Facial rejuvenation: It is all about the diagnosis

Posted on the 13 January 2014 at 14:21

We all know that there are a number of reasons that can result in a disappointed patient. In my view the number one cause of patient dissatisfaction is wrong treatment as a result of wrong diagnosis. 

Last week I saw a very intelligent, professional lady who came in to see me as she had heard very good things about us. A brief account follows:

She tells me she does not want a consultation, just wants me to do some Botox for her wrinkles. I suggest to her that as this is the first time we have met, let us have a little chat, go through her medical history form, take some photos and have a discussion. I reassure her that this would not cost her extra!

On questioning it emerges that she has tried Botox three times previously and she did not think it worked that well for her! On examination it is evident that she has static wrinkles in her glabella, forehead and around the eyes. These are effaced on gentle stretch test. There is no change in depth of these rhytids on animation. I illustrate this to her in her photographs. A diagnosis is made that she has static and not dynamic rhytids [wrinkles]. 

I suggest to her that in my view botulinum toxin is unlikely to provide her with satisfactory result and that a hyaluronic acid filler such as Restylane would be a better choice. She agrees and is very pleased with the outcome. 

Some other examples may be treatment of deep nasolabial folds where many syringes are injected directly under these without satisfactory effacement. The cause may lie in deflated cheeks where a cheek volumising filler may have worked better. Similarly wrinkles along the jaw line and lower face may be due to excess facial and neck skin where a better choice would be a facelift or radiofrequency skin tightening. Lip lines may be better treated with CO2 laser resurfacing rather than too much filler giving a trout pout!

Patients often form firm opinions about what works and what does not work. We have a number of treatments available but they have to be applied for the correct indication otherwise they can result in a dissatisfied patient. Aesthetic medicine is no different from any other branch of medicine in that a correct diagnosis forms the basis for correct treatment recommendations.

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