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Keys to injectable success includes when to say ‘No’


Heidi Waldorf, M.D., provided her formula for great filler results. One key to avoiding upset patients is rejecting unsuitable ones, she noted. She also pointed to patient behaviors that should raise red flags.

Las Vegas – Heidi Waldorf, M.D., provided her formula for great filler results this past week at the Cosemstic Surgery Forum meeting here: "You need the right patient and injection plan, and you need to limit post-treatment disturbance" so patients don't get upset over common side effects. She is director of laser and cosmetic dermatology and associate clinical professor of dermatology, Mount Sinai School of Medicine, New York.

One key to avoiding upset patients is rejecting unsuitable ones. Listen to your instincts if a patient makes you or your staff nervous, she advised. "You will never regret not injecting someone," she said. Patient behaviors that should raise red flags include the following:

  • Presenting a list of complaints about their prior procedures and physicians.

  • Being unclear or vague about their past injectable treatments. Some patients don't know what they've had injected, she explained. If someone has gone to an established local provider, said Dr. Waldorf, it's likely they received hyaluronic acid. "But very often patients will say, 'I was at an event, and someone came in'" to perform injectable treatments. "You don't want to be injecting over silicone or something you could restimulate, like one of the polymethylmethacrylate fillers from South America."

  • Showing excessive anger or devotion. "If they look at you like you're a rockstar, the person who loves you too much is probably going to hate you too much." People with body dysmorphic disorder take slight or imagined concerns to extremes, said Dr. Waldorf, and they may take their feelings out on their physician.

  • Expressing unrealistic expectations. "The 10-0-1 patient is the patient really needs at least 10 syringes to make a difference, and they say they're just going to have one."

If you're unsure about a potential patient, added Dr. Waldorf, "Suggest a follow-up discussion or appointment," or refer them elsewhere. 

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