Commentary on Facial Treatment Preferences in Aesthetically Aware Women

As experts in facial aesthetics, we each have a tailored way of performing the cosmetic consultation. Our aesthetic consultations emphasize listening to our patients, and start by “handing the mirror to the patient,” and asking questions to better understand patient aesthetic desires and wishes, rather than leading the discussion during such encounters. Indeed, it is often surprising what an individual patient is looking for. However, for the first time, the study published by Narurkar and colleagues1 gives an unbiased insight into what female patients are most interested in correcting, which will no doubt inform the patient discussions. What makes this survey-based study important is that it asks patients, outside the doctor's office environment, what they would “fix,” keeping in mind that the women surveyed are treatment naive but not treatment unaware. Currently, there is a paucity of data-driven information on patient aesthetic preferences. The demographic evaluated are those patients (age 30–65 years) with financial resources they are willing to spend to improve their appearance; precisely, the patients who are most likely to make their way into the offices for aesthetic procedures. In brief, Narurkar and colleagues assessed data from surveys of 603 women across the United States who were part of a web-based research panel. The study focused on 3 main objectives: (1) the facial areas most likely to be treated first, (2) the relationship between the most bothersome facial area and the area first planned for treatment, and (3) differences between younger and older women. The results, to these authors, were somewhat surprising. Although, as a specialty, we have moved away from filling folds, the popular media often discusses fillers in the laugh lines (certainly advertisements for commonly used fillers focus on these) and amelioration of glabellar furrows. These women however were more focused on crow's feet, oral commissures, and tear troughs. Not surprisingly, the areas that were most bothersome to the patients were the areas they were most likely to treat first. The study found that aesthetically oriented women demonstrate differences in facial treatment preference with age, as older women (50 years or older) had increased preference for treatment of the lower face and women in the younger cohort (younger than 45 years) preferred treatment of the upper face. This preference mirrors what we know to occur during the process of aging with the inversion of the “triangle of youth.”2–4 As mandibular extension and nasal bone resorption occur, the lower face shows greater signs of volume loss and distortion. Interestingly, the cheeks, chin, and temple were the least likely to be treated by these women, yet, as a specialty new volumizing agents and published techniques seem to be more focused on these targets.5,6 The results beg the question: Are we, as treating physicians, focusing the advancements on areas that are disconnected from what the patients really want? Is the study limited by its design of not asking open-ended format questions (like fill in the blank) or touching on items such as texture, tone, and color? We cannot help but wonder how different answers would be if those surveyed had aesthetic treatments in the past and were thus more familiar with the range of options available to them. It may be that in terms of aesthetic treatments, the majority of women chose what they knew they could easily treat. In other words, if they were given an option for easily treating dyspigmentation, they may have chosen that as their main concern. Additionally, if an area had already been treated, additional areas would become a higher priority. Further studies subdividing individual cosmetic areas and detailing specific changes such as resolution of redness or telangiectasias or scarring would certainly be welcome. The authors also make a point of highlighting the demographics of the study population. Namely, a high proportion of women were married or living as a couple (82%). Although the authors did not specifically ask why the women would seek facial aesthetic treatment, they speculate that it may be to achieve personal beauty goals or to retain their current partner. In the authors' opinion, the data are too limited to hypothesize any motive. It may be that disposable income is higher in dual-earner households (the majority of the survey population was employed full time) or that women feel they are more settled and have achieved other personal goals and can now focus on themselves. The authors' experience is that the aesthetic patient often has a myriad of reasons to seek treatment, and future studies should directly pose the question because these data certainly give intriguing preliminary information. Overall, Narukar and colleagues do a commendable job in garnering the opinions of women who we are likely to see in the office setting. The data presented are clear and show results that may change the way we practice or approach the cosmetic consultation. We suggest that practitioners consider using the diagram the authors use in the survey (presented as one of the figures) to allow patients to precisely identify areas on the face they are dissatisfied with. For future work, this study could act as a springboard for projects assessing the aesthetic preferences of men and of course further subdividing the information presented. For now, these authors have provided us with plenty of material to digest and use to enhance the aesthetic patient encounter.