2 Diagnosis of the Cosmetic Facial Surgery Patient
The Art of the Consult and the Office Patient Experience
There is no more important aspect of the cosmetic surgery experience than the initial patient consult. As they say, you never get a second chance to make a first impression, and the first impression occurs when the patient phones the office to make an appointment. Unfortunately, this is where a lot of patients are lost. Having personable, friendly, energetic staff answering the phone can be one of your best referral sources. Patients often tell me they actually saw three or four other surgeons, but the professionalism and attitude of my staff persuaded them to come to my office. Many barriers between the initial phone call and the operating room can be eliminated by an astute front desk person. A compassionate receptionist can alleviate many patient apprehensions and get the client into the office. I call this staff member the patient representative. Our patient representatives are familiar with every procedure we perform and can discuss them accurately with prospective patients.
The cosmetic surgery office should be clean, pleasant, and in most practices decorated to accommodate females, since the majority of cosmetic patients are women (Figures 2-1 to 2-4). Consider your experience at a very high-class hotel and try to duplicate that in your business. A patient greeter, providing drinks and snacks, assisting patients with paperwork, and having educational material available are all amenities appreciated by patients.
Meeting a stranger and discussing one’s deficiencies can be very stressful for patients. When I go to examine a new patient, they are often perspiring from nervousness. A productive consult requires a relaxed patient. This is best achieved using an intermediary, and in my case this person is my cosmetic coordinator. She escorts the patient to the room, seats them, and makes nonsurgical small talk before addressing cosmetic concerns (Figure 2-5). She tells the patient about the surgeon, performs an “across-the-room” evaluation, and discusses some of the more obvious concerns. She may say, “I believe Dr. Niamtu will want to discuss eyelid surgery, cheek implants, and facelift with you.” She displays our website on the widescreen TV in each consult room and goes through specific procedure pages to discuss what we do and how we do it. She will also show the patient before-and-after pictures of relative cases (Figure 2-6).
After the preconsult, I am called into the room and introduced. This initial meeting can make or break a relationship. I always shake hands with the patient as I believe “laying of the hands” puts patients at ease and subliminally melds the doctor-patient relationship. A show of personal warmth, an unhurried attitude, and some small talk with the patient before getting to the cosmetic problems will be time well spent. I may ask them what they do for a living, how they heard about our office, how they are enjoying their summer, etc. Again, putting a patient at ease is an art form (Figure 2-7).
Most of our patients register online and are asked to bring a list of cosmetic facial concerns to the first appointment. Nervous patients often forget to ask key questions. Patients also frequently are also asked to bring in younger pictures of themselves to see what they considered their strong or weak points and how they have aged (Figure 2-8).
The most important instrument used in the consult is a hand mirror. I ask patients to tell me what bothers them or what they would like to change and to show me in the mirror (Figure 2-9). Occasionally a patient will say, “Doctor, what do you think I need?” The novice surgeon should never fall into that trap. It is imperative that the patient take ownership of what bothers them or what they would like to change. A patient that cannot communicate their cosmetic problems may have other underlying problems. Some patients are embarrassed to discuss the topic and need some prodding. The other problem with answering the question “What do you think I need?” might encourage the surgeon to say the patient could benefit from eyelid surgery, and the patient may think their eyes are their best feature and be offended!
An alternative to using a mirror is to take several pictures of the patient just before the consult and project those images on the widescreen monitor. This can have great impact when showing patients their aging changes. Also giving the patient a copy of the pictures to take home can go a long way in having them realize their aging problems.
The best way to discuss cosmetic deficiencies is to make the consult an educational experience. I explain to the patient that I am going to discuss the entire head and neck in terms of diagnosis and potential cosmetic treatments, but this does not mean that I believe they need surgical correction of all areas discussed.
The most orderly means of systematically discussing facial aging and potential treatment is to explain to the patient that the face is divided into thirds, and we will discuss the upper, middle, and lower third then discuss the skin as a separate unit. During this discussion, the surgeon should never assume, for example, that the patient understands the difference between brow aging and eyelid aging. Always stay elementary when explaining diagnosis and treatment. Many patients have never heard of cheek implants or understand what a browlift or facelift does. If patients are put off by discussion of multiple procedures, and if I sense the conversation going that way, I consider this patient more conservative and stay closer to their main concerns.
As I talk to the patient, I include my cosmetic coordinator in the discussion. I may say, “Mrs. Smith, I think you are a great candidate for laser skin resurfacing. Don’t you agree, Ginger?” This adds a third opinion to the discussion, puts the patient at ease, and reinforces my diagnosis. My assistant is continually recording bullet points of the consultation discussion and prepares a form to/>