Complications: How to Avoid and Treat Undesired Results
Adverse events do occur. This chapter focus on unwanted results (when there is a result that is not appreciated by the patients and/or aesthetic physician) and real adverse events (like foreign body reactions in filler patients) and how to deal with them.
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Berthold Rzany
Basically two different types of complications can occur: (1) an undesirable result or (2) an adverse event.
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12.1 Undesirable Result
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What is an undesirable result? First: a result that the patient or the aesthetic physician do not like.
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12.1.1 Misunderstanding Between the Patient and the Aesthetic Physician
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In general, if the patient and the aesthetic physician agree that the result is not perfect and should be corrected, then there is not much that is left than to discuss the possible ways to improve the result. It is more difficult in case the patient sees room for an improvement and the aesthetic physician do not. Here is the first and important step for the aesthetic physician to try to understand the patient. There are patients similar to make up artists who see tiny things that even an aesthetic physician might have overlooked. In case the aesthetic physician can follow this patient, then there is no real problem.
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12.1.2 Dysmorphia as a Base for Misunderstanding
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There, however, might be a problem in the case where the assessments of the patient and the aesthetic physician are really divergent. In this case, one reason might be that a patient with dysmorphia had been treated (which in the first place should not be done). Those patients in general are very difficult or nearly impossible to be satisfied. In case, when dysmorphia is assumed, further invasive procedures are strongly discouraged.
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M. de Maio and B. Rzany, The Male Patient in Aesthetic Medicine, DOI: 10.1007/978-3-540-79046-4_12, © Springer-Verlag Berlin Heidelberg 2009
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B. Rzany
12.2 Avoidance of the Undesirable Result
27 How can this situation be avoided?
28 12.2.1 29 Patient Information and Informed Consent 30 31 32 33 34 35 36 37
Here it is very important to stress the significance of the first contact between the patient and the aesthetic physician. To avoid unsatisfied patients, the individual demands of the patient need to be ascertained. It is recommended to use a mirror or better a recent photograph of the patient to discuss therapeutic strategies. In addition, it is helpful to show realistic before and after photographs and also – if there is a downtime associated with the procedure as in deep peels or a CO2 laser treatment – the in-between photographs. To invest time before the procedure will save time afterwards. In addition to the photographic documentation, the written consent of the patient to the procedure is strongly encouraged.
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12.3 Adverse Event
40 The adverse events are procedure related. There are basically two types of adverse events: 41 (1) due to overtreatment and (2) due to immunologically mediated procedures, which we 42 only partially understand so far.
43 12.3.1 44 Overtreatment 45 46 47 48 49 50 51 52 53 54 55 56 57 58
With the use of botulinum toxin A, the paralysis of adjacent muscle groups can occur. One of the most known ones is the eyelid ptosis after the treatment of the glabella (se
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