The Last Word: Treatment Duration

By Dr MJ Rowland-Warmann / 20 Nov 2019

Dr MJ Rowland-Warmann explains why she believes practitioners should stop advertising the length of treatment times for dermal filler procedures

Advertising how quickly a procedure can be carried out is the latest fad. A 10-minute lip filler here, a five-minute non-surgical rhinoplasty there, facial volume replacement promising recontouring in five minutes… Is this good practice or is promoting accelerated aesthetic treatments potentially harmful? Is ‘fast’ really what our patients want? 

In this article, I explore whether promoting and promising speedy treatments is actually beneficial for both the patient and the practitioner, while discussing what I believe to be best practice.

Patient perception

Some practitioners want to minimise their patients’ time in the chair, one of their reasons being that faster treatments equate to a better patient experience. But is this really true? Patients are surprisingly unconcerned about many aspects of their treatments if they feel they are being adequately cared for.5 

In a recent straw-poll of around two dozen of my patients, not one mentioned treatment time when asked what their priorities were during a procedure. It’s not news that what patients really worry about is the standard of care given to them and the effectiveness and quality of that treatment. The latter has been shown to influence patients’ intent to revisit a service.5 Supporting this concept is research into patient satisfaction.5,6 

As a key quality indicator in healthcare, satisfaction is directly linked to not only retention and outcomes, but also malpractice claims.5,6 Whilst time waited before receiving treatment is often cited as a contributing factor to satisfaction (especially in public healthcare systems such as the NHS), the speed of the treatment is not.6 Conversely, there is a strong link between increased time spent with the patient and increased satisfaction.6 This indicates that, in fact, your patients want to spend longer with you, not be ‘over and done with’ in just 10 minutes.

As providers of luxury medical procedures, I believe we should strive to provide a compelling patient experience. In my opinion, perceived indifference, the act of making a patient feel unvalued and unimportant, can occur when the patient is not awarded with enough time. According to John Gattorna of Macquarie Graduate School of Management, perceived indifference is the reason 68% of all customers switch to competitors.2,8 

I must presume that these five-minute nonsurgical rhinoplasties being offered by some clinics don’t include greeting the patient, photography, consent, and preparation of the patient or the room, as well as making sure the patient is comfortable and happy. At the very least this mismanages the patient’s expectations for treatment, as the actual time spent surrounding the procedure is not made clear. If it is the case, I have serious misgivings about significant aspects of the treatment procedure being omitted. 

Expectation setting is a key ingredient in the practitioner-patient relationship and should start at the advertising stage with clear and transparent statements.

Practitioner perception

There is an obvious difference between working efficiently and rushing procedures. Yet in my opinion, many practitioners seem to get the two confused. They fall into the trap of believing that if they can do it faster, they must be better. A tried and tested USP is usually the basic faster is better model. 

This is certainly what some customers want in some industries, however I would argue that patients simply aren’t interested in express aesthetic treatments. What I see is practitioners advertising internal KPIs in place of a competitive selling proposition in a ‘race to the bottom’ that is not good for patients, the aesthetic market as a whole and the perilous incidence of serious complications.

Just because you see someone else promoting their services in this way, it doesn’t mean that you have to.

It cannot be disputed that there is a correlation between injection speed and the incidence of complications

Clinical considerations

It cannot be disputed that there is a correlation between injection speed and the incidence of complications.1 Rapid injection and flow rate increase the amount of filler volume placed, increasing discomfort, swelling and bruising at best and possibly resulting in disastrous adverse events such as obstruction of vessels or even blindness at worst.1,3 On the contrary, slow injection of micro-volumes are less likely to result in complete blockage of vessels, or retrograde flow capable of blocking the ocular circulation.1,3 

Injecting slowly and with caution allows practitioners to monitor the patient and change technique intra-procedurally should the need arise.7

I would argue that boasting about taking five minutes to complete a potentially risky aesthetic procedure undermines the seriousness of its medical nature. It has also been suggested that it would likely be indefensible in a negligence action, should it come to light that a complication had arisen when the practitioner spent such little time on the procedure.7 

I would strongly encourage practitioners to consider your position if a patient raises a grievance or negligence action for a complication. Imagine arguing at the tribunal that you took care of the patient and were doing a splendid job, yet opposing counsel produce your advert promoting your five-minute procedure.

So, with that information in mind, practitioners who continue to inject quickly and carry out treatment as quickly as possible, with a disregard for these obvious elements of safety, will soon be graduating from ‘negligence’, when your patient suffers harm as a result of a breach of a duty of care, to ‘recklessness’, where you are deliberately and unreasonably disregarding risks that could potentially result in injury to the patient, vitiating consent and constituting a criminal assault.9

Moving forward

I believe the way to grow a patient base and have the practice and patients you want is to spend more time with patients. You must be caring, build relationships, do a good job and get repeat business. In my experience, patients respond well to values of basic decency in any service or retail business. 

Advertise your excellence in care, not speed. As complications are becoming more widely reported, in part due to the growth of the industry and its unregulated nature, we should consider it our responsibility to not to contribute to them, but to conduct safe and careful procedures.

References
  1. Ablon, G, Understanding How to Prevent and Treat Adverse Events of Fillers and Neuromodulators. Plast Reconstr Surg Glob Open, 2016
  2. Aesthetic Business Transformations, How to maximise your medical aesthetic business profits, 2019 <https://www.aesthetic-bt.com/grow-your-practice-in-todays-economy/>
  3. DeLorenzi, C, Complications of injectable fillers, part 2: vascular complications. Aesthet Surg J, 2014
  4. Glogau, R G., Kane, M. A, Effect of injection techniques on the rate of local adverse events in patients implanted with nonanimal hyaluronic acid gel dermal fillers, Dermatol Surg, 2008
  5. Kim, C E et al., Quality of medical service, patient satisfaction and loyalty with a focus on interpersonal-based medical service encounters and treatment effectiveness: a crosssectional multicenter study of complementary and alternative medicine (CAM) hospitals. BMC Complement Altern Med, 2017
  6. Prakash B, Patient Satisfaction. J Cutan Aesthet Surg, 2010
  7. Urdiales-Galvez, F et al., Preventing the Complications Associated with the Use of Dermal Fillers in Facial Aesthetic Procedures: An Expert Group Consensus Report. Aesthetic Plast Surg, 2017
  8. CustomerThermometer.com, CSAT Stat of the Month: 68% <https://www.customerthermometer.com/customersatisfaction/csat-stat-68-percent/>
  9. Loveless J, Intention, recklessness, negligence and gross negligence, Complete Criminal Law: text, cases and Materials, 2016

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