'Elderly'? Not from your patient's perspective

The psychological considerations are always a factor when assessing potential cosmetic surgery patients, and that certainly also applies to assessing the elderly cosmetic surgery candidate. But the picture can become a little nebulous, Anthony Napoleon, Ph.D., tells Cosmetic Surgery Times .

'THAT'S NOT ME' Dr. Napoleon, a researcher and writer on the psychology of plastic and cosmetic surgery, completed a two-year fellowship in medical psychology in an accredited outpatient plastic surgery practice associated with Scripps Hospital, La Jolla, Calif. He observes that the term "elderly" is poorly defined "and carries with it a negative connotation that the vast majority of cosmetic surgery patients reject as applying to them. Only 20 percent of cosmetic surgery patients 70 years and older describe themselves as 'elderly.'"

Dr. Napoleon adds that the term "elderly" is not reliably defined by any fixed bio-psychosocial markers, and that as physical attractiveness increases, the label is less likely to be used to describe oneself. Also, the label may be evanescent. Some "elderly" patients, after undergoing cosmetic surgery, drop the label altogether and feel that it no longer applies to them, he says.

That said, there are still special considerations that it behooves physicians to take into consideration when managing their older patient populations. First, what warning flags indicate that an older patient may pose a significant "psychological risk"?

GOOD VIBES "Cognitive and emotional vibrancy, as I refer to these psychological health markers, are of paramount importance when it comes to patient assessment in older populations," Dr. Napoleon explains.

"A good measure of cognitive vibrancy is the degree of awareness, connectedness and interest the patient has in the topical issues of the day. These can be news events, pop culture, sports, local events and societal trends." Early Alzheimer's patients, for instance, can give very accurate accounts of the past, but not necessarily current issues. "A patient who appears disconnected from the zeitgeist of our shared experiences, in favor of living in the past, needs further patient screening." He says that high energy and an animated facial affect are additional positive indicators of emotional vibrancy.

GETTING REAL A benefit of being older? Older patients tend to have the best expectation profiles of any patient demographic, Dr. Napoleon says. "I like to say that 'this patient demographic wants to look better, not best.' Every cosmetic surgeon knows the difference. Even a moderately successful surgical result at correcting upper bleph and submental laxity (two areas where age-related visual cues are overweighted for the greatest potential for patient satisfaction) often results in an older patient who is absolutely ecstatic with his or her surgery."

However, he adds that there are some caveats physicians should bear in mind in following older patients. Noncompliance with post-operative guidelines that, to the patient, may appear to be picayune or "optional," is one example. In addition, healing times, susceptibility to infection, increased ecchymosis risk — all require more attention to detail when it comes to post-op care.

Dr. Napoleon feels it's time to retire the word "elderly" in labeling older aesthetic surgery patients. "Patients don't like the term and it's so ill-defined that its usefulness has reached a point of diminishing returns in modern medicine."

"I often quote the great baseball pitcher, Satchel Paige, when I discuss the issue of aging. 'Age is a question of mind over matter; if you don't mind, it don't matter.'"

REFERENCE

Napoleon A, Lewis CM. Psychological considerations in the elderly cosmetic surgery candidate. Ann Plast Surg. 1990;24:165-169.