Back to reality

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Back to reality
Media portrayal of cosmetic procedures can lead to patients being misinformed with unrealistic expectations and little understanding of risk-factors. Miss Julie Brackenbury discusses how this can affect the patient practitioner relationship

With a growing influx of cosmetic television programmes, most aesthetic practitioners would agree they have noticed a shift in their practice trends. As well as affecting the consultation process and the patient’s perception of procedures, we may need to be prepared to make a few changes to clinical practice.

Arguably, we now live in a beauty- and youth-focused society. With cosmetic surgery and non-surgical procedures not only available to the rich and famous anymore, we now see people in their 30s or even younger, wanting to slow down the ageing process. This is indicative of how our society, values and expectations have been indoctrinated by the media in our culture. Without doubt, television is one of the most intrusive of the various media tools available and what television portrays can have major effects on our values and behaviour.

With the advent of the internet, information is now easily accessible in our contemporary society so practitioners know and should expect that many patients research procedures before seeking a consultation. Irrespective of the source, or whether the information is accurate or not, we have a professional responsibility and duty to establish and manage realistic expectations. This process should be completed on an individual basis by means of thorough consultation, evaluation of medical history and a continuous review of informed consent.

The savvy aesthetic patient

While modern patients may have more prior knowledge than in previous years, they may only be informed of key words without knowing or understanding the full background and procedures involved in a treatment. Patients often lack the crucial information behind the procedures they may have witnessed on television, thinking that their experience will be similar.

This inaccurate misunderstanding of information can result in potential conflict between expectations, the realities of the treatment processes, as well as affecting the patient-practitioner relationship.

It is not just television programmes and the world wide web that are responsible for this misrepresentation, but the mass media as a whole, including recent media news coverage and the release of the Keogh Report on cosmetic procedures.

Most patients welcome the introduction of industry directive and such regulation empowers patients to feel more knowledgeable and inevitably safer, knowing that there are industry standards to which professionals are held to. More frequently, patients are more inquisitive about the procedures, sometimes questioning qualifications and training—rightly so.

This evolving change in cosmetic cultural behaviour certainly reflects the notion of the “savvy aesthetic patient”.

Although patients appear to be more educated about cosmetic procedures than they were several years ago, misinformation still persists. In his 2005 paper, Pollock suggests that personal contacts such as family and friends have also become a source of information and knowledge when discussing aesthetic procedures.

Subsequently, we are accountable for disseminating accurate education and strengthening the collaboration with our peers to improve not only our outcomes, but the accuracy of information in light of the mass media that appears to have placed a barrier between the patient and practitioner. As we have seen, there are positive and negatives attached to this as the globalisation of the cosmetic industry continues.

Trivialisation of cosmetic procedures

As well as having to make adjustments to the way consultations are conducted, follow ups and even how website content is presented, we cannot deny the fact that television has often been blamed for trivialising cosmetic treatments. Medical aesthetics is a discipline that should only be performed in the hands of someone with high expertise and it is imperative that we are aware of the unhealthy and unrealistic expectations that some aesthetic patients may seek.

In a 2009 paper, Sperry indicated that surgeons and practitioners should assess the relevance of cosmetic surgery reality television viewership for patients’ attitudes towards and expectations about cosmetic surgery and worryingly, explains the link between contemporary media influences, body dissatisfaction, disordered eating, and cosmetic surgery attitudes.

The culture of instant gratification—a more recent phenomenon in the 21st century—has led to clients becoming less patient and demanding services which they believe will give them instant results without considering the risks involved. This is yet another barrier to the consultation process.

Someone once said that that the “customer is always right”; some would argue that this should not be applied to cosmetic medicine as if they are the patient and you are practising in this industry, then you are indeed the subject matter expert.

A deterrent to treatment

One of the most effective ways to deter a patient from aesthetic treatments is to instil an element of fear, and that is often what cosmetic reality television can achieve. Interestingly, in research by Walden et al, cosmetic television programs were noted to have a lesser influence on this particular group of patients than previously thought.

She found that aesthetic patients are generally well educated, part of the workforce and have a tendency to be independent and private thinkers when it comes to their decision making. However, the American Society of Plastic Surgeons has previously concluded that cosmetic television played a significant role in patient perceptions and decision making.

Crockett et al agrees, commenting that patients who regularly watched one or more reality television shows reported a greater influence from television and media to pursue cosmetic surgery. These patients also felt more knowledgeable about cosmetic procedures in general, and held the belief that this form of television was more similar to real life than did other, more low-intensity viewers. So it is very clear that cosmetic shows are having a massive influence on the surge in demand for cosmetic surgery and non-surgical procedures.

Ethical practice

It is important to modify the cosmetic consultation to the patient’s needs and expectations. The practitioner’s ability to practice in a transparent, upfront and honest manner should be the driving force in building up a client’s comfort level and trust. In turn a practitioner’s reputation will positively benefit, and this can be achieved even if you make the decision to decline treating a patient.
Through explanation to a client as to why they should not have a procedure, a practitioner can receive the same amount of kudos than if they had performed an unnecessary procedure well.

Reality-based shows have no doubt affected the patient-practitioner relationship. Potentially, there are heavily edited and selected scenes from reality, which have consequently lulled the public into thinking there are no real risks or complications in these procedures. Just because a patient saw a procedure on television or read about it in the newspaper or magazine does not make it real, accurate, or even medically possible for them.

It is our obligation to inform our clients of any risk associated with any procedure. Patient safety must be considered paramount and while this is often not the message patients may want to hear, it is the message we are obligated to give. It is at this point where advocacy and authenticity must be exercised and become part of the consultation process and it is our ethical duty to do so.
The image of the aesthetic industry may have taken a recent hit with regard to ‘botched jobs’, but as long as we focus on serving our patients and educating the public about our exciting and unique specialty then this can only improve practice and enhance patient outcomes.

It can only be a positive thing that we have to provide further explanations in consultations as well as having to justify our clinical practice, and even why we may practice differently from our peers. Some say timing is everything, so for those who have not yet considered extending the time slots for new consultation appointments and indeed follow ups, now is this time to do so.

Miss Julie Brackenbury RGN, INP is an aesthetic nurse specialist based the South West. She is a member of the British Association of Cosmetic Nurses. E: julie@jbcosmetic.jdfx.co.uk


1. Crockett R et al. “The Influence of Plastic Surgery ‘Reality TV’ on Cosmetic Surgery Patient Expectations and Decision Making”, Plastic & Reconstructive Surgery 2007;120 (1) 316-324

2. Haas, C et al. “Motivating Factors for Seeking Cosmetic Surgery: A Synthesis of the Literature,” Plastic Surgical Nursing 2008. 28 (4) 177-182

3. Pollock, K. “Concordance in Medical Consultations: A Critical Review” Radcliffe Publishing Ltd 2005; 1 edition

4. Sperry, S et al. “Cosmetic surgery reality TV viewership: relations with cosmetic surgery attitudes, body image, and disordered eating,” Ann Plastic Surgery 2009 62(1) 7-11

5. Walden, J et al. “Contemporary Decision Making and Perception in Patients Undergoing Cosmetic Breast Augmentation,” Aesthetic Surgery Journal 2010 30 (3) 395-403


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About the Author
Miss Julie Brackenbury, RGN, Independent Nurse Prescriber

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JBCosmetic - Bristol, Bath and the South West