The aesthetics sector appears to be changing. Our consultations increasingly focus on natural, subtle changes to the face as a whole, rather than trying to modify one specific attribute, or chasing lines. Fortunately, this change in practice aligns well with our professional ethical codes. The NMC code (2018) states that nurses must ‘act with honesty and integrity at all times’ and ‘treat people in a way that does not take advantage of their vulnerability’. Patients who request a cosmetic enhancement because they are addicted to the procedure and the positive feeling it brings them, as opposed to having a genuine need for it, could be classed as vulnerable. It is our duty as health professionals to protect them from being taken advantage of, not only physically, but financially. Where is the justification for treating a young girl requesting unnaturally big lips? Are we acting with integrity when we treat someone knowing that they are likely to be unhappy with their treatment months down the line?
I have dissolved fillers in the lips of numerous patients who have realised that they look unnatural. One patient told me that she felt like a ‘freak’, but had become addicted to fillers due to the ‘boost’ it gave to her self-esteem when she was depressed. It has always frustrated me that someone, somewhere, is injecting these patients and missing or worsening a possible diagnosis of body dysmorphic disorder. Many of these patients had visited multiple previous practitioners for dermal fillers and had only approached me when they were unhappy, due to my reputation as a cautious injector. This got me thinking: if we all said ‘No’ when we should do, these vulnerable patients would not be able to practitioner-hop to satisfy their addictions.
At first, I assumed that money must be the motivation behind some practitioners' decisions to over treat. However, when reflecting on my own practice, I must admit that there have been times, particularly at the beginning of my career, where I have treated a patient only to later question whether I should have said ‘N0’. My tendency to want to please people for fear of making them unhappy led me to give in to the patient's demands. Subsequently, with increasing confidence in my abilities and technique, came an increase in assertiveness and the ability to say no. By being more assertive, we value ourselves as skilled professionals worthy of our patients' and colleagues' respect. This can surely only be a good thing.
I found that my patients responded positively to my change in attitude when they realised that I was putting their needs before my own. Effective communication is key to the successful integration of this assertiveness, and it is important to match the style of communication to the particular patient. During the consultation, I will describe the long term effects of over filling and explain to the patient how correcting this might incur further financial costs in the future. Alternatively, I might highlight the changing trends and advise the patient that if in 5 years' time they want a different ‘look’, this may not be easily reversed. I also sometimes remind my regular patients of their very first consultation with me. Many of my patients start with a request for natural enhancements, but this slowly gets forgotten as they ‘get used’ to the changes. When I feel it is time to say ‘No’, I get out the before photos and remind them of this in a sensitive manner. Ultimately, we want our patients to have a positive experience with us. Although they may appear disappointed with a declined request at first, at least we know that we have acted in their best interest, and the impression they are left with is that of a professional, knowledgeable and ethical practitioner, which will be much less damaging to our reputations in the long run.