Confessions of an aesthetic doctor: how to spend smarter on treatments

If two acne scars bother you more than anything else, treating them may give more satisfaction than addressing five minor features somebody else noticed. A consultation should clarify your priority, not manufacture a longer list of insecurities.

A useful exercise before any consultation: write down, in your own words and without using any treatment names, what you would want to look different. If you cannot fill three lines, you probably do not need three treatments.

Collagen remodelling, pigment clearance, scar improvement and gradual biostimulation do not happen overnight. Adding treatments quickly because the first result is not yet visible is one of the commonest routes to overtreatment — and to paying twice for one outcome.

Take standardised photographs, wait for the expected biological response, then reassess before adding anything. Our article on why skin ages sets out the timelines involved.

Photographs matter more than most people expect. Memory for one’s own face is unreliable, and the mirror is looked at daily, which makes gradual change almost invisible from the inside. Without a baseline image, a real improvement can be dismissed and an unnecessary second course begun.

A reasonable test: if the recommendation would have been the same before you described your concern, it was not a plan.

Treating three things in one visit has an obvious appeal and a hidden cost. If the result is good, you do not know which of the three delivered it — so you repeat and pay for all three. If something goes wrong, you do not know which caused it.

There are legitimate exceptions. Combining treatments that address genuinely different layers, or consolidating downtime into a single recovery period, can be sensible and is sometimes the more considerate plan. The distinction is whether the combination was reasoned or simply bundled.

Price alone tells you very little. Two clinics can advertise the same treatment name while using different products, doses, protocols, operator experience and aftercare.

• A discount that expires today. Medical decisions should not have countdown timers.
• Concerns you did not raise being pointed out and priced.
• No discussion of risks, or risks described only as “mild swelling”.
• Guaranteed results. Biology does not offer guarantees.
• No named product or device, or reluctance to state it.
• Payment for a large package before any treatment has been trialled.
• No plan for complications, or no clarity about who manages one out of hours.
• Before-and-after photographs with different lighting, angle, makeup or expression.

None of these is proof of poor practice on its own. Several together is a reason to take a week and think.

Faces look natural because features relate to one another. Adding volume in one area, aggressively tightening another and repeatedly shifting proportions produces a face that reads as treated rather than refreshed — usually without any single step being obviously wrong.

That is the trap. Each individual treatment can be defensible while the cumulative direction is not, because nobody is standing far enough back to assess the whole. Periodically reviewing the overall trajectory, rather than the next procedure, is worth more than any single technical decision.

For most patients the goal is to look like themselves on a good day, not to assemble a new face from a catalogue.

A good aesthetic consultation should be able to end with “I would not treat that”. There are several situations where that is the correct answer: the concern is not visible to anyone else and is not affecting the patient’s life; the realistic result would not meet the expectation; the timing is wrong; or the underlying issue is not one a procedure addresses.

That last case deserves saying plainly. Sometimes distress about appearance is out of proportion to what is visible, or persists and moves to a new feature each time one is treated. When that pattern is present, more procedures reliably fail to help, and talking to a doctor about it is a more useful step than booking the next treatment. It is a common experience and not a character flaw.

• What exact problem is this treatment meant to improve?
• What result is realistic for my anatomy and skin type?
• How long before I should judge the result?
• What are the important complications — not only the common side effects?
• What happens if I do nothing?
• If I choose only one treatment, which gives the most value for my priority?
• What does maintenance look like over the next year, and what will it cost?
• Who manages a complication, and how quickly can I be seen?