Manual Dexterity Does Not Predict Early Practice Outcomes in Aesthetic Medicine: A Retrospective Study

Abstract

Introduction

Manual dexterity is essential in procedural disciplines, and has long been correlated with technical competence (Gallagher & Satava, Surg Endosc 2002; 16:151–155). Dentists, given their precision-based background, often outperform peers in fine-motor tasks. However, real-world success in aesthetic medicine depends not only on hand-eye coordination but also on risk tolerance, confidence, and professional autonomy.

Research in surgical education has shown that whilst dexterity contributes to initial proficiency, clinical confidence and decision-making ultimately drive procedural independence (Schlick et al., Ann Surg 2016; 263:1212–1217). This study examines that relationship within aesthetic training.

Methods

Study Design

Retrospective observational analysis of 40 healthcare professionals completing Harley Street Institute foundational injectable training (January–May 2024).

Skill Assessment

Injection technique was video-recorded and rated independently by two blinded assessors using a 3-point ordinal scale:

Average scores produced each participant's Injection Skill Score.

Follow-Up

At 4–6 weeks post-training, participants reported whether they had performed independent injections (botulinum toxin or dermal filler) outside the training environment.

"Independent practice" = ≥ 1 unsupervised treatment on family, friend, or client.

Statistical Methods

Differences between groups analysed using unpaired t-tests (skill) and chi-square or Fisher's exact tests (practice). Significance at p < 0.05.

Results

Dentists demonstrated greater technical proficiency yet were less likely to apply it within six weeks. Amongst medics, even those with no prior injection experience frequently began independent practice soon after training.

Common themes amongst dentists who delayed practice included fear of complications, regulatory uncertainty, and integration issues with dental practice workflow.

Discussion

These findings indicate that manual dexterity does not predict early real-world implementation in aesthetic medicine. Despite superior technique, dentists were slower to initiate practice, suggesting other determinants at play.

1. Confidence vs. Competence

Psychological models, including the competence–confidence curve (Kruger & Dunning, J Pers Soc Psychol 1999), describe how inexperienced individuals may overestimate ability, whilst skilled professionals exhibit self-doubt. In this cohort, medics may have over-estimated readiness, prompting earlier practice, whereas dentists—aware of risks—acted cautiously.

2. Fear of Complications

Fear of vascular occlusion or blindness remains a top barrier for new injectors (Stewart et al., Plast Reconstr Surg Glob Open 2021; 9:e3674). Dentists' surgical training may make them more acutely aware of these risks, leading to delayed action despite high technical ability.

3. Professional and Regulatory Influence

Dentists operate under the General Dental Council's strict competence guidelines, often leading to hesitation until indemnity and advertising compliance are secured. Medical practitioners, particularly nurses and non-surgical doctors, face fewer structural barriers and often greater motivation for new revenue streams, encouraging rapid adoption.

4. Access to Patients and Practice Logistics

Dentists frequently cited logistical hurdles—such as lack of setup, product ordering, or appropriate space—as reasons for delay. Conversely, medics leveraged existing contacts or informal networks for initial cases.

Limitations

Small single-centre sample, self-reported outcomes, and limited follow-up period constrain external validity. No baseline confidence or risk-tolerance data were recorded. Nonetheless, statistical trends were strong and internally consistent.

Conclusions

High manual skill alone does not ensure early practice transition. Psychological readiness, risk perception, and system barriers significantly influence post-training outcomes.

Aesthetic education should pair technical mastery with confidence development and structured mentorship to enhance translation of training into practice.

References

1. Gallagher AG, Satava RM. Virtual reality as a metric for the assessment of laparoscopic psychomotor skills. Surg Endosc. 2002; 16(1):151–155.
2. Schlick CJR et al. Psychological determinants of operative performance amongst surgical residents. Ann Surg. 2016; 263(6):1212–1217.
3. Kruger J, Dunning D. Unskilled and unaware of it: how difficulties in recognising one's own incompetence lead to inflated self-assessments. J Pers Soc Psychol. 1999; 77(6):1121–1134.
4. Stewart KJ et al. Global trends and complication management in facial injectables: a survey of 700 practitioners. Plast Reconstr Surg Glob Open. 2021; 9(11):e3674.
5. Drossos C et al. Bridging the gap between simulation and operating room performance in surgical education. J Surg Educ. 2020; 77(5):1103–1110.