BIOL67540 Aesthetic Medicine: Aesthetic Intervention

In this assignment integrate and test knowledge from a number of e-learning modules. It is recommended that you have completed all e-learning prior to submitting this assignment.

(a) With reference to the following conditions, describe what you might need to consent your patient for when considering aesthetic intervention:

- Diabetes

- Autoimmune disease

- Immunocompromised patients

(b) Describe the stages of an aesthetic consultation. Include within your answer:

History

Examination

Consent (written and verbal)

Record keeping

Cooling off period

(c) How would a competent practitioner manage the following events in practice:

Vasovagal episode (include causes, signs/symptoms and treatment)

Needle-stick injury

A patient who is needle-phobic and wants topical local anaesthetic

 

(d) Describe and explain how the bone, muscle and fat of the face changes with progressive ageing.

 

(e) Describe how physical features affect our perception of beauty in Western culture. Include in your answer age, facial shape, brows, skin folds and facial contours.

 

(f) As with other medical treatments, continuity of care post-treatment is critical. Explain what comprises of continuity of care. Include in your answer what lifestyle changes you would advise to your patien.

(g) Explain the requirements for a premises in order to safely carry out aesthetic treatments. How might routine audit of clinical outcomes improve your professional practice?

(h) A patient comes to see you in clinic who requests treatment with both Botulinum Toxin and Dermal Fillers. Explain how combination treatments may be beneficial to achieve facial rejuvenation, and the importance of physical examination of the patient prior to treatment.

The first consideration includes a case of a diabetic patient. In this case, the patient will have to undergo preoperative evaluation and laboratory tests before I can clear them for surgery. The patient has to have a full report from an endocrinologist managing their diabetes, an evaluation of the drugs being used and the effect of diabetes on the body tissues has to be determined. On the other hand for those patients that have been diagnosed with any autoimmune disease, I will have to consider how severe the condition is in the first place. It is also appropriate and part of good practice that any kind of medication the patient is currently taking be considered with an intention of determining wound healing and any potential risks of infection. Patients who are identified as immuno-compromised have to undergo several specific perioperative and surgical treatments before aesthetic intervention. In considering a patient’s medication before aesthetic intervention procedures, it is imperative to determine the need for either an increase and/or a reduction in the particular medication they are on. For all the three conditions, it is important to consult with the patient’s physician to determine severity of the condition and the type of medication the patient is taking to avoid complications in future.

b) Stages of an aesthetic consultation

The first stage once the patient presents their problem, it is important to let them present their underlying aims. The aims of the patient and/or goals should then form the specific agenda for consultation. The second stage involves the determination of the specific solutions that the patient expects. In this regard, it is imperative that the patient be assisted to understand how you can help them achieve their broader aim in the aesthetic intervention. The next stage after the patient’s aims and specific goals have been determined, it is paramount to then consider the patients’ medical history. This mainly includes a thorough establishment of any existence of genetic conditions, diseases that may interfere with immunity and the types of medication the patient has taken in the past or is currently taking. Fourthly, it is necessary to explore the concerns and expectations that the patient is likely to have and address them through the provision of any required treatment where it is necessary. It is very crucial that there be an agreement that is mutual on the treatment plan. This includes the cost of the aesthetic procedure and medication of perioperative medical concerns. Being one of the universally set ethical standards, provision of the patient with information that is both written and verbal on the procedures and implications that may occur is important. Next, take before photographs, for record keeping then perform the aesthetic procedure. Further, provide the patient with aftercare advice including side effects that might occur and inform them of follow up procedures.

c) How to manage a vasovagal episode, needle stick injury and a needle phobic patient

Vasovagal syncope is normally caused by a response to a particular triggering factor. It comes about as a result of a dysfunction in the body’s regulation of blood pressure and a dysfunctional heart rate.  The specific symptoms of vasovagal episode include, light headedness, feeling extremely cold or hot, general body weakness, inability to form coherent words, a tendency of being nervous and further, loss of consciousness. The main approach in managing and/or treatment it include avoiding the triggers which bring about the vasovagal episodes. The practitioner can help the patient by ensuring that their blood pressure does not drop and that there is enough blood flow to the brain. For needle stick injuries, it is imperative to thoroughly wash the wound with soap and water or use alcohol based solutions if soaps are not available. Ensure you rush to a doctor or the emergency department. When managing a patient who has a needle phobia, constantly reassure them and communicate empathy for the person’s feelings. The practitioner can also help the patient in relieving the tension that results from the needle phobia.

d) Description of how the bone and muscle fat of the face changes with progressive ageing

Aging of craniofacial structure occurs due to atrophy and changes in the dynamics of bone expansion and loss. Changes in the maxilla and mandible result into a reduction in facial height with a modest increase in the width and depth. Perioral wrinkling can occur due to maxillary resorption, a condition that then brings about the loss of support for the upper lip. As a result of loss of any tooth, this particular resorption occurs at the alveolar ridge and changes the projection of the chin and also its shape. Studies indicate that progressive aging is also associated with a loss of soft tissue in certain areas of the face and persistence in others. The malar fat pad can slide forward gradually and then bulges against the nasolabial crease. This is the reason that causes the nasal fold to be more prominent in an aged face. These processes occur continuously as one ages further. In essence the repeated muscle action brings about wrinkling at some sites in the aging face. This is accompanied with sagging of the skin which normally occurs in other areas as a result of accumulation of fats and/or a lack of elastic recoil. Changes in the muscle fat also cause the loss of anterior projection at the forehead and brows.

e) How Physical features affect our perception of beauty in western

A younger facial appearance is perceived as being more beautiful because of its rigid appearance and the proportional alignment of features. A long and thin facial frame is considered more desirable among the western culture as compared to short and chubby face since the thin facial frame appears to be more proportional in terms of distribution of the facial features. Thick and thinly framed brows are considered more ideal as they emphasize the shape of the eye and elevate the beauty of the face. Minimal brow hair is considered undesirable since it makes the face look blank.  Skin folds are viewed as undesirable features since they disrupt the symmetry of the face and give it a droopy appearance that is considered unattractive.  Facial contours are another aspect that determines the level of beauty in the western culture. Individuals with a thin and slightly long nose and well defined lips are considered more beautiful. A thin chin, a finely chiseled jaw and high cheek bones are also considered as aspects that make an individual more beautiful. Basically, the features a younger looking face is considered to be more beautiful than the older facial appearance that is usually droopy due to physiological changes.

f) Continuity care

Continuity of care post treatment is important in the healthcare management of the patient towards achieving the aim of the treatment. Ensure the patient is aware of any necessary follow up appointments to check their progress and effectiveness of treatment. It is also important to ensure the patient has the necessary equipment and medication that will enable them to take care of themselves. The patient should be aware of any complications that might arise and they should be given guidelines on how to handle them and who to contact in case any medical help is needed. The patient should be given clear written information about the treatment they have received and the medication that has been used incase another doctor takes over the patients care in order to facilitate effective continuity of care. Recommended lifestyle changes in continuity care would include eating foods that are easier to chew and swallow. It might be necessary to stick to liquids the first few hours after a procedure. It is also recommended to sleep with the head elevated and lying on your back to avoid bruising. The patient also has to avoid smoking and tobacco products since they can slow down the healing process. A balanced diet rich in fruits and vegetables is also suitable and constant intake of water.

(g) Explain the requirements for premises in order to safely carry out aesthetic treatments. (137)

Premises for aesthetic treatment should meet the requirements highlighted below.

First, the construction of these premises must meet the requirements of the local council. Second, the surfaces of the premises must be made from materials that are easy to clean in order to maintain hygiene. Third, the floors should be used of non-slippery tiles to prevent the risk of fall. Forth, they should be adequate ventilation and lighting. Finally, the premises should be equipped with a washbasin with warm and clean water, a separate sink that has an adequate supply of water to clean the equipment, alcohol based cleaners to disinfects, single use towels and hand driers, disposable gloves and gowns, and a disposal bin. These requirements must be met by all beauty treatment operators to avoid unnecessary suits or legal claims in case of non-compliance. 

How Routine Audit of Clinical Outcomes Improve Your Professional Practice

Clinical audit refers to the examining of the healthcare to determine whether the healthcare services provided are in line with the laid standards.  The major component of the audit is to review the performance of the healthcare givers to ensure what should be done is done accordingly. In this case, the major focus of the audit is to evaluate the services given to check if they are up to the expected standards and at the same time identifying the areas that need improvement. The audit focuses at improving the quality of healthcare services in order to enhance patient outcome. In this case, through the audit, errors and mistakes in the nature of healthcare services can be detected and appropriate steps taken to enhance patient and clinician safety, which enhances an improvement in the professional practice.

h) Benefits of combining treatments in achieving facial rejuvenation and importance of physical examination prior to treatment

Combination of treatments can help in addressing more than one facial aging concern and achieving better results. It also ensures a shorter period in achieving the desired results since the patient does not have to wait for the first procedure to be done before undertaking the next one. It is also cost effective since the patient covers the cost for performing two procedures all in one session. For example, a patient who requests for treatment with both botulinum toxin and dermal fillers is able to get rid of wrinkles and folds through the use of dermal fillers and at the same time smoothing out folds and lines hence resulting into a much younger looking skin. The process becomes much easier, more effective and it is less costly. A physical examination of the patient prior to treatment is necessary in order to detect any medical issues that could lead to complications during treatment. The identification of these conditions is important because it will ensure the safety of the patient. A physical examination can also help in identifying prior medical history of the patient and any procedures that might have been done on the patient that could determine the outcome and the procedure to be used.  

Bibliography

Arnab, S., & Clarke, S. (2017). Towards a trans?disciplinary methodology for a game?based intervention development process. British Journal of Educational Technology, 48(2), 279-312.

Broer, P. N., Juran, S., Walker, M. E., ... & Persing, J. A. (2014). The impact of geographic, ethnic, and demographic dynamics on the perception of beauty. Journal of Craniofacial Surgery, 25(2), e157-e161.

Cotofana, S., Fratila, A. A., Zilinsky, I., & Pavicic, T. (2016). The anatomy of the aging face: a review. Facial Plastic Surgery, 32(03), 253-260

Day, K. M., Scott, J. K., Kennedy, W. J., &Brzezinski, M. A. (2016). Plastic Surgery Chief Resident Clinics Facilitate Progressive Surgical Autonomy and Continuity of Care. Plastic and Reconstructive Surgery Global Open, 4(10).

Foersterling, E., Golatta, M., Schott, S., & Heil, J. (2014). Predictors of early poor aesthetic outcome after breast?conserving surgery in patients with breast cancer: Initial results of a prospective cohort study at a single institution. Journal of surgical oncology, 110(7), 801-806.

Friedman, D., & Kutscher, T. D. (2016). Minimal energy eMatrix treatment combined with elure application for an expedited response in the treatment of hyperpigmentation and overall facial skin rejuvenation: A case report series. Journal of Cosmetic and Laser Therapy, 18(2), 66-68.

Gonzalez-Santiago, T. M., & Drage, L. A. (2015). Nontuberculous mycobacteria: skin and soft tissue infections. Dermatologic clinics, 33(3), 563-577. 

Haneke, E. (2017). What is beauty? A historical excursus through a continuously evolving subjective and objective perception. Cosmetic Medicine and Surgery

Lau, E., & Nissen, L. (2017). Evidence in patient care: Adverse events following vaccinations. Australian Pharmacist, 36(7), 46.

Malhotra, S., Sharma, S., Bhatia, N. J. K., & Hans, C. (2016). Needle-stick injury among health care workers and its response in a tertiary care hospital.

Sjöström, L., Carlsson, B., & Sullivan, M. (2004). Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. New England Journal of Medicine, 351(26), 2683-2693

Wong, C. H., & Mendelson, B. (2015). Newer understanding of specific anatomic targets in the aging face as applied to injectables: aging changes in the craniofacial skeleton and facial ligaments. Plastic and reconstructive surgery, 136(5S), 44S-48S.