The Patient Journey in Facial Aesthetics: Findings from a European Consensus Meeting on Improving the Quality of Life for Patients Receiving Botulinum Toxin Injections

Figures & data

Figure 1 The patient journey in facial aesthetics. (A) Screening, (B) assessment, (C) treatment, (D) posttreatment, and (E) follow-up.

Abbreviations: FLO-11, Facial Line Outcomes; FLSQ, Facial Line Satisfaction Questionnaire; PRO, patient-reported outcomes.

Box 1 Optimal Screening Strategies

Request patient completion of PRO questionnaires
The FACE-Q or FLO-11 can be completed by patients before their visit at home or in office

Abbreviations: FLO-11, Facial Line Outcomes; PRO, patient-reported outcome.

Box 2 Optimal Assessment Strategies

Understand the patient’s goals for treatment
Use the FLSQ baseline to gauge self-perception and goals
Take pre- and posttreatment photographs (using the same camera, lens, settings, magnifications, illumination, and patient positions at each visit)
Create an open dialogue with the patient
Address major patient concerns
Discuss the risks and benefits of treatment
Obtain a current medication list
Collect a complete medical history, including information about allergies, illnesses, previous aesthetic procedures (including satisfaction with the outcome), previous surgeries, immunizations, and pregnancy/breastfeeding

Abbreviation: FLSQ, Facial Line Satisfaction Questionnaire.

Box 3 Optimal Treatment Strategies

Spend adequate time in discussion with and educating patients on the appropriate treatment approach
Tailor treatments to the patient’s goals and comfort level
First-time or anxious patients can return to the clinic 7–14 days after the initial injection to promote confidence

Box 4 Optimal Posttreatment Strategies

Request intense (not rapid) muscle movements immediately after the injections (eg, looking angry, lifting the brow, and/or smiling)
Provide contact information for the clinic in the event there are questions or concerns and be available posttreatment for patient concerns; consider using an instant messaging platform that ensures doctor-patient confidentiality to promote swift responses
See patient if needed

Box 5 Optimal Follow-Up Strategies

Provide PRO questionnaires (FACE-Q Psychological Function and/or Satisfaction with Outcome, FLSQ Follow-up, or FLO-11)
Provide before photos to encourage patients to track results
Contact patients who report low satisfaction and suggest a follow-up appointment for touch-ups
If touch-ups are warranted, consider the dosing, timing, and area(s) treated prior to performing the injections
Request that the patient record a video of facial movements 14 days posttreatment to be assessed at the follow-up visit

Abbreviations: FLO-11, Facial Line Outcomes; FLSQ, Facial Line Satisfaction Questionnaire; PRO, patient-reported outcome.

Figure 2 Representative photographs of a patient treated with onabotulinumtoxinA over an 18-year period. This patient began receiving onabotulinumtoxinA in December 2000, but no digital photographs were available until 2006. Photos were taken upon arrival to the clinic, and images from an interval of approximately every 1–2 years are shown as follows: 2006 (A), 2008 (B), 2010 (C), 2012 (D), 2014 (E), 2016 (F), 2018 (G), 2020 (H), 2022 (I), and 2023 (J). On average, the patient received 3 sessions per year from March 2006 (age, 43 years) to June 2023 (age, 60 years), totaling 58 clinic visits, including 5 touch-ups. The total dose of onabotulinumtoxinA per treatment session for glabellar frown lines, horizontal frontal rhytids, and canthal lines varied between 40 and 60 units.