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Defining the minimally invasive patient

Article-Defining the minimally invasive patient

There were 5.9 million documented cases of nonsurgical facial rejuvenation procedures, specifically soft tissue fillers and botulinum toxin in 2013 — and a 5,680% increase in injectables in the past 25 years. The numbers are only expected to grow. But how well do you know who this population of “minimally invasive” patients are?

In their study, “Motivations for Seeking Minimally Invasive Cosmetic Procedures in an Academic Outpatient Setting,” (Aesth Surg J. 2015,Vol35(8)1014–1020), authors Joseph F. Sobanko, M.D., Anthony J. Taglienti, M.D., et. al., cite this exponential rise of minimally invasive procedures, combined with the limited amount of patient data gathered from research in this area. Their goal: to better define and understand who those patients are and what’s driving their motivations.

Jointly, they carried out a prospective cohort study between the Division of Plastic Surgery and the Department of Dermatology (Hospital of the University of Pennsylvania) between September 1, 2011 and December 1, 2014. They invited patients to participate who were between the ages of 25 and 70 and who visited the Department of Dermatology or the Division of Plastic Surgery for minimally invasive facial rejuvenation procedures, defined as botulinum toxin injection or soft tissue filler injection. They excluded patients with prior facial cosmetic or reconstructive procedures, craniofacial abnormalities or facial scarring.

Demographic Snapshot:

  • 72 patients (70 women and 2 men)
  • Average age: 47.8 years (SD±12.0; range, 24-69 years)
  • Half (36/72) were married
  • Most had children (62.5%)
  • Most were employed (83.1%)
  • Most possessed a college or advanced degree (88.9%).
  • Approximately 75% (75.3%) disclosed annual salaries greater than $75,000; 42.3% reporting income of more than $150,000 per year.

In This Article

What the Minimally Invasive Patient Wants

Patient Expectations & Restraints

Treatment Influencers

So Who Is the ‘Minimally Invasive’ Patient?


What the Minimally Invasive Patient Wants

Of the participating patients, an “overwhelming majority” felt that skin care was “critical to improving the appearance of aging in the face.” The authors note that approximately one-fifth of patients (19.4%) disclosed extensive amounts of prior sun exposure (e.g., numerous blistering burns, sunbathing regularly, history of skin cancer), while 12.5% reported diligent sun-protective behaviors without any history of blistering burns; 86% of patients stated that they apply sunscreen on a daily basis. Patients varied in their use of adjuvant skin-care treatments: cosmeceuticals (46.4%), chemical peels (22.5%), topical retinoids (41%), lasers (11.2%), medical esthetician (18.3%) and spa treatments (12.5%). One-third of patients (33.3%) reported being active smokers.

What They Want to Improve:

  1. Eyes 78.8%
  2. Cheeks 28.1%
  3. Lips 15.4%
  4. Nose 7%
  5. Neck 21.1%

NEXT: Patient Expectations & Restraints


Patient Expectations & Restraints

The authors note that in their cohort, more than a half (59%) of patients reported that they anticipated “moderate” improvements in their appearance. “Interestingly, a quarter of patients believed that the minimally invasive procedure would ‘significantly’ improve their appearance, expectations that may be difficult to satisfy.”

The study authors found that financial restraints (41.7%) were stated as the largest factor in postponing treatments over the past six months. Almost one-third of patients (29.1%) experienced a major life event — defined as either a birth or death in the family, a new job or loss of job, a marriage, or a divorce — within the preceding year. Almost half (43.1%) of the patients reported a history of mental health treatment. Approximately a quarter (23.6%) of patients reported the use of psychiatric medication (defined as an antidepressant, antipsychotic, or anxiolytic) at the time of treatment.

The authors note that the overwhelming majority of patients who sought minimally invasive cosmetic treatments were women, middle-aged, highly educated, and employed. “It seems possible that a higher educated patient population could feel averse to the greater side effect profile of invasive surgical procedures and would prefer minimally invasive procedures,” they say. “Additionally, 80% of our cohort was employed and might have selected minimally invasive procedures because they could not tolerate significant downtime from work. Perhaps the finding most pertinent to peri-procedural counseling is that approximately one-third of patients experienced a ‘major life event’ such as a death of a loved one, divorce, or change in employment in the year preceding treatment. The most cited reasons in in this group of patients were death of a loved one (28.6%) or divorce (19%). Such events are considered major life stressors and can be associated with a level of psychosocial distress that could contraindicate surgery.”

NEXT: Treatment Influencers


Treatment Influencers

Interestingly, when asked, “who/what was the biggest influence in opting to pursue treatment,” an equal percentage of patients (27.8%) noted that “friends” and the “pressure to look younger in the work setting” were the most important factors. Pressure from spouses (2.7%), children (1.4%), or teasing from others (0) did not appear to be a factor in patients seeking treatments. The study patients reported a desire to maintain and preserve a youthful appearance, exemplified through their embracement of photo-protective measures. The “overwhelming majority” of patients (86%) reported daily application of sunscreen and many integrated varied topical chemo-preventative treatments such as retinoids and chemical peels.

“However,” the researchers note, “one-third of our cohort did disclose being active smokers. This finding reveals that smoking cessation counseling may be a worthwhile endeavor with select patients as nicotine and tobacco are known accelerants of skin aging.”

NEXT: So Who Is the ‘Minimally Invasive’ Patient?


So Who Is the ‘Minimally Invasive’ Patient?

While acknowledging the limitations of a small cohort, the authors nevertheless summarize that their findings “reveal that patients who sought injectable aesthetic treatments in an urban outpatient academic center were mostly employed, highly educated women who believed that their procedure would positively impact their appearance. These patients tended to understand the importance of sunscreen and skin care in their overall appearance compared to their peers. A significant minority of these patients experienced a major life event within the past year, a salient finding that an astute clinician should address in the initial patient consultation. Interestingly, in the age of the Internet and social media, trusted friends and word of mouth were more influential to our patients’ decision making than websites or newspaper advertisements. We believe that the results of this study will lead to a better understanding and increased awareness of the psychosocial factors characterizing patients seeking minimally invasive aesthetic rejuvenation.”

The authors intend to continue long-term follow-up studies of the study cohort, further investigation if injectable cosmetic procedures can significantly improve patient-reported psychosocial outcomes.

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