Jodi, RN, BScN,
Incoming patients may inquire about a large number of facial rejuvenation products that are available on the market today. Nurses who perform aesthetic facial consultations and treatments need to be knowledgeable about the use of botulinim toxin A (BotoxÆ) as well as a range of facial fillers. They also need to have a strong understanding of facial rejuvenation surgical procedures, as some patients will need more than injectatracble treatments alone.
Education is a primary function of the patient consultation. Patients need to be made fully aware of all the options, and the risks, recovery time, and cost involved in any procedure before it is undertaken. The consultation is a lengthy process of an hour or more where the aim is to arrive at a treatment plan that meets the patient’s desires and expectations at an affordable cost.
A complete history of medical conditions, medication use, allergies, and family history is important, and no questions should be skipped. Sometimes you have to delve into a patient’s history to find relevant information that he or she may have withheld due to embarrassment, such as previous procedures. Patients may also have forgotten to note something significant on their medical form, such as a relative with Von Willebrand’s disease, a common inherited coagulation disorder that could signify the potential for excessive bleeding during procedures.
Just as important is your understanding of a patient’s rationale for having the procedures. Plastic surgery is a field where patients drive the treatment, often with highly unrealistic expectations. The initial desire for the treatment is as important as the treatment itself, as it may not be the full solution to the problem. Hidden agendas, like a recent breakup, or the belief that the procedure will save a marriage, need to be uncovered and discussed.
The next step is to develop a treatment plan with patients, based on their stated wishes and the available products
Commonly Used Injectable Fillers
- JuvÈderm® Ultra and Ultra Plus
- Prevelle™ Silk
Anesthesia should be fully discussed. The FACE survey done in Canada showed that 32% of patients cited pain as the reason for avoiding treatment.1[Ms. Hotta: Can you please provide the reference article as a pdf? Or alternatively, a full citation? We haven’t been able to locate it. Thank you.] Topical creams such as TAC (tetracaine, epinephrine, and cocaine), LET (lidocaine, ephinephrine, and cocaine), and EMLA (lidocaine and prilocaine) are very effective, as is ice applied to the injection site.2,3 Iontophoresis can also be used, in which a small current is applied to a lidocaine-soaked patch of skin, providing a deeper anesthetic than topical creams.3 When vibration technology is applied to a certain area around an injection site, it will distract the patient from the pain of the injection itself.
Assuring patients that different kinds of anesthesia can be used to minimalize discomfort during an office procedure will help them make the final decision about going forward. Informed consent for all procedures, as well as consent to take before and after photos, should be obtained at this time.
Documentation of the baseline condition of the face is very important to both the success of the treatment and to setting reasonable patient expectations of what can be achieved. Patients see themselves in their own terms. Frequently, they are focused on one or two areas that trouble them and don’t see small anomalies or asymmetries that could affect the overall look of their face.
Taking pictures during the consultation allows us to show patients a realistic image of their face, and show them things they may not have noticed previously. The digital cameras available for aesthetic treatment practice today are extremely sensitive and sophisticated, and can provide a range of useful photos that help to provide standard and consistent photos.
Before patients leave the initial consultation, it is a good idea to show them around the procedure room. Ask patients not to wear make up on the day of the procedure, or to plan to take it off when they arrive at the office. Suggest that they bring make-up with them to put on if they are returning to work.
During the Procedure
The primary concern during an in-office procedure is patient comfort. During the procedure, it’s a good idea to sit patients up and show them one side that has been corrected. This makes patients feel like they are part of the treatment process.
Documentation throughout the procedure is important, including the specific products and lot numbers, quantities, and needles used. This information often becomes invaluable after the procedure to determine what, if any, follow-up procedures need to be considered, and to evaluate potential adverse reactions.
Before the procedure is completed, begin to give patients an understanding of what to expect immediately afterwards. Informed patients are more compliant patients. Explain that the reason they should not exercise is to avoid redistributing the product and increasing the potential for bruising. Patients should be prepared for some residual tingling or mild pain.
Let patients know that you will be massaging the area immediately after treatment to ensure even distribution of the product but that they should not touch the treatment area themselves. After the final correction is achieved by massage, inform patients that you are cleansing with a sterile saline solution.
After the filler is injected, ice can be applied to the site to minimize swelling and other skin reactions. Patients can be instructed to continue to apply ice at home as needed.
Before patients leave the office, give them a cell phone number that they can call over the weekend or during evenings if there is a problem. Patients should not be left without a contact at the plastic surgery office, but should have ready access to a nurse or other qualified professional to address any concerns that arise.
A follow-up appointment should be scheduled for 2 weeks to reassess the treatment area, consider the possibility of further treatment, and take postprocedure photos for the files. This final follow-up appointment is a good time to elicit any questions or concerns that may still remain, and to get patients’ reactions to the results. Maintaining strong patient contact helps to improve patient satisfaction.