Over the course of my professional career I have been presented by an array of symptoms (scarring, port wine stains, hair loss) on a multitude of patients.

As a practitioner one should never just look at the symptom alone, but take into account the way it is presented by the patient. This brings into account the emotional impact and therefore the mental health of the patient.

Being presented with ‘You are my final hope,’ and ‘I have nothing left anymore’ and lives that are totally consumed by the visible difference; losing jobs, friends, relationships. Even though at this point in time Medical Tattooing may not be the best option for the patient, sending them off into the great unknown could cause more harm.

So where do they go?

This is when it is imperative a practitioner knows the correct referral pathway.

An important part of the assessment is knowing your options and knowing when to apply them. The first option offered to all patients must be to ‘Do Nothing’. As an option for most patients this is the worst case scenario. They don’t want to do nothing. They want to do something. They have thought about the situation for months or years, carried out a lot of research on ways they can help themselves, and have finally chosen a practitioner and are ready for treatment.

The majority of my patients do fall into the category of being able to treat immediately. Even in this case it is still important that they know one option is to ‘Do Nothing’.

For the few, they may have to wait for the area to heal more, they may have to wait to stop breastfeeding, they may be in a career that wouldn’t support the healing process, or they may be in an emotional state of mind that wouldn’t benefit from treatment. It is here that the patient needs to trust you. Needs to know you will do your very best for them, and that in this moment the very best option is to ‘Do Nothing’.

Doing nothing for me as a practitioner is a really important part of my skill base. It is knowing when to hold back, when to guide the patient in a different direction, one that will support the whole of their body and mind. 

Using the assessment and care pathway makes it easier for practitioners to determine based on research how to proceed. Patients are asked about areas which are shown to be contraindicators for an aesthetic intervention. For this group of patients an aesthetic intervention is likely to mean they are not satisfied with the result, they experience increased anxiety and potentially heightened awareness of the visible difference leading them to seek more and more aesthetic interventions. We all have a clinical responsibility to help patients make decisions that will enhance rather than compromise their psychological wellbeing. 

For patient with these contraindications, they can be offered; 

  1. Do Nothing
  2. Discussion with Medical Tattooist to work on aligning expectation with outcome
  3. Signposting to relevant charities for psychological support e.g. Changing Face
  4. Working with the patients current psychologist/psychiatrist in there are already under care of mental health professional
  5. Signposting to psychology service 

A year ago I had a consultation with a young man with scarring. We had been through his medical history, previous treatments and outcomes, and his expectations of Medical Tattooing. He fell into the category that research has shown to be vulnerable. He was young, male and had not been happy with the results of his previous treatments. We had a long chat on the phone, and I informed him of the situation. We went through what Medical Tattooing could achieve and what his expectations were. I advised him to really think about what he needed, and that I advised Medical Tattooing may not be the answer for him at this moment in time.

Because of the long distance I could not refer him to anyone local for help, but told him I would check in with him in a few months to see how he was doing.

I received this email, which he has given consent for me to share, which for me is imperative for other practitioners to read, so we can spread the support and the care we offer, even when it means ‘Doing Nothing’.

“Hi Rae, I wanted to thank you for the phone call and for sending your followup email. It played a part in my decision to admit myself to psychiatric care. You are in a unique position to help people in a vulnerable time in their life and I’m grateful you had the moral tenacity to do so. A lot of other’s wouldn’t. I wish that more people in the world had an aptitude and attitude like you do, as you helped me realise that my predicament was a cause of my problem and that getting to the root of the issue would be much more beneficial to me at this time. Thanks again for being such a great individual.”

With the rise in male suicide it is now more than ever important to offer a research-based care-pathway for patients with visible differences to enable practitioners to make ethical decisions about when and whether to offer aesthetic interventions. 

For more information on Permanent MakeupSkin Camouflage or Medical Tattooing please email me at: makeup@raedenman.co.uk

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