The patient, a 36-year-old female patient, was diagnosed with neurofibromatosis type 2. She also developed a benign tumour that affected her hearing nerves. The patient had the tumour removed and received therapy, which resulted in some deafness and paralysis of the facial muscles on the left side of her face. She uses a cochlear implant and lip reads to communicate.
Her presenting complaint to me came originally in March 2022, when I first launched CJS Holistic Aesthetics in the southeast of England. I was advertising my new medical aesthetics clinic on social media and the patient contacted me to enquire about the treatments I was offering. She had had unsuccessful facial physiotherapy to rectify her uneven expressions and had read about botulinum toxin as a possible treatment. Nonetheless, her needle phobia posed an even bigger challenge to manage alongside an already complex case.
Emotions and strategies dealing with the case
In all honesty, I was very hesitant to treat the patient at first, as even my highly experienced colleagues in aesthetics had advised me that they would steer clear from such a challenging case. However, I truly wished to help this patient regain her confidence, and I also worried she may end up seeking treatment from someone that could not provide her with appropriate treatment under the best model of care.
As such, I felt a duty to help her. I decided to initiate some research myself into the patient's medical condition. I also arranged a phone call with her specialist neurology nurse.
The specialist nurse, along with her consultant, believed it was acceptable for the patient to receive botulinum toxin treatment. I received this confirmation in writing for assurance.
I was honest and upfront with the patient from the beginning about my limitations and the range of my expertise. As the patient contacted me quite shortly after I qualified in aesthetics, I explained I would like some time to practice my new skills until I felt confident in providing her treatment. The patient respected this and felt reassured by my communication, thus agreeing to wait.
The patient is extremely needle phobic, so I made sure to allow additional time during all her appointments; the communication barrier due to her hearing disability was another thing to factor in when developing our nurse-patient relationship.
The procedure
The patient attended her treatment at the end of May 2022. We had a thorough consultation prior to this where I explained my treatment plan. We decided to start conservatively with her first Botulinum toxin treatment, and I advised her as I did with all of my patients, that we could add if need, but not remove, the Botulinum toxin. We decided to plan a two-week review ahead of the original treatment.
Due to the patient's needle phobia, I made sure the clinic was as calming as possible. She would use a meditation app on her watch which vibrated to encourage slow breathing, and this was naturally incorporated into her treatments. The patient preferred to be notified when and where I was going to inject, so we developed a technique of me tapping the target injection area of the face before I actually placed the injection. The patient managed all treatments well with the help of these techniques.
» I was honest and upfront with the patient from the beginning about my limitations and the range of my expertise… I explained I would like some time to practice my new skills until I felt confident in providing her treatment. The patient respected this and felt reassured by my communication, thus agreeing to wait «
» For aesthetic practitioners who may come across similarly complex cases, my first advice is to not feel pressured to do anything sooner than you feel ready to «
When the patient visited me two weeks later for her review, we were both amazed by her results. She had an even frown expression; her eyes were symmetrical, and we managed to treat the static lines on her forehead. We decided during the review that she did not need any further tweaks, so we made a note of what amount was administered to achieve this result. Since then, the patient has seen me every three months to maintain her Botox treatment and we have both been satisfied with the results each time.
Advice for practitioners when handling a complicated case
For aesthetic practitioners who may come across similarly complex cases, my first advice is to not feel pressured to do anything sooner than you feel ready to. I was very lucky to have such a patient and understanding client, who allowed ample time for me to conduct research and speak to her specialists. Under such circumstances, I felt sufficiently comfortable to provide her with the best care I could possibly offer.
Another advice is for practitioners to be honest with patients about their professional limitations—I found this to be quite key, as it built much more trust between the patient and me in the long run.
Finally, it is important to not be frightened of challenging cases. It is perfectly sensible for a nurse to have some reservations initially, and it is alright to prepare until a practitioner feels confident enough to perform a treatment. As long as both the practitioner and patient understand the risks associated and are on the same page, satisfactory results can realistically be achieved. Remember that the patient, after all, is most knowledgeable of their own conditions; it is thus important to listen carefully to their first-hand experiences, so as to plan how best to address their surgical needs.
Key points
- When dealing with a medically complex case, it is crucial to sufficiently understand the patient's condition first. It may he helpful to reach out to other specialists who know the patient and understand their condition.
- Patients of complicated medical cases may use different techniques to cope with the stress they may have.
- Allow time for thorough communication with the patient; take into account any physical, psychological, or communicative barrriers and contemplate how to address them beforehand.
CPD reflective questions
- Have you ever encountered a medically complicated case? If so, how did you manage it? If not, how would you prepare yourself for such potential cases as an aesthetic nurse?
- What are some ways that nurses can increase their technical knowledge on medical complications in aesthetic nursing?
- What are some ways to prepare the patient psychologically in such cases?