Introduction:
Cosmetic dermatology is a branch of dermatology that deals with procedures to enhance the appearance of skin. As these include esthetic procedures, assessment of the patient's psychology is very important. Patients undergoing these procedures expect an improvement in their appearance to boost their self-confidence and self-esteem.
The psychological evaluation of a patient before any cosmetic procedure helps in selecting the right patient for the procedure as the patient having unrealistic expectations from the cosmetic procedure may not often get many benefits. The objective of cosmetic procedures is to achieve patient satisfaction as much as possible.
How Is Psychological Assessment Done Before Cosmetic Procedures?
Usually, the patients seeking cosmetic treatment are not happy with their appearance and want to look like someone whom they find attractive and perfect in appearance. In addition to this, peer pressure also compels someone for cosmetic procedures to enhance looks. Some of the patients willing to go for cosmetic surgery fall under some mental disorder for which a psychiatrist's opinion is essential. These mental disorders are:
- Body dysmorphic disorder (BDD).
- Narcissistic personality disorder.
- Histrionic personality disorder.
1. Body Dysmorphic Disorder (BDD): The patients suffering from this disorder excessively think about their appearance. They keep on looking in the mirror several times a day and minor imperfections in their looks which are unnoticeable to others can bother them extremely. These kinds of patients are usually unsatisfied with the cosmetic procedure- results and may go for repetitive procedures.
Therefore, patients suffering from this disorder are not suitable for cosmetic procedures. Psychological treatment would benefit them more as compared to cosmetic treatment. Their focus area is predominantly on skin, nose, and hair. The major concerns of these patients include wrinkles on the face, nose appearance(size and shape), acne, hair loss, or excessive hair growth. Symptoms of BDD can be:
- Repetitive mirror checking.
- Excessive grooming.
- Skin picking.
- Always seeking reassurance from others about their looks.
- Avoiding social gatherings.
- Low self-esteem.
- Constantly thinking that others are noticing the flaws.
2. Narcissistic Personality Disorder (NPD): Patients suffering from this disorder are extremely self-centered and always want attention from other people. These patients lack empathy for others and are not a good choice for cosmetic treatment. The cause of this disorder is related to genetics (inherited characteristics) and childhood environment. Children who receive excessive adoration or excessive criticism from people around them, especially from parents who suffer from this disorder. Symptoms of NPD can be:
- Having unrealistic expectations from the treatment.
- Needs to be admired excessively by others.
- Thinking of themselves as special and expecting special treatment from others.
- Not willing to understand the needs of others.
- Always show arrogant and haughty behavior to other people.
- These patients exaggerate their achievements and talents.
- Always surrounded by their fantasies related to perfect love, beauty, power, or brilliance
- Have exploitative behavior and a tendency to take advantage of others to reach their goals.
3. Histrionic Personality Disorder (HPD): Patients suffering from this disorder are extremely emotional and attention-seeking. These patients are also not a good choice for cosmetic treatments. The cause of this disorder is similar to NPD. Symptoms of this disorder are described below:
- These patients feel uncomfortable when they do not get attention from others.
- Their behavior is seductive or provocative.
- Highly emotional and dramatic.
- Rapid shifts in emotional states are predominant in these patients.
- Easily get influenced by other people's suggestions.
- Speech is usually vague and impressionistic.
- These patients believe that relationships are more intimate than they literally are.
All the patients suffering from these mental disorders are a poor choice for cosmetic treatment. Patients want to go for cosmetic treatments to improve their personality, their social status, to get better employment, etc. Therefore generally, these patients are self-conscious and feel nervous before treatment. For the assessment of a patient's psychology before the cosmetic treatments, the STEP technique is employed by the dermatologist. This technique is described below:
What Is the STEP Technique?
The STEP technique involves the following steps:
S Stands for Stress: The stress of the patient is evaluated by asking the patient about the kind of stress they have and about the situation in their home.
T Stands for Target: Here, the patient's expectations are evaluated whether they are realistic or unrealistic and in which body area patients want changes. The reason behind this change (whether the reason they want to go for cosmetic treatment is acceptable or not).
E Stands for Envision: Here, the patient is evaluated on their capability to think about their life after the changes made by cosmetic treatment. They should be able to think about how their life would be after the cosmetic treatment and whether their quality of life will improve, whether they will feel better than before or not.
P Stands for Proactive: If in psychological assessment it seems that the patient is fit for cosmetic treatment, which means the patient is having realistic expectations and goals that are achievable from the cosmetic treatment, then a treatment plan should be made for them.
What Are the Other Methods?
In addition, there is a questionnaire that sums up the STEP technique that should be asked during the psychological assessment before the cosmetic procedure. Patients should be made comfortable and relaxed to answer this questionnaire. These questions are:
- How long has the patient desired this modification or change?
- Why does the patient want this modification or change?
- Does the patient believe this cosmetic procedure will change or improve anything else for him/her?
- Does the patient want to undergo the cosmetic procedure because someone else wants him/her to undergo the procedure?
Who Cannot Undergo Cosmetic Treatments?
The patients who are not ideal candidates for cosmetic procedures are:
- Patients suffering from major depression.
- Patients having suicidal thoughts.
- Psychotic patients.
- Patients who are troubled on the day of the procedure.
- Patients who are self-harming or with self-mutilation.
Who Can Undergo Cosmetic Treatments?
The patients who are ideal candidates for cosmetic procedures are:
- Patients who do not have any psychopathology.
- Patients who have realistic expectations from the procedure.
- A patient who is self-motivated.
Conclusion
With the increasing demand for cosmetic treatments, the number of patients willing to undergo these procedures has also increased significantly. However, for a successful treatment result and to achieve maximum patient satisfaction from the treatment results, it is extremely important to select the right patient for these treatments. A proper psychological assessment should be done prior to the procedure to rule out any psychopathological issues with the patient.
