It is not uncommon to see patients unhappy with their body image in modern society. Accessibility to social media has made the world in some ways, a small place.
It is possible to observe the lives and bodies of thousands of people including celebrities and models. People show us what they want us to see. It can be easy to forget that many of the images we see are not representative of real life. There is no doubt that constant comparison to others can have detrimental effects on mental health.
Body dysmorphia is a type of anxiety disorder where the sufferer has a preoccupation with perceived defects or flaws in their appearance. This can be extremely disabling and affects males and females equally. There can be varying degrees of the condition and mild cases can be extremely tricky to diagnose.
In the world of cosmetic dermatology and aesthetics, it is hugely important to be tuned into the patient during consultation to look for clues suggestive of BDD. Screening questions enquiring why a patient is interested in having a particular procedure, how much stress their condition is causing and how much time they spend in a day thinking about their problem can be helpfula pointers.
If BDD is suspected after history and examination of the patient then it is essential to have the confidence to refuse treatment. Confidence in saying no comes from experience and training. The Cadogan Clinic is a consultant-led clinic and we have all completed specialist training. This training is deliberately long to gain expertise in not only performing treatments but engaging with patients and picking up warning signs or red flags early.
BDD needs to be handled sensitively with the patient but in an ideal scenario, input from a mental health specialist is required. If I have any concerns then I will refer onwards to either a consultant psychiatrist or dermatologist interested in psychodermatology depending on the specific concern.
From personal experience, I am seeing more patients in recent years that I am refusing to treat. There are figures available that show that one of the fastest growing areas of cosmetic dermatology is injectable treatment in the Millenials. This is partly being driven by celebrity culture – think "Kylie Jenner Lips" – and partly through readily available videos taking away the mystery around treatments.
It is important, however, to remember, just because one has the tools to carry out a treatment, it does not make that treatment right. Injectable treatments like Botox and dermal fillers are medical procedures and should therefore be treated as such. My first and utmost priority is to do no harm. I am frequently finding I am turning away patients in their 20s asking for injectables. Some I feel are combatting self-esteem issues that no amount of lip filler will solve, others simply will not get a good aesthetic result as it will ruin the natural beauty or harmony of their face, and some quite frankly, just are not at the stage in their life where they need treatment of enhancement. I am not naïve, though, and I recognize that for everyone I refuse, there is an practitioner somewhere that is happy to take their money and do the injections – regardless of whether it is right or wrong.
What does not help is the open advertising of injectable treatments. Cosmetic dermatology and surgery are all over social media and clinics that do not provide "before and after shots" lag behind on numbers of followers. It is worthwhile remembering through, that numbers of followers are not a surrogate marker for expertise or ethical practice.
How's this for a sobering thought? It was recently in the news that less than 20% of the self-proclaimed plastic surgeons on Instagram were actually "board-certified". This means the other 80% calling themselves plastic surgeons have not completed specialist training. Frightening. I suspect the figures for cosmetic dermatology are pretty similar.
The other thing to note – there are strict guidelines about posting about prescription only medication (e.g. Botox). Doctors who advertise "before and after photos" for prescription only medications, are breaching the Advertising Standards Authority's guidelines. It largely goes unchecked so social media is littered with these kinds of images.
Clinics need to take responsibility and advertise responsibly. Cosmetic procedures should require proper consultations prior to any injection, a "cool-off period" should be instituted, and offers such as 2-for-1 should be discouraged. There should never be a situation where a patient is coerced into having a treatment.
We are lucky in our clinic as all our doctors are on the General Medical Council specialist register in our respective fields. Completing a specialist training programme allows for maturity, expertise, competency combined with ethical practice.