The Aesthetic Consult

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Kent Remington, MD

Dr Remington is an internationally recognized leader in the aesthetic dermatology industry. In this presentation, he discusses his novel approach to the aesthetic patient. Dr Remington’s aesthetic consult is quite different from that of other dermatologists. We all want to reinvent ourselves and it’s necessary to keep up with the ever-evolving field of aesthetic dermatology.

How can we get patients who are on a budget to go ahead and agree to a fairly comprehensive procedure/project? It’s all in the consult. It is important, as physicians, to recognize that patients are skeptical, suspicious, leery, tentative, intimidated, apprehensive, tense, cautious, and so on when it comes to facial rejuvenation. Dr Remington stresses the importance of “peeling all of these layers off” to be able to have some connection and engage with your patient(s). Remember “one size fits none.” Patient’s are not paying for cost, they’re paying for good results. If you look at patient’s animations, not everyone is the same. We have to be able to teach our patients what their face really needs. Dr Remington feels that most injectors just follow what everyone else is doing. It’s easy to follow what everyone else is doing; we are extremely busy in our clinical practices and we can tend to confuse being busy with accomplishment. The old aesthetic rule was “if it ain’t broke, don’t fix it.” The new rule is “if it ain’t broke, break it and make it better.”

The aesthetic consult requires that you look at the “whole face.” Attention to detail should be your major focus. Patients tend to have selective focus. They come into your office with a focus on their nasolabial fold or their frown zone and that’s it, they don’t see anything else. Patient’s perception of reality and reality are often quite different…we look with our eyes and see with our brains.

Patients expect value for their dollar and they expect to be treated well, i.e., they don’t want good results, they expect outstanding results. This requires careful planning on the part of the physician by balancing neuromodulators, fillers, surgery, lasers, energy devices and fat busters with cost. Its not about dollars, its about results. Patients are willing to pay for good results. Dr Remington has five nurses who work with them and they take a very detailed approach to facial reflation and contouring.

Faces are all about genetics, genetics are about biology, biology is about physiology, physiology is about physics, and physics are about mathematics; therefore, faces are all about math. You have to have a plan in mind, eg., where is the peak of the brow? What is the width of the lip? As far back as 1934, makeup artists were given guides to the face on where/how to best apply makeup based upon facial dimensions. Dr Remington refers to his process as “facial beautiPHIcation.” “Creating great results is a result of good mathematics, I am not talking about left brain math, but right brain math”

You want to uncover the “real reason” that your patient is interested in looking better. You can discover the reasons not by questioning, but by intuitively interacting with your patients.

Dr Remington asks every patient to bring in a good photo of him or her. Usually, this is a picture that was taken in his/her twenties. Dr Remington isn’t trying to make them look twenty, but he wants evaluate past symmetry,balance, proportion and balance or lack thereof. A picture makes it much easier to create what you’re trying to show them. Often times, he will split the face in a computer screen set up to show the patients youthful photo beside the current one. This helps patients see clearly why we need to look at and treat the whole face in a planned restoration project. Not to make them look different, but to restore what they used to look like A dedicated camera room with a high-resolution monitor is a MUST, according to Dr Remington because this is where he can do much of his education and visual perception for his patients. Sometimes Dr Remington will convert the color photos to black and white because it is easier to show contrast, volume loss and wrinkles.

Good results come from commitment to a detailed consult,.In North America, many people come from a combination of ethnic backgrounds. Dr Remington spends a lot of time with his patients discussing their genetics. Why is this important? We want to find out the positive part(s) of their genetics. He tries to not only retainthat part but also, accentuate it. Aesthetic physicians need to train their eyes to be like video cameras with Panavision friendly focus; but the aim is on information and figuring out everything about the patient. You must understand where the patient is coming from—this comes from connecting and engaging with your patient.

Dr Remington and a colleague found that there are seven types of consulting styles.

  • Socializer
    • Initially impress patients
    • Rarely get past the social part
    • A lot of odour, little substance
  • Consultants
    • Good listeners
    • Go with patient’s monotherapy focus
    • Succumb to patient’s unreasonable requests
  • Closers
    • Smooth, slick style
    • Up sell rather than up serve
    • A lot of dancing to seal the deal
  • Storytellers
    • Love to detail patient case studies
    • Forget to focus on the bigger picture
    • Try to endear themselves to the patient
  • Focusers
    • Know the science of all their products and devices
    • Discuss and treat selective focus areas of the face
    • Tunnel vision
  • Narrators
    • Love to listen to themselves talk
    • Discuss procedures like robots
    • Do not recognize that “one size fits none”
  • Face whisperers
    • Engage the patient and ease their apprehension
    • Up serve rather than up sell
    • Calm, focused assertive energy

Patients can sense your uncertainty. You have to present with confidence so that your patient(s) understand and agree with the procedures that you recommend. Remember that words are extremely powerful. “Words are the most powerful drug used by mankind. Not only do words infect, egotize, narcotize and paralyze—they get into color even the minutest of brain cells.” (Rudyard Kipling) Words are hypnotic and they can make a huge difference to your patient.

Dr Remington has discovered that an aesthetic patient is driven to look more youthful not on the size of their wallet or their hormone level it’s in their DNA. You have to determine which patients are aesthetically wired, and which are not.

Men and women focus on different things when they look in the mirror. Women tend to focus on their eyes and their lips and men tend to focus on spots. Again, patients have selective focus. What they see and what is actually real are often quite different. As aesthetic physicians, we have to gently teach patients what we see. We are image enhancers. We want to find and point out the patient’s positive facial features. This is important for our patient’s self image, self-esteem and self-concept. How we think we look has a direct influence on our appearance.

It is important to take a “global approach” to facial restoration and beautiPHIcation. Physiognomy (face reading), personology (reading personalities) and phenomenology are becoming more and more a part of our interest as aesthetic physicians as this gives us the information we need to know about our patients.

Clinical Photography

You have one opportunity to get a baseline, pre-treatment photo. As previously mentioned, a dedicated camera room with a high-resolution monitor is highly recommended. You want to evaluate your patients in good lighting. Start early with your photography, you can teach your patients from the photos.

One of the most important things that Dr Remington does for teaching is insisting on the patient bringing in his/her old picture so he can split the face to show the difference over the years.

If you look at aesthetic clues about who is interested in aesthetics, there are verbal clues, non-verbal clues, and visual clues—be observant. You need to recognize patients who have had procedures in the past e.g., prosthetic dental work, face lift, rhinoplasty, those who style/dye their hair, patients with special events or milestones coming up such as a wedding or anniversary, and patients with special circumstances, e.g, their partner is younger or a milestone birthday.

In conclusion, it is imperative that you to take a global approach to your patients. A combination of procedures may be necessary for optimal results. Remember to connect with your patients and engage them in the process as our current aesthetic patients world wide expect outstanding clinical results.

MauiDerm News Editor-Judy Seraphine