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Patient history, examination and marking

As stated above, the first step to any procedure is to take and record the patient’s history. It is very important to also include the patient’s particular aesthetic history in addition to the usual medical history, but unfortunately, any previous aesthetic treatments are often not documented in a cosmetic record. In this case it is necessary to interview the patient and record their comments in writing. Duplication can be avoided if certain diagnostic procedures or laboratory tests have already taken place.
Particular importance must be placed on determining if the patient is pregnant, on allergies or drug intolerances, and on any medicines or food supplements. For example, aspirin or enzyme products can considerably increase an individual’s predisposition to haemorrhages. Oral anticoagulant therapy is not necessarily an obstacle to mesotherapy provided the treatments are limited to superficial techniques. An adverse family history, autoimmune disorders, HIV, hepatitis or herpes infection should definitely be considered in the consultation and recorded in the patient notes or file.
If the patient is being consulted for body modelling treatments, it is compulsory to record height and baseline weight, as changes in weight can have significant effects on the treatment. Current BMI is a key factor in the therapeutic strategy, which should include clarification as to whether a local treatment is to be carried out in isolation or in combination with a weight loss treatment. The local treatment may help the patient lose weight in any specific problem zone, rather than all over and, for example, in the face or breasts.
When carrying out your patient inspection and examination, remember to also pay attention to facial expression and body posture as well as to overall visual impression.  The following areas as a minimum should be observed:

the state and consistency of the skin
connective and adipose tissue
hair condition
assessment of skin type
perfusion status
any pathological changes
check for any prior damage, e.g. as a result of previously used permanent fillers.
In a small number of cases, it is possible that Dysmorphophobia (dysmorphic body disorder) may be present and the physician should be familiar with this syndrome. Dysmorphophobia is a false, psychopathological perception of one’s own body.
An aesthetically successful treatment comprises all the aspects discussed above, and the better the patient selection process, the choice and the combination of the required measures, the more convincing the eventual treatment outcome will be.
Observation criteria
Face, frontal view
Face shape and asymmetries
Facial contours and fat distribution
Structural and facial expression lines
Skin quality and colour
Hairline and hair structure
Is treatment of the neck and/or cleavage also necessary?
Degree of elastosis
Face, side view, profile
Assessment of the profile
Structural and facial expression lines
Fat distribution
Assessment of the hairline and hair structure.
Contours, particularly the transition between chin and neck (double chin, sagging?).
Body, overall view, front, back, side views
Evaluation of posture and musculature
Fat distribution, metabolic or gynoid type
Skin quality
Adipose and connective tissue quality
Venolymphatic insufficiency in the legs?
Key points of the first consultation
The first consultation with any patient is very important and can be critical to the success of the overall treatment, so use the following list as a reminder of the key points:
Take your time
Document everything.
Explain the alternatives (example: lipolysis or liposuction, Mesolift or facelift)
Examine the patient and then summarize the results of the examination
If necessary, draw up a global therapy concept (coaching, lifestyle counselling)
Find a consensus – and motivate the patient!
Marking
It is often necessary to mark the area to be treated by drawing on the skin, which also helps the patient visualize what is being done. Hand-held and/or wall-mounted mirrors are very helpful for this. The body’s anatomy changes considerably with every change in posture, so marking is best carried out with the patient sitting (face) or standing (body), as the effects of gravity become more obvious in these positions. Facial structures (lines, too much or too little volume) are best evaluated with the face tilted forwards slightly. A white eye-liner pencil is the best option for drawing on the skin as it can avoid causing persistent dark marks. Before doing so, the skin should be disinfected and anaesthetic cream applied, if necessary.