AHPRA Screening Guidelines for Cosmetic Practitioners.
How to Implement Body Dysmorphic Disorder Screening.

Presenter: Dr Toni Pikoos

Dr. Toni Pikoos, a distinguished clinical psychologist and researcher, holds a PhD in the linkage of cosmetic procedures, mental health, and body dysmorphic disorder (BDD). She is a Post-Doctoral Research Fellow at Swinburne University and a practicing specialist in BDD in Melbourne. An in-demand speaker, she educates on BDD at global conferences.

Through research and consultation with cosmetic companies and practices, Dr. Pikoos enhances psychological safety in the cosmetic industry.  


Participant Feedback

“This webinar provided valuable insights into the new guidelines and the role of psychological assessment in the cosmetic field. Dr. Pikoos’s expertise was obvious, and she provided valuable resources for practitioners navigating these changes”


As of July 1st 2023, cosmetic practitioners administering both non-surgical and surgical cosmetic procedures will be required to routinely screen for body dysmorphic disorder (BDD) as part of their consultation process. We are also expected to assess the patient’s motivations and expectations for the procedure to ensure that they are realistic. 

Dr Toni Pikoos is an expert in body dysmorphic disorder and sat on the AHPRA cosmetic guidelines review process. She is ideally placed to explore the use of screening tools that comply with AHPRA guidelines and how to implement them them in cosmetic practice. 

In this webinar, Dr. Toni Pikoos, a clinical psychologist specializing in body dysmorphic disorder (BDD), discussed the new guidelines for cosmetic procedures and their implications for practitioners. Dr. Pikoos is the co-founder of ReadyMind, an assessment platform that helps practitioners comply with the guidelines. The focus of the webinar was on the changes to patient assessment required by the guidelines, particularly regarding BDD.

Dr. Pikoos highlighted the importance of assessing patients’ motivations and expectations for cosmetic treatments, as well as screening for underlying psychological conditions such as BDD. The new guidelines emphasize the use of validated psychological screening tools to assess patients for BDD and other mental health issues. These tools are time-efficient, provide documentation, and support clinical decision-making.

The webinar introduced the Cosmetic Readiness Questionnaire developed by ReadyMind, which assesses not only BDD but also self-criticism, self-esteem, perfectionism, psychological distress, and openness. The questionnaire categorizes patients into three zones: green, yellow, and red, indicating their readiness and risk factors for treatment satisfaction.

Dr. Pikoos discussed the implications of BDD in cosmetic settings, such as increased risk of dissatisfaction, potential complications, revision surgeries, and legal issues. She emphasized the need for practitioners to be aware of and address psychological concerns to ensure optimal patient outcomes.

Overall, the webinar provided valuable insights into the new AHPRA guidelines and the role of psychological evaluation in the cosmetic surgery field. Dr. Pikoos’s expertise and the ReadyMind platform were highlighted as valuable resources for practitioners navigating these changes.

Welcome everyone. My name is Dr. Ben Buchanan, and I’m a clinical psychologist, and we’re joined tonight by Dr.
Toni Pikoos, and we’re very privileged to have access to her expertise tonight.
Both Toni and I have been working at the interface of cosmetic procedures and mental health for a long time, and we’ve learned a lot from cosmetic practitioners over the years working alongside them.
With some of them more tricky patients in particular, patients with body dysimorphic disorder.
And so tonight we’re gonna be talking about the appra guidelines and talk about the how some of the complications that we’ve heard from cosmetic practitioners that they see in practice how that’s been translated into the upper guidelines that starts they come into effect on
the first of July, so a little over a week and a half from now.
So let me introduce Dr. Toni Pikoos.
Tony has a Phd. In clinical psychology about the intersection of cosmetic procedures, mental health.
Bodiesmorphic disorder and client satisfaction with cosmetic procedures.
She is a postdoctoral research fellow at Swinburne University, and is a practicing clinical psychologist in Melbourne, specializing in body dysmorphic disorder.
She’s the co-founder of ready mind.
Ready mind, assessment, platform, which we’ll talk a little bit about tonight, which helps people umly with the new upper guidelines.
And she’s a very sought after public speaker I happen to know that she’s been invited to many, many conferences, both nationally and internationally, talking about how we can create the most satisfied clients.
One in the cosmetic industry, twenty’s had a long journey in this area from a Phd.
To working with body dysmorphic disorder, working with patients who have got cosmetic procedures.
She was involved with the App opera consultation process given her expertise in the area.
And now she’s doing a lot of public speaking and helping practitioners comply with these new guidelines.
So welcome, Tony!
Great. Thank you so much, Ben, for the lovely introduction, and welcome everyone.
It’s great to see many people here. I’ll just share my slides.
So before we jump into talking about the new guidelines, we thought we would just do a little bit of a poll to see how everyone here is actually feeling about the new guidelines.
So by now we’re  days out. You’ve probably had a chance to have a look at them.
So first, I want to know how you’re actually feeling about the new screening guidelines in particular.
And then the second question we have in the poll.
That’s just come up is how confident do you feel with managing Bdd.
In your practice. Currently, Bdd, being body dysmorphic disorder.
Okay, so, how to look at the results looks like there’s a few mixed feelings about them.
A lot of people say, you know, they are okay, or a lot of people not knowing enough yet.
And hopefully, after tonight you’ll feel like you’ve increased your knowledge a bit about that.
And some people feeling cynical as well, which which makes sense whenever there’s a period of change and new guidelines being brought in, makes sense that you have a mixture of emotions coming up.
And I know that, you know, lumped in with all of the other upper changes that are going on.
It might feel like some of the new guidelines are a bit extreme, or it’s like throwing the baby out with the bath water.
So, yeah, all of these responses make sense in terms of how confident you are managing.
BDD, so there’s around a third of people saying that they’re not at all confident.
At the moment, and I imagine you know, with the change in these guidelines we’re gonna get a lot more confident, really quickly.
But essentially, why, you know, I’m here, and why ready mind is here is to equip you with all the tools and the skills that you need to feel more confident around managing.
BDD. If it does come up in your practice. And yeah, a lot of people feeling, okay?
And a small proportion, feeling very confident. So hopefully tonight I’ll help you change some of that.
And through the other tools and services that we can offer you.
So it then gave me a pretty long introduction there, so I don’t think I need to say too much more about that.
At the moment. Ben’s kind of been our software in tech Guru, but he’s also clinical psychologist with expertise in BDD and cosmetic procedures, and also a doctorate in this area.
For me. Ben mentioned you know I’ve been working with patients getting cosmetic procedures for a long time now now, and I’ve seen people who have been really satisfied with their treatment, and it’s been really life changing for them, and they have felt a lot more confident afterwards, and
that is, the vast majority of patients that I worked with have had that experience when they’ve had cosmetic treatments.
But on the flip side I’ve also worked with patients who have maybe got cosmetic treatments when they weren’t in the right mindset or the right headspace.
Oh, they had unmanaged mental health issues, and then experienced worsening mental health as a result, or were really dissatisfied with the treatment outcomes.
So it’s through this knowledge and experience that ready mind was really born out of trying to use this knowledge that I’ve developed to help cosmetic practitioners to maximize patient outcomes.
So the new guidelines come into effect in about  days, and you can read a copy of it if you haven’t seen online, I would really recommend you read the full document before the guidelines come in.
But these are new guidelines for registered medical practitioners, performing cosmetic surgery and procedures.
So technically, these guys only apply to doctors working in this space.
However, we know that, you know cosmetic nurses and dentists and other groups are also involved in administering cosmetic procedures, and so the guidelines and the advice for nurses.
If you look on the nursing board, is that these guidelines serve as an evidence based framework, and they outline conduct and best practice for medical practitioners in this space.
So it really serves as a guide, for I guess how everyone should be practicing in.
In the cosmetic industry, and also we know that nurses will often be working with doctors who might be prescribing the medications, and so they need to know what what’s expected of their prescribers as well.
So, I’m gonna be focusing really on the changes to patient assessment.
There’s a whole lot of other changes to be aware of.
But but that’s going to be the focus of tonight.
And the guidelines do separate out cosmetic surgeries and non-surgical procedures, and they have slightly different wording for each of them, for the for cosmetic surgery.
One of the major changes that’s come in is that patients need to have a Gp referral before getting the cosmetic treatment.
And that Gp needs to be someone who’s not working in the cosmetic space and must be independent of the cosmetic practitioner.
And the other changes which have been brought in is that the medical practitioner performing the surgery has to discuss and assess the patient’s motivations and expectations for the treatment, and make sure that they’re realistic.
They need to ask if a patient has been declined, cosmetic surgery in the past is, that might be a bit of a red flag that another practitioner has picked up on something an area of concern and his has been a major change where the medical practitioner who’s performing the
surgery must assess the patient for underlying psychological conditions, such as Bdd.
Which might make them an unsuitable candidate for surgery.
The practitioner must use a validated psychological screening tool to screen for Bdd and the process and outcome of this assessment must be documented in the patient’s records.
So there’s a few key changes there, which I’ll go over, and if you, a person detects issues with the motivations, expectations, or Bdd, then they should refer that patient on for further assessment with a psychologist psychiatrist or general practitioner before going ahead with
any cosmetic surgery. Now for non surgical procedures.
The wording is quite similar, so the medical practitioner in this case, who’s either performing the cosmetic procedure, or if they’re not the one performing it.
The one prescribing the cosmetic injector should also be assessing the patient for underlying psychological conditions like Bdd.
And they must also be assessing them motivations and expectations to ensure that they’re realistic.
And again, if there are indications that the patient has any psychological issues which might make them unsuitable for the treatment they should be referring on to a psychologist psychiatrist or Gp, so essentially the main changes that you need to be aware of for both surgical and
non-surgical procedures is that the wording has been strengthened from a should.
In the past Medical Board guidelines to a must.
And so you need to be assessing motivations, expectations, and conditions such as Bdd and you need to be aware of the referral process.
But for surgery only. So not non surgical.
That’s where the Gp referral is needed and a validated Bbd assessment tool has been specified but we’ll talk about tonight.
You know what a validated Bdd assessment tool is?
And I think it’s a pretty good standard to have for both surgical and non-surgical procedures, and we’ll make the process simpler for you as well.
So I’m gonna delve a little bit more into Bdd in particular, and some of the psychological concerns that have been specified, so that you have a bit of a better understanding of what you’re looking for, and why you’re looking for it.
So body is something you’ve probably all at least heard of before.
A psychiatric condition where people become obsessed with perceived flaws in their physical appearance, and they’re things that feel very real, very significant to them.
But to other people might seem really subtle, or they might not even notice them at all.
So an example of that is on the slide with Danielle.
So when I look at Danielle, you know I see she looks pretty symmetrical to me, very attractive, but when she looks at herself she sees you know she’s got this wide face and protruding chin, and so she’s seeing herself really differently to how we might
see her. And so if Danielle comes into your clinic requesting treatment to balance out her facial proportions, you would have a really difficult time doing that for her, because her perception is quite distorted.
So we know. With Bdd. There is often a distorted perception of what they look like.
Usually they spend many hours a day worrying about their appearance, and it’s often, at least more than one now a day.
But most commonly between  to  HA day, and people with Bdd tend to engage in repetitive or compulsive behaviors in response to their appearance, so things that they might do to check or fix or hide or try to cover up parts of themselves that they’re not happy
about, and so that might be spending lots of time in the mirror kind of looking at their perceived floors from different angles and in different lighting.
Or taking lots of photos of themselves, or on the flip side, completely avoiding photos or avoiding there is altogether or they might spend lots of time doing their head, doing their makeup and trying to look as presentable as possible.
If they’re going out, people with BDD. Often have a significant distress levels.
So we know that up to % of people with BDD experienced suicidal ideation at some point and % of actually attempt suicide.
So they are really vulnerable group, and they’re often experiencing a lot of distributed relation to their appearance, and it can interfere with their ability to socialize, to work to date, and sometimes in more extreme cases, their ability to really leave the house at all.
And what we know about BDD. Is that what we might see is the appearance concerns on the surface, and the things that they’re fixating on, and often with BDD.
The fixation tends to be around facial features or the skin, or the proportions of the body, but it can really focus on any sort of feature for men.
It might be about their hairline. And so a lot of the concerns that people with Bd might have might actually lead them to seeking cosmetic treatments as the solution.
So instead of viewing it as a psychological concern that they have, they see it as a physical concern that needs a physical fix, and so often they’ll come and seek dermatological treatments or cosmetic treatments or surgeries in the hope, that it’s going to make them feel better about
themselves, but in reality, what we see is that people with Bd are experiencing a whole lot of other kind of risk factors, other things that are going on for them that are presenting as their appearance concerns.
So we know, you know, from the research in this space that people with Bdd often have neurobiological vulnerabilities in that they might have an over focus on visual detail.
So when they they process faces of themselves or others, they might focus on the detail rather than the big picture.
And so they don’t really see themselves completely, accurately.
We also know that people with BDD. Often have a genetic contribution up to % have experienced some kind of childhood trauma or bullying.
So often they have had a significant event in their lives that has made them feel really self-conscious of their appearance, and sometimes that trauma bullying was around their appearance specifically, but other times it was just just a general trauma that they’ve experienced and they might have learned to
create by focusing on the way that they look. Perfectionism is often really prevalent to BDD.
As well, and we know that societal impacts of social media and societal pressure that we might feel to to look attractive or to fit with beauty standards can all play a role in the development and presentation of BDD so when a person with BDD does get a cosmetic treatment.
It might address what’s going on in the surface, but doesn’t address anything going on under the surface, and therefore usually people with beta don’t get the outcomes that they’re looking for.
So? Why has Bdd. Been specified? So it’s not because, you know, Btd is important and other psychological issues aren’t because we know that there are other mental health issues that can cause dissatisfaction and become a problem in the cosmetic setting as well, but the reason
that Bdd specifically was specified in the guidelines is that there’s an enormous body of work supporting the fact that people with Bd are often dissatisfied with the treatment.
So we know that in up to % of cases, people with Bdd don’t experience any change in their in their symptoms through cosmetic treatment.
But they feel the same before and after. In % of cases, people with Bdd will get a cosmetic treatment.
But then continue to worry about the area that they’ve had treated.
So it doesn’t really rectify their concerns.
Sometimes what we see is that the concern might shift.
So, for example, you know, there might be a line that they want treated with an anti wrinkled treatment, and then, you know, once they’ve had that anti wrinkled treatment, they might begin to worry that, you know, now their forehead looks strange or that area. Looks weird.
Because it’s not moving, and it doesn’t look natural, and other people might judge them, because now they look like they’ve had work done.
And so the worries are still there. They just take on a different form.
In % of cases, people develop new appearance concerns.
So they get one treatment done, might feel a bit better about that, and their concerns shift to another area.
And in % of cases, the Bdd symptoms actually deteriorated and got worse after a cosmetic treatment.
There’s also been research which shows that people with Bdd have a greater risk of experiencing complications and needing reoperations and revision surgeries in particular, rhinoplasty surgeries has been found to have really high rates of review for people with Bdd
and there’s also a potential for addiction to to develop.
So if they find that you know the cosmetic treatment makes them feel a little bit better in the short term, they might become reliant on it, for that dopamine hit, and there’s potential that they then become addicted to the treatments and get more and more treatments that they might not
need, and in up to % of cases, there have been complaints, threats, and litigation issues caused by someone with Bdd, so they’ve yeah, either, you know, left a negative review or come back asking you for you to redo the treatment or to give them money.
Back, or maybe more extreme threats or legal issues. So we can see that Bdd. In a cosmetic setting has a number of implications for the practitioner and for the patient themselves.
Now, when it says other psychological concerns in the guidelines, what do we mean?
So it as I said, there are other mental health issues that can cause issues in patients seeking cosmetic treatment and depending on the procedure that you’re doing or the setting that you’re working in.
You might come across patients who have anxiety and depression.
Ocd. Health. Anxiety. Eating disorders and personality disorders, and we know that % of people seeking cosmetic treatments do meet criteria for at least one mental health issue.
So I think you know it would be crazy to suggest that anyone with a mental health issue can’t have cosmetic treatment and would be really unfair.
Wouldn’t respect the patient’s autonomy either, but what we do know is that unmanaged mental health issues can sometimes complicate a recovery process.
So if a person’s really anxious before they have a procedure, they might still feel really anxious.
During their recovery period, it might spend lots of time worrying about side effects or looking at themselves in the mirror.
A lot, and noticing different things, popping up, and that can can sometimes complicate how well they recover, and how satisfied they are with the treatment, so it can it can decrease satisfaction with the treatment as well.
Sometimes it can even create physical health risks and an example of that might be, you know, person who has obsessive, compulsive disorder where they might spend lots of time washing their hands or showering or cleaning themselves.
Now, if they’ve been given directions after a surgery, after a procedure not to wash your plea in the area, not to wet the area for a while.
That might be a real, difficult recommendation to comply with, and so, you know, they, because of the compulsive element, and then they might end up increasing the risk of infection following the surgery or the procedure if their Ocd is not well managed beforehand there’s also potential for the
cosmetic procedure to exacerbate that underlying psychological vulnerability.
So if they’re already not in a great emotional space, and they get a treatment where they do experience adverse events, or something goes wrong, or even, you know, it’s fine, but it just doesn’t meet their expectations.
That might exacerbate any mental health symptoms that they’re already experiencing.
But certainly working with patients with mental health issues, does introduce a few different ethical dilemmas regarding the the right for the patient to their autonomy, to make decisions about their body and what they want to do to their bodies, but then also about their competency so whether they’re in a
capable enough headspace to exercise judgment and to make decisions about the risks and benefits of cosmetic treatment.
Okay. And there’s also the aspect of beneficence.
Essentially do no harm, that you know what these treatments, these cosmetic surgeries and treatments, can help people.
And we want them to experience the benefits and not the risks.
So the other thing that you have to do as part of your guidelines is to assess motivations and expectations.
Now this is something at ready mine. We’ve got some tools under development that you’ll be able to use in our system to do this as well, but I know that this is something that cosmetic practitioners already do really.
Well, it’s it’s commonplace for you to ask your patients why they’re there, why they want the treatment.
Why did they start thinking about it? And so those are some of the really key questions to start to identify.
If your patient is there for themselves, are they there for intrinsic reasons like you know, wanting to boost their self esteem, or confidence, or to because they want to look back more attractive?
Are are they doing it for someone else? For external reasons, like potentially wanting to be more competitive on the job market, or for dating reasons?
So we want to work out that they’re there, you know, really, for themselves.
So here are some questions that you can ask to do that, and you know what prompted you to consider this treatment.
Why now? Why now is often a really powerful question, because that might reveal some things about, you know, recent events that have occurred that prompted their interest.
Maybe they’ve got a wedding coming up, or maybe they’ve just split up from a partner.
They’ve had a divorce, and they wanted to freshen up afterwards.
And so that information of why now can be really valuable to workout. If you know now is the right time for this cosmetic treatment for that person, you can also ask if anyone else has influenced their decision or encourage them to get the treatment to workout if they’re doing it fully
for themselves, and ask them about their expectations. What are they hoping to achieve with this procedure?
And not only how they’re hoping to look different afterwards, and assessing, if that expectation of how they’re going to look is realistic, but also how they’re hoping to feel differently afterwards.
So you know, potentially if they are someone who’s struggling with a mental health issue, are they expecting that after they get this treatment or after they get this surgery, life is gonna be dandy, that they’re gonna be really happy?
And then they won’t experience that mental health issue anymore, because that might be a bit of an unrealistic expectation that needs to be addressed.
So with the new guidelines. They recommend psychological screening tools and validated psychological screening tools.
And you know, one way of doing this is you could includeorporate a whole bunch of extra questions into your consultation with your patient, and that would be one way to assess their mental health and the presence of body dysmorphic disorder.
But the reason that they’ve specified psychological screening tools is, firstly, there are a lot more time efficient.
So you can do a cyclological questionnaire in just a couple of minutes, and you can gather a lot of data really quickly.
It also requires a lot less expertise than a clinical interview.
So if you’re going to sit down and ask them about their mental health and their body image, that involves, you know, a lot of trust.
It involves potentially a lot of time for the consultation and comfort with whatever’s going to come up feeling confident to manage whatever they do say to you during that interview so there’s a bit more expertise involved having a questionnaire.
Also ensures that you don’t miss anything, and I know you know, for you.
If you’re doing surgery, if you’re doing non surgical procedures, there’s a lot of things that you have to assess during your consultation, and a lot of things that you’re holding in mind, and it can be really easy just to you know forget.
One question, or to miss out something, and you don’t want that thing to be the to be something that’s really significant.
Or then leads to the patient feeling dissatisfied afterwards.
So a psychological screening tool can help to make sure you don’t miss that.
It also provides you with documentation. So you’ve got a record on file of the patient’s responses, and how they they were scored.
And that’s useful, if you need it later on. If there was any legal issues or an audit, or something like that, that you’ve got the documentation, it also supports your clinical decision-making.
So already in the guidelines. Since  there was a recommendation that if a patient was unsuitable for the treatment, you would refer them onto a mental health professional, but in the past, if you were to do that, you had to do that just relying on your clinical intuition which is a little bit
of a tricky conversation to have to say to someone you know.
I don’t think I can treat you, because you know, I don’t feel it’s going to be appropriate.
But now what you can do is you don’t have to just rely on your own judgment to do that.
You can actually rely on the screening tool, and you can blame the screening tool almost for why, you have to refer them on.
If that is the decision that’s being made. So it supports your decision-making, and it provides you a framework to discuss that referral rather than just relying on clinical intuition alone, and the other thing that you can do when you’ve got these sorts of questioners on file is you
can track your patient’s outcomes and see how they’re going.
Throughout the treatment. And if potentially this, their body image or their mental health or their quality of life, is changing over time, which is really nice for you to know, and for your patients to know as well.
So there are a range of different Bdd screening tools out there and a lot of validated screening tools, and in our ready mine platform, which I’ll talk to you more about in a moment.
We do have a number of those tools available. And some of them, you know, quite brief, like less than  ids to quickly assess a patient for body dysmorphic disorder.
And you can definitely use one of those questionnaires as per these guidelines.
The other thing that we’ve developed is the cosmetic readiness questionnaire.
And becausemetic readiness questionnaire is essentially designed to cover you.
If you’re assessing the Bdd.
But also that and other psychological issues category. And so it’s a little bit longer.
It’s got  items from well validated scales, but it still takes less than  min to complete and essentially what the cosmetic readiness pressure does is, it assesses for body dysmorphic disorder it also assesses the patient’s self criticism so how they
view themselves to. They have really low self-esteem.
Are they really hard on themselves? We know that the patients with really really low self-esteem might not get the results always that they’re looking for from cosmetic treatment.
Are they quite perfectionistic? So they hold themselves to a high standard.
Are they more likely to be critical of the outcomes that you might get from a cosmetic treatment, and it also assesses psychological distress.
So things like anxiety and depression that would come up with other psychological issues in a cosmetic setting.
And the final scale that we’ve included in the cosmetic readiness questionnaire is an openness scale because one of the things that you know, I’ve heard without fail.
Whenever I speak about assessing for Bdd. In a cosmetic setting, everyone always asks, but weren’t the patients just cheat the system?
And weren’t they? Just, you know, circle on those so that they can pass the screening question and get the cosmetic treatment.
And I definitely think that that will happen and that it’s, you know that’s a real risk, especially if someone really wants the procedure.
They’re really motivated to get it. So without openness scale, it essentially assesses how open a person has been in their questionnaire.
And if they were potentially being dishonest or the truth a little bit.
And so it will score, according to all  sub-sales, and taking all  sub-scale into account, the cosmetic readiness questionnaire gives you a report which tells you whether your patient is in the green zone, and in the green zone, it means I’ve got a ready
mindset, they’re prepared for the procedure. They’re more likely to be satisfied.
And that’s most patients, we think % of patients fall into that green zone.
We then have a yellow zone. Now the Yellow Zone, a patient per have moderate risk factors showing up, or they’ve got some risks, but not not that many and essentially all.
They might have some unrealistic expectations. Now for patients in the Yellow Zone.
That that’s around  to % of patients. And for patients in the yellow zone that can probably be managed in the cosmetic clinic by discussing some of those risk factors further with your patient and discussing you know, if they do have unrealistic expectations.
Or if they are a little bit of a perfectionist.
How that might impact the treatment process and doing that, as part of your consultation can help to manage those expectations before going ahead with any treatment.
Then we have the Red Zone and the Red Zone of patients who experience mental health challenges or many risk factors which might reduce their satisfaction with treatment and the Red Zone is around  to % of patients and those are the ones that are considered higher risk and and probably flagged for a
referral onto a mental health professional and why we’ve come up with this cosmetic readiness questionnaire based on well validated scales is because if you’re looking at Bdd alone, what can happen is you might end up having lots of people screening if we don’t
necessarily have Bdd. But who might feel uncomfortable about their appearance.
Or dislike their appearance, which would be common in the cosmetic setting, and this by incorporating other factors. It allows a more nuanced decision-making process about that patient’s risk profile rather than just screening everyone positive.
Scale has been validated. So in our validation study we looked at the association of the cosmetic readiness scale with the goal standard for Bdd diagnosis, and that gold standard is a psychologist or psychiatrist clinical interview using the gold standard diagnostic
tool and the cosmetic readiness questionnaire strongly correlates with that official gold standard babyd diagnosis, the cosmetic readiness questionnaire and sub scales were also associated with past to satisfactor with treatments and having unmet expectations which means that a
patient scoring highly might be more likely to be dissatisfied with the treatment, and the other thing that we did was we compared the cosmetic readiness scale to a psychologist rating of the patient’s cosmetic readiness after doing a thorough analysis of their motivations expectations
and mental health, and we found that questionnaire results were also strongly associated with that more in-depth clinical interview that might take place with a psychologist, which essentially means that doing the cosmetic readiness questionnaire can almost be like there’s a psychologist there with you in your
practice to assess for these mental health concerns and potential red flags.
So, how does this screening system work? So without ready mind platform, we’ve made it really easy to implement these screening processes.
So, instead of having lots of extra paperwork that you have to manually score and add up for each patient what you can do is you can generate a link and send your patient at the questionnaire to complete on their own device, and you can do the cosmetic readiness questionnaire all one of
the other Bdd scales that we’ve got, and the patient completes it on their own device.
The results are instantly scored and interpreted, and can be emailed to the practitioner or they’re also accessible in the ready mine system.
The practitioner can then use that report to guide their consultation, or to refer the patient on, or to track patient outcomes.
And here’s an example of what the cosmetic readiness report will look like.
So it gives you the overall score. Essentially, if a patient is in the green, yellow, or red zone, it also breaks it down, and you know, for some patients that might be all you need to see that you can see if they’re green it’s okay, to proceed if they’re red, you might know
that you need to refer them on, and if they’re in the Yellow Zone you might want to investigate a bit further and look at the individual sub scales and see how they’ve gone green, yellow, or red on the end of sub scales then in the interpretation section it
explains to you what it means that they’re in the Red Zone, and what the recommendations are to do next.
So in this case it might be, refer them on for further assessment to a mental health, professional.
It also gives you some consultation, prompts things to ask the patient about, to talk to them about before going ahead with the treatment or a potential script to actually explain the need for referral to your patient.
So you know the report at the beginning, while you’re getting used to this process, you might be reading everything to see what you have to do.
But we imagine the more times that you’ve done it the more you’ll get really confident with those recommendations.
And manage them, managing them yourself. But at the beginning it can help to build your confidence and know that you’ve got a bit of support with this process.
So here’s the breakdown of the scoring based on our validation sample, and we had  people seeking surgical or non-surgical treatments, and what we saw is that, looking at the Bd scale alone, % of those patients would be in the red zone and
% in the yellow zone. So again, we think sometimes those Bdd scales are oversensitive because we know that it’s actually a much smaller proportion of people in the cosmetic setting than that who actually have true Bdd, but then looking at the other scales you can
see that that percentage is quite a bit lower for patients who would score in the Red Zone.
So because with the cosmetic readiness questionnaire, we can take into consideration not only Bdd.
But also these other risk factors that someone with a true case of beauty is likely to present with.
We think that % of patients will screen, read.
And for about % there in that year zone and the Yellow Zone is the opportunity for you to have that more in-depth, thorough consultation with them and do do a bit more kind of education or managing expectations before going ahead with any treatment and we give you
support in that Yellowsone, as well with in the report.
It will tell you how to manage some of those expectations or red flags that come up as well.
So one of the questions that you might have thinking about this is okay.
Well, how are these changes going to affect my business? And so, if I’m screening patients for Bdd, a lot of the times that I’ve been having chats with cosmetic practitioners about this, they’re like, oh, but you know, lots of patients might have Bdd, does that.
Mean, you know, I’m, going to be losing a whole portion of my business essentially, and so, you know, we’ve done some modeling around some potential scenarios with this screening process.
And essentially, you know, as things might be at the moment, you might not have a screening process in place, or you might be concerned that some you might screen.
But another practice might not, and we think that, you know, if a practice wasn’t doing any screening, essentially, what you would see is with a hundred patients coming in for a consultation.
You might be treating all a hundred of them, and we expect in that scenario that satisfaction rates the amount of people that are really satisfied with that treatment without coming back with any complaints with or without just disappearing to another clinic would probably be around % with a simple
bdd, screening questionnaire like a one of the short measures that we do have on the platform as well.
We know that if you gave that questionnaire to our  patients, quite a big chunk of them might actually screen positive if they’re being honest.
And so you might end up with around % of your patient screening positive for Bdd, and so those are  patients that you’re essentially referring on or potentially saying no to.
And so you might lose those patients, and have  that you’re going ahead with treatment on.
And then we expect still the satisfaction rates are going to be higher, so you’ll still end up with % being satisfied because the patients that have there, you’ve kind of screened appropriately.
First, now with the cosmetic readiness questionnaire, which takes into consideration not only just the the general Bdd screen, but all these other factors as well, we expect, you know, if you see a hundred patients that about  of them will be okay to go ahead with treatment and the others you know Mike.
come back after the referral and assessment process and then you’ll have also % of patients feeling satisfied because you’ve been able to manage their expectations.
Have these important conversations with them and screen them for any potential issues.
So one of the next biggest challenges that comes up is, what do we do next?
Once we do find a patient in the Red Zone. How do we actually refer them onto a mental health professional for further assessment?
And one of the things I will say is, you know, when I talk about this with patients and the terminology that we like to use at ready mind is a cosmetic readiness assessment rather than A Bd screen which might come up with negative connotations for the patient we talk about it as cosmetic
readiness, because we’re assessing whether you’re in the right headspace or you’re ready right now for this cosmetic procedure.
And so that language can be really beneficial in the way that you expand this screening process and talk about it with your patients.
But in terms of how to discuss the referral. So we’ve come up with kind of this  step process.
I call it the  h. And essentially you start off by just relating to your patient, you know, on a human level, you can express your concern for the distress or the anxiety that the patient is experiencing, and you might have picked up on that during your consultation, or you can refer back to the
assessment results, and again, you don’t have to mention Bdd, if that’s the concern.
Because it’s not necessarily your role to diagnose Bdd and Bdd screening tools are not diagnostic tools.
They suggest that there’s an increased chance of the disorder.
But it’s not a diagnosis, so you can say something like, you know.
I can tell how much your anxiety about your appearance has been impacting you.
You can then reassure them that you have their best interests at heart, and that means both their physical and their emotional well-being.
So I want you to know that my main priority here is your physical and your emotional well-being, and we want you to get the best possible outcomes from this treatment.
The next thing is to refuse to do any treatments at that time.
On that day. So explain that because of the guidelines you have to refer them on before proceeding with any treatments, and this is where you can kind of blame the questionnaire, as I said, so based on your screening results.
And my requirements under the new guidelines. I’m unable to proceed with treatment today and then suggest a referral onto a mental health professional.
I think it’s the best thing is to have a relationship with someone that you know that you can refer them onto so that it feels like a really normal, comfortable process.
Or you know a clinic doesn’t have to be a specific individual.
But you know, I’d like to go and have a chat with so and so to help clarify your motivations and expectations, and work out whether now is the right time for this cosmetic treatment, and if it’s going to help you achieve your goals and so we can speak, about it in
a really normalized and comfortable way. And this is something I know we’ll take a bit of practice, but we can one of the things that we’re going to do at ready, mind is we’ll develop videos to help demonstrate this conversation a little bit more.
And we’ve also got scripts that you can practice practice on each other initially, and then practice using with your patience.
The psychologist role is what happens next or psychiatrist or Gp for me.
You know my experiences as a psychologist doing this.
I know that these are assessments often take an hour, which is time, that we as psychologists, have but other professionals, might not have as much time to do it, and we also have guidelines from the Australian Psychological Society, which both ben and I contributed to on how to conduct these
psychological evaluations. So anyone that you’re referring to should be aware of these guidelines and should be using this in making their assessment of their patient.
So we’ll do that. Those assessments, and then we would report back to the referral or back to the cosmetic practitioner and let them know essentially our assessment of the patient’s risk.
So we might say that they’re, you know, low risk.
We have an identified, any significant factors which could complicate the treatment.
And we’re happy for them to go ahead, or we feel comfortable.
Recognizing that it’s okay to go ahead. If they’re moderate risk, we might be suggesting some cycleological support.
Maybe before getting a cosmetic procedure or surgery, or potentially afterwards to help them manage and adjust to it.
And if they’re high risk, then we might be saying, Look, it’s not the right time for a cosmetic treatment.
And again we would provide recommendations for what support they need.
In the interim, and we can always reassess that again in the future.
So it’s never a blanket. No, it’s always a if a patient is determined.
Is not. Now, that’s that’s the key, and we’ll recommend supports to to help them, and then reassess if they need the cosmetic treatment later on.
And most patients that I assess do end up being cleared to go ahead with a cosmetic procedure.
But they do so after having a really in-depth and thorough supportive discussion about all the benefits and the risks and and their personal factors which might impact the cosmetic treatment process so that they can go into it feeling much more confident.
So what? Are the other things? You might be a bit concerned about is how patients are going to respond to being asked about their mental health, or having to do these questionnaires in your practice and you might have already been doing.
Some of them before, and seen what it’s like. But if you haven’t tried it yet, I did do focus groups with patients seeking cosmetic treatments.
And I asked them how they would respond to having psychological screening in their practices.
And  out of  patients said that they had a positive response to the implementation of these routine cycological screening questionnaires, and they said that they really valued a practitioner who could manage expectations and say no if the procedure wasn’t in their best interests that would make them trust
the practitioner a lot more now. The remaining participants didn’t say it was a bad idea, but what they did say was that if it wasn’t a routine process for all patients, and if you just pulled out a questionnaire, or if you started talking about mental health only with patients, that you
were concerned about. Then they would start to feel a bit targeted, so that suggested to me that you know, by having it in the guidelines that can really help to normalize and make this a routine process because it will mean that patients don’t feel singled out they know, it’s just like
being asked about their medical history.
So ready mind has provided a lot of the tools that you might need to adjust to this process.
So we do have a software platform which we can show you in a moment, which includes lots of screening and assessment tools that you can use some different simple Bdd question is, and also the cosmetic readiness questionnaire.
And it automatically scores and generates the report to tell you what you need to do next.
It gives you recommendations for things you can discuss in your consultation, and also any pre-operative care that you might need to give to your patient, and we’ll also be, as I said, providing scripts and videos and doing upcoming training in managing some of these
difficult Conversations with patients. If they do come up other things you might need are like referral letter templates or information handouts for your patients, and we’ve also developed that and got that on our website.
And we also do at ready mind. We do the cosmetic readiness assessment.
So I’ll be doing them myself if you do have a patient.
You need to refer, but we also have a team of psychologists that we can refer to for further assessment as well, and that can all be done online via telehealth.
Virtually so. It can be Australia, wide, and I’d love to hear from you as well if there’s anything else that you need to feel confident in managing these guidelines, please reach out.
Let me know, and we we can look into it.
So I’m gonna open the floor to questions. In a moment.
But on the slide I’ve got a QR. Code for you to have a look at the ready.
Mind software yourself. And I think that we’ll do a little demonstration as well.
And but essentially you can. You can sign up to the platform.
You’ll get a free trial so you can test it out on yourself.
Test it out on your patients. It starts at $ a month for an individual practitioner.
And so, yeah, we’ve tried to make it as low cost as possible to make it really easy for you to start implementing this screening.
So yeah, you can do that from the QR code. And if anyone’s does need to go early, thank you so much for joining us.
But I will open up for questions now, and I can see a lot come through on the chat.
And yeah, Tony, thank you. And there have been a lot of questions that have come in.
And so I think I’ll go through.
I’ll go through some of them, but I would also encourage everyone to take the questionnaire on yourself.
I love taking cyclical question as I’m myself, because I always learn something I’m like, oh, gosh! I’m more insane than I thought.
And yeah, it’s just a good thing to put oneself in the patient’s shoes, I suppose, just to take the question as so we know what we’re giving them.
So I’m gonna go through some questions. Tony Michelle said.
Early on you referred to complications. When you say this, do you mean surgical error, or do you mean psychological complications where people are dissatisfied with a clinically good outcome?
Yes, so it could be either actually more often it would be a psychological concern that they’re dissatisfied, even though the outcome was was perfect, or it was exactly as it was expected to be.
But the other thing is, I guess some mental health concerns might complicate the recovery process like, for example, someone who might be regularly touching or feeling, you know, their nose after a surgery because they can’t resist the urge to do that.
They might actually cause complications through that process. So it can be a little bit of both.
Yeah, and I mean, I’ve certainly seen people where you know every surgeon they go to says your notice is perfect.
There is no asymmetry that the patient is convinced.
It’s it’s a botched job of a surgery.
We’re and it’s fine. It’s just a psychological complication rather than a medical one.
A couple of questions have come in, Tony saying, how often does a Biddy assessments will need to be done for a patient if they’re coming in every  months for Anti Wrinkle.
Does it need to be done every time?
So that’s a great question. I’ve clarified that with opera as well, and they said that the practitioner needs to do an assessment of the patient suitability every time they come in.
So you know, every time they come in you might be checking on their medical health to check that.
It’s it’s suitable to go ahead with the treatment and psychological health should be included in.
That was the guidance that they gave. So they did say, though, that you don’t necessarily have to do the full assessment every time you can have it.
An abridged version. If it’s a patient who’s coming in quite regularly, you know them well, and so that might be, yeah.
A few questions that you asked to see if anything’s changed since the last treatment that they’ve had.
This question comes in, it says, the initial slides, said that a validated edited tool needs to be used and documented in surgical patients.
Does this mean for a cosmetic medical patient? A validate, a validated tool isn’t needed.
That’s correct, based on the guidelines. For if you say cosmetic, medical, I’m assuming non-surgical, the guidelines for non-surgical.
Don’t say it has to be a validated Bdd screening tool, but you still have to assess for Bdd.
And I think the easiest and simplest way to do that confidently is probably with a validated screening tool.
Some more interesting questions can you clarify whether orthodontic treatment and dental veneers are categorized under cosmetic precedures?
Oh, that’s an interesting one. There is at the start of the guidelines.
There’s quite a comprehensive definition of what non-surgical treatments mean from memory.
I don’t remember seeing those under the list. Yeah.
The. And another related question, Tony, to these guidelines apply to ther therapists for skin at oh, or just medical practitioners registered with appra.
So the guidelines are just for the medical practitioners at this point in that you know if there was a problem with it, I guess the medical practitioner could be held accountable.
But there isn’t any mention of Dermal therapists at the moment.
However, the definition of cosmetic procedures that they’ve given extends to a lot of the treatments that ther ther therapists would do, and I think, considering that these guidelines are now considered kind of evidence-based best practice, it’s really important for derm therapist to be aware
of it, and it might help you to make to work with patients who you might be concerned about, or to help them be more satisfied with the treatments as well.
Yeah, and certainly appraise talked about nurses as well.
And you know, in our work we’ve been talking with like scripting companies.
So nurses working with prescribing doctors, for example, and and essentially everyone’s gonna have to be on board.
If because the nurse is gonna need to be organizing the assessments and handing them to the doctors.
So another.
Yeah, I will. Then I’ll just say one more thing on that as well.
What I’ve heard, as well as there might be more changes that come for the non surgical space, because at the moment it’s very much been focused on cosmetic surgery.
And there was that extra little section for non-surgical procedures.
But I think that there has been talk of looking into that more in the future as well.
Question. Throughout your talk you have referred to treatment. This suggests it has been applied in a non-surgical domain as the tool being validated with surgical patients.
Yeah, so our our cosmetic readiness questionnaire was validated with patient-seeking cosmetic surgery and non surgical procedures as well.
So we had  groups. Yeah, and same with the other Bdd questionnaires on the platform.
They’ve been validated in a few different settings, and some of those are surgery patients.
The another question in an earlier slide you had mentioned only patient second surgical procedures would need to have a valid database screening tool completed.
But non searchable. Am I correct in understanding that screenshot is not needed?
However, at the time of treatment, the practitioner performing the treatment must ensure.
They assess for motivations, expectations and underlying cyclical conditions at a minimum.
So I think. Yes, is the answer. Is that right?
Yeah. And it does say that you still have to assess for Bdd, so as a non-surgical practitioner.
And someone else. How about a questionnaire in paper form that they will fill out before the visit?
Yes, absolutely so. People can do it on on paper form, and there are.
There are lots of questionnaires available for day-to-day that have been validated, and a validated tool is really one where it’s been.
There’s been some scientific review put into it.
And this is what’s called the psychometric properties have been evaluated.
And you can print. You can print these off and use them without any of them, you know, like a standard questionnaire.
I suppose that, and and you’re welcome to do that where you can download Pdfs for nothing from from readymind.com to a year.
The romance software will just score it instantly for you and you go to Pdf.
And it will give some of them have quite complicated scoring rules.
It’s like, if question one, they say, yes.
But if question , they say no, and then quite compared to going role.
So we think the benefits of automated scoring will be, you know, self evident web.
It’ll save, you know,  to  min on scoring the thing, and you’re guaranteed to have it scored correctly every single time someone says, how do we get access to ready?
Mind, let me share my screen.
So I’m ready. mine.com so I’ll just show you the cosmetic readiness scale as well.
So cause medical readiness, questionnaire, photos, is more to sort of question, an aesthetic surgery, appearance, anxiety, inventory. In fact, we’ve got lots of these available, and if you go into here, you can download the Pdf, yeah, you could print that off and give
to them it to them, that it would be quite difficult to score the other way of doing it.
Well, and I encourage everyone to press, administer now, actually, and just take the question.
Naire yourself, just to see what what it’s like.
But you can also press. Sign up here, and it will ask you to put in your details, and then, once you’ve logged in, this is what the platform looks like.
And you can see a list of assessments, cosmetic, grading scale better than Qas.
Appearance, anxieties, inventory, Cosmetic Procedure, Screening questionnaire, also some ones for eating disorders as well, and self esteem, and also health, anxiety.
Lots of people say. Dermatologists in particular have health, anxiety, and then what you do is you can just press, administer, pick a clients, and then they can do it on the computer just like this, or you can just send a link to them as well, and setting a link like in a welcome
SMS or email can be quite good. And then, once I’ve done the questionnaire, a Pdf.
Will be generated with this one of the cosmetic readiness questionnaire.
Consider this person’s in the Yellow Zone overall with a different sub.
Scales are in. Some of them are so, some let me see some other questions.
I’m confused about whether you’re assessing readiness or predicting with risk, which is correct.
It’s a good question.
Yeah, so essentially, we talk about it as cosmetic readiness, because these factors are all associated with.
I guess, risk in the pre-operative period and post operative period, and the factors which might make a patient less ready and prepared for their cosmetic procedure.
So in a way, we’re kind of assessing a bit of both.
But I am.
Yeah, I think I think it’s both so what? Yeah, we’ve defined readiness as as are the risk factors.
Are the absence of risk factors. Yeah, and a psychological risk factors in particular.
I mean, there are a whole bunch of medical risk factors, for example, that we’re not assessing like.
Smoking variety of past is a risk factor. For example, we’re not assessing that we’re just looking at that.
The psychological side.
Rachel asks, is there any extra information regarding the registered nurses, and who wants to become a cosmetic nurse?
And how the the upper guidelines will affect them.
So then, Tony, you know the answer to this. I think.
Yeah, I think, well, the Nursing Board has essentially said, for nurses practicing this space.
They need to be aware of the Medical Board guidelines and treat them as that evidence-based standard of practice and you need to be aware of it because a lot of this responsibility for falls on the prescribing doctor in terms of other changes for nurses apart from the screening
guidelines that might be a little bit out of my scope, so you might have to have a read of the guidelines for that.
And Steve asked, Do patients get a copy of their report?
The answer is that they can get a copy of their report if if you give it to them, or if you press a little button that says, Give a copy of the results to the patient, Trinity asks can the report be updated to online filing system like timely yes, so every time a report gets
completed a Pdf. Is generated an email to you, and you can download that and upload that to time.
Is this platform appra recognized as a valid tool?
That’s a good question. Apra has specified, broadly validated a screening instrument, and the reason I’ve done that is because instruments are evolving all of the time, and so they don’t have a list of ones that are in
and ones that are at it just has to have some scientific rigor to it, and preferably some publications, and have yeah, done statistical things.
Psychometric properties, factor analyses to make sure that it’s measuring what it says.
It’s measuring.
Joanne says, can you please explain how your website works?
If we elect to subscribe Tony, turn to this.
Yes, so I can see I don’t have it loaded up to still have loaded up there.
Yeah, so essentially, if you sign up, it just means you get access to all of the questionnaires, and it will be automated.
And so it means that you can send links to your patients of tools like the cosmetic readiness questionnaire, and all of the other.
Well validated tools. And so, for example, if you generate a link, if they and put it in your welcome SMS, or welcome email, it means when they fill that out, it will land in your inbox and you’ll be able to know whether in the grain yellow or red Zone before they even walk in the
door, and that can be a good place just to start a discussion.
Of course, if they’re in the green zone, it means that you barely have to talk about it at all.
And if they’re in the yellow or red zone, it means that probably focusing initial consultations on whether they’re ready or not would be a good thing.
And so, if you are interested in that, you can press, sign up, and it will ask for your and email address, and so on.
And it will give you a  day free trial, so you can.
So you can see whether it works for you whether it’s the sort of thing that makes your life easier.
And yeah, helps you assess patients better.
Some other questions, lots of questions coming in. I find out how to sort them.
So other questions about, yeah, how often we have to assess them, Tony and I initially thought before we clarify this with appra, that it might be like once a year.
But opera has confirmed that every time they get a treatment or a procedure, and then it’s be assessed.
Someone’s. Michelle has asked Michelle.
You’re asking the best questions. By the way, when you start the your tool covers you.
The surgeon for day-to-day and other psychological issues, and ensures you don’t miss anything.
Are you confident that you have measured all all the powerful predictors or could we be missing something?
That’s very good question, Michelle.
Yeah, absolutely. And I think people are already have systems in place for how they do that consultation.
If you’re a surgeon, if you’re a nurse, if you’re a doctor working in this space, you already have questions that you know, to ask patients like I said about motivations and expectations.
And so this is essentially covering you for the mental health, aspect.
But that doesn’t mean that, you know. You might not find things in other areas of your consultation or questions that you asked to the patient, or things you might notice outside of the questionnaire that could raise a red flag for you.
So it forms a part of your question and make sure you don’t miss anything about the mental health side of things, but it doesn’t necessarily have to be the full assessment.
If you do detect other red flags.
Sarah has asked. Our cosmetic nurse is able to refer straight to a psychologist for an assessment.
Yeah. So I think, referral in the guidelines can be in the loose sense of the word referral, and that you can, you know, recommend that your patient go speak to a psychologist first.
Usually, when I do get referrals to do these assessments, we’ll talk them through.
How the payment works and the options. So if they did want to get a mental health care plan from a Gp, we would send them to their Gp.
To get that referral and come back, but I might have already received an email from a cosmetic nurse or a doctor just explaining briefly why they’re sending the patient over to me.
So in that sense you absolutely can refer. And then if they do want a mental health care plan, we’ll send them back to the Gp.
Yeah, so in order to get a medicare rebate, they’ll need a referral from a Gp.
But but they don’t need a they don’t need a referral like that.
But they just won’t get a medicare, but they might get health insurance.
Someone’s asked, can the patient learn to fake the screening tool and answer the questions that would score lower?
Umhm, so with some questionnaire, that’s definitely a problem if it’s a short Bdd questionnaire, it’s quite easy to fake with the cosmetic readiness questionnaire.
We did include an openness scale which is designed to detect, I guess, how honest and open a patient has been in their responses.
And so if you get a high score on that openness scale, it would then flag you as potentially, being dishonest in that questionnaire.
And so an example of a question like that is, we haven’t used this particular question, but the way I come at psychometric assessments are constructed with these sorts of scales is questions like, have you ever borrowed anything and forgotten to give it back?
If people say strongly, disagree, you think like, oh, really!
Like never, and so it’s a sort of a way of assessing whether someone’s purposely or sometimes by accident, trying to show that their self trinity has us is the app available on apple or android, or both.
It’s available on both its cross platform. It’s in the web browser, so it’ll work on any device.
So, is the $ a month for a clinic, or just a sole practitioner.
So It’s $ for a individual practitioner, and we’ll go to practice plan as well.
Which is more expensive, and you can use it with multiple parties within a clinic and I suppose that I mean we’ve got he’s the people using it.
It’s the practices using it and putting through a fair volume of assessments.
And the feedback that we’ve got from the practices that are doing.
It is just saving them so much time in that it’s now just part of a process there’s no scoring of the questionnaire.
There’s no, you know, paper forms or scanning, or anything.
And so we think that the time saved will be, yeah will be worth it.
At least I hope it isn’t Janelle.
Hopefully. You can let us know if it is saving you.
Much time. Michelle asks. And, by the way, we’ve got lots of questions coming through if you do need to go now, thank you for attending, and thank you, Tony, for informing us about the new upper changes and the screening guidelines we
will. We’ll stick around. Just ask. Answer a few more questions.
But thank you, everyone for attending, and if you’re going to be at Nss next week, Tony will see you there.
Tomorrow. Yeah, we’ll find out tomorrow.
Tomorrow. Yeah. Oh, yeah. Flying out tomorrow.  days.  days.
So farewell. Everyone who’s gonna leave us now, and and we’ll there’s a few more questions that we’ll get to before we wrap it up.
Finally Michelle asks, rather than having a patient go through the  min questionnaire with  questions, the cosmetic readiness, questionnaire Tony mentioned earlier that perhaps the shorter version of the cosmetic ready and this questionnaire can be done at those shorter
intervals. Is there a sheet available on the shorter version, or will it be available on the website?
So what we’re working with the cosmetic readiness questionnaise being able to shorten it over time, because we know  questions can be feel a bit lengthy.
You might we do have shorter Bdd questioners that are only like  items.
I think is the shortest one we’ve got, so that might be something that you decide to do.
You know more frequently every time they come in, but then you can do the more comprehensive assessment.
You know. Do it once a year, potentially, or if they’re requesting a new treatment or something like that, or if you notice a change potentially in their presentation.
But yeah, we’ve got. Yeah, we do have shorter questionnaires on the platform.
Michelle asks, with a green, yellow, and red caviar categories what are you using for your risk, matrix, as the surgeon is now responsible for assessing risks?
I am concerned that the risk has not been defined, and also that you think that % fall in the green zone, that that’s based on the empirical data that we’ve collected in the validation that % of people seeking cosmetic procedures will fall
in the green zone based on the scoring.
How it’s scored so it’s not that we’re guessing.
It’s an empirical observation, most risk models tend to have much greater percentage in the orange zone.
So this is a great question, and the real. So the key thing is that there’s been a whole bunch of which through over the years, showing that more than % of people withd, have worsening or no change in symptoms, and the large proport a similar
proportion a dissatisfied with the with the outcome.
And so we’re really defining risk as worsening in symptoms and dissatisfaction with outcome or and by symptoms I mean worsening in distress.
And dissatisfaction in outcome. So I think that’s I think. I hope we’ve covered all the questions.
Guys yeah, the feedback that we’ve got been really great.
So thank you for attending tonight, you know, and and I suppose you know if come January July first, lots of clinics are already ramping up with their screening processes, and so I suppose, with a week and a half to go hopefully, you’ll have time to figure
out what you’re gonna do, how you’re gonna assess for?
And associated risks, and do feel free to have a look at those Pdfs and download them from the website.
Take the assessment is, and consider a trial of ready mind to see whether it’s gonna suit your needs.
So we’ll we’ll see you at NSS.
With those people who are gonna come and take care and goodbye.
Same. Thanks. Everyone.