A Decade of Telemedicine for Facial Plastic Surgery: Tips and Techniques from 2000 Consultations before the COVID Pandemic.

Abstract

Many practices now offer telemedicine.1,2 Reports have reviewed telemedicine for follow-up care but not for initial consultation.3,4 This article reviews initial video consultations for aesthetic surgery done by Dr. Spiegel between 2012 and 2020. Before 2012, video consultations were performed but the information was not readily available. In 2012, 62 persons had a video consultation; by 2013, that number had more than doubled to 134. In 2014, possibly because of the increased availability of video conferencing software, the number of video consultations increased by 63% to 219. Between 2014 and 2019, the number of initial video consultations done by our practice stabilized, with an average of 232 per year over this period. In 2020, there were 437 video consultations, up 88% (Fig. 1). A total of 2024 initial video consultations were performed during this 9-year period.Fig. 1.: Video consults by year.There are advantages to this approach. For all participants, the costs of consultation are reduced, reflecting monetary as well as time savings. The prospective patient can work until the consultation starts from their own home or office and costs related to transportation to the office are eliminated. For the doctor, savings are realized in terms of reducing the need for room cleaning and preparation and patient amenities (ie, coffee, water, brochures). Typical new patient consultations only take 10 to 15 minutes, although some consultations may exceed this time frame. There are disadvantages as well. Successful aesthetic surgery practices design their offices to highlight the competence of the surgeon and the practice. With a video consultation, the patient remains in his or her own environment, so this ability is lost. In addition, some patients lack familiarity with the required technology. They may not know their username for programs such as Skype (Microsoft), may not understand that Apple devices are required for FaceTime, or may be unfamiliar with how to access Zoom. Some newer telehealth software programs ameliorate these problems by providing a simple emailed link. Possible issues also include camera malfunctions, speaker malfunctions, poor internet access, and bulky headphones obstructing the patient’s face. Lighting issues are common, and patients often sit in front of bright windows, where backlighting obscures their face. Patients are often unable to determine the proper degree of rotation from the camera to show their profile and may have a camera that is off to the side of their screen so the practitioner cannot see them face on. In addition, laptop cameras aim upward toward the face, so it can be difficult to get a proper view of the patient. In a video consultation, it is not possible to see inside the nose or mouth clearly or to feel tissues; it is necessary to communicate these limitations clearly to the patient. Patients often appear unprepared for the consultation. They may be driving, partially dressed, in bed, or in a public place with a lack of privacy. Patient privacy is an important consideration, but one that in a video consultation largely falls to the patient, who selects his or her own environment for the consultation. Some patients multitask during the consultation or ask the doctor to wait as they finish another task. The practitioner must keep in mind that there may be other people present out of the camera view. Video conferencing provides a net advantage for the medical practice and its availability is expected by patients. Our experience performing more than 1200 surgical procedures solely based on video consultation reinforces the reports of others that video consultations result in high levels of patient satisfaction.5 There are steps the surgeon can take for a successful video consultation. One must create a professional environment in which to perform telehealth services. Good lighting and a suitable background reinforce the proper image (Fig. 2). The telephone must be muted and a sign hung on the office door to prevent anyone from knocking or entering during these consultations.Fig. 2.: Office configuration for video consultations. Walls and backdrops are set to create a professional environment.Performing video consultations well takes practice. The doctor should look directly at the camera to reflect his or her engagement with the patient. To watch for patient reactions, it is helpful to position the camera close to the spot on the screen where the patient appears. Patients should be sent instructions before the consultation regarding lighting, hair position, cosmetics limitations, and equipment testing. In conclusion, our experience with more than 2000 video consultations reflects that this format can be successfully employed in facial plastic surgery consultations. High-quality experiences require physical preparation of the office environment and new communication protocols. Software and technology will continue to evolve to facilitate the process and permit more enhanced consultations opportunities as telemedicine consultations increase in frequency. DISCLOSURE The authors have no financial interest to declare in relation to the content of this article.