, maybe I’d be the one to finally be the one that helped them. 3 weeks later my dysmorphic patient turns up at my clinic unhappy and saying I can’t see a difference.
We really are more than just a guy or a girl with a needle, we are medical professionals, and we took an oath, to do no harm. And sometimes treatment of a patient really can do them harm, it can do you harm too! Yes, we want to help but for some patients we really are doing them a disservice by treating them with injectables.
Body Dysmorphia Disorder
The NHS says that Body Dysmorphia Disorder (BDD) Is a mental health condition where a patient spends an unhealthy amount of time worrying about the flaws in their appearance which can be undetectable to others.
We need to be a psychologically minded practitioner to help all our patients and for many of us this proves hard, because we are emotionally charged people with the drive to make people happy.
Doing the job we do and the longer we do it for we pick up on certain phrases patients may say that alert you to how they are struggling, not even phrases but their reaction too when we hand them the mirror.
They may show us a picture of themselves and display it saying, “look how hideous I look; I need to know how to fix it!” I may not have seen the picture, but the words resonate with me. The picture maybe flawless, to me anyway. The tiniest of imperfections that this patient is showing me is so insignificant we can barely see it but for this patient its huge, its screaming at them, its hurting them causing them an emotional trauma that we can not heal with more filler or toxin or what ever tools we use in our clinics.
But the conundrum lies when someone who is struggling emotionally with a treatment that is less than perfect because the treatment may have been done in a less than perfect way by ourselves, by another practitioner, by themselves?! Do we step in? Do we try to attempt to resolve the problem?
I believe that if there is a flaw in the treatment, we have carried out on that patient we have an obligation to do the right thing, but again to the patient it maybe not enough in their eyes. Ground rules must be in place and like all treatments with all patients these rules are there as we all like to know what the plan is, the flowchart of what to expect and what to do if things don’t go to plan.
Treatment adjustments
If it’s a simple thing like adding a bit more filler to a lip where an indentation has been left due to a void of filler than this must be pointed out and this be treated, and then this is where it must be left.
I truly believe that a patient should return to their previous practitioner for tweaks, fixes, complications because as soon as we start working with the patient, we then take on that responsibility and this can cause issues later down the line. It also doesn’t allow the previous practitioner to learn from their mistakes, how does anyone not improve unless they are told that something was wrong in the first place?
Of course, if a patient cannot return to a previous practitioner due to safety or relocation then this needs to be truly deeply thought about. I will talk with patients who are dysmorphic, they need to be treated like anyone else, they have needs, wants like all of us but understanding that the ground rules need to be in place and if I truly don’t think I can make a difference I must say so.
But how do you tell the difference between the patient who is on the neurotic end of the scale or just scared and anxious, these are very similar behaviours. Is the patient displaying behaviours that seems disproportionate to the response? And the hardest patients are really those that have picked up on something, but its very mild but in their head its very huge. The patient may have you looking at photos of them and this sometimes can alert you, the patient maybe displaying unnatural expressions where they strain to show the imperfection(s). They may send you loads of photos! These can certainly be alarm bells.
But the best tools to help us is to use BDD screening tools, Dr Tim has one too! Download the Dysmorphia VS Body Modification checklist on the website.
These tools are here to help us as well as our patients, I implore you to use them, remember we work from a medical model not a commercial one!
I believe that it is hugely underestimated how many patients have BDD as it’s a known fact that those that have BDD will seek out aesthetic procedures or surgical interventions. But in my 4 years of treating patients with injectables I have only really thought of 6 had BDD and I declined treatment and suggested to them to seek further support from their GP or a service for cognitive behavioural therapy. I am sure I have treated many more, but I haven’t been so fine tuned to have picked up on them or because they’re excellent at hiding it after being turned down by many other practitioners.
Satisfaction is subjective
Satisfaction is subjective. This I am learning daily and I’m sure I’ll go down more pitfalls and again I’ll learn from them. But what I always say to my patients, I say to other practitioners, “go with your gut”, if you feel nervous about a patient then you should say no.
Below is a link that may help you support your patients with potential BDD, many won’t take our advice, and many will just hop from practitioner to practitioner, but it is our duty to do no harm and to help with what we have, to be ethical and ultimately responsible medical professionals.
Aesthetics eLearning Courses
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Further resources
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Dr Tim Pearce eLearning
Dr Tim Pearce MBChB BSc (Hons) MRCGP founded his eLearning concept in 2016 in order to provide readily accessible BOTOX® and dermal filler online courses for fellow Medical Aesthetics practitioners. His objective was to raise standards within the industry – a principle which remains just as relevant today.
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