How Managing Aesthetics Patients’ Expectations Can Make You More Successful

Managing aesthetics patients’ expectations is vital to being a successful clinician.  In fact, doing this well can elevate your business and help you to build a loyal client list that refers others. 

The importance of this aspect of practice is often underestimated and misunderstood, so let us explain: 

• Why effectively managing patient expectations can make you more successful 
• The role understanding patients’ treatment motivations plays here 
• How to ensure you give your patients the most realistic idea of what can – and cannot – be achieved through aesthetic treatments.

This is a topic our Chief Medical Officer, Dr Emily Mehta spoke to Hamilton Fraser about for their podcast. You may have seen some of the clips published on their social media channels, or the Harley Academy Instagram account. 

As an experienced medic, educator and expert aesthetic practitioner at STORY Clinics in Marylebone, London, as well as her work with The Academy Clinic, Dr Emily has plenty of valuable expertise in this area. 

Here we explore her advice on this topic, plus some practical insights you can use in your own practice. 

Properly managed patient expectations are a win for both parties 

Dr Emily explains that properly managing patients’ expectations is important as “it has such a strong correlation between how well your clinic goes. This impacts outcomes for both the patient and you as a practitioner – not to mention how much you can enjoy your job!” 

As an aesthetic practitioner... 

Dr Emily advises that solid expectations management can: 

• Inform your treatment planning  
• Help you to deliver results your patients are happy with and you’re proud of 
• Minimise the chance of patient disappointment or complaints 
• Give you a sense of achievement and job satisfaction 
• Ensure your clinics go well and you enjoy your job! 

As a patient seeking injectables... 

She notes that ensuring treatment drivers are properly explored and realistic ideas of what’s achievable are discussed, can help patients to understand: 

• What you can deliver – and what you can’t 
• The timeline involved in achieving their desired outcomes 
• Why certain treatments won’t work for them or aren’t suitable 
• The extent of what’s involved so they can make an informed decision about whether they want to continue 
• That you care about them and are not just taking their money! 

Part of high standards of patient care 

At Harley Academy, we champion high standards of patient care and believe all aesthetic practitioners should strive to provide an optimal, ethical service.  

"Having high standards can help you avoid some sticky situations with patients you shouldn't treat,” shares Dr Emily.  

"It's so essential that both patient and practitioner understand each other so they can feel good about the outcome. This is why I cannot stress enough the importance of having a thorough consultation that really delves into their ‘why’ - their motivations for treatment. 

“People often talk about aesthetic results,” she says. “But you can deliver a perfect outcome but if your patient's unhappy with it, there are a number of negative implications.  

“You can be disappointed and feel like you haven’t achieved very much. Even more worrying, you could end up dealing with complaints, which is stressful and time consuming. These can also negatively impact your business if the patient shares their feedback with others, especially online.” 

Conduct a thorough clinical consultation including psychological drivers 

Dr Emily emphasises, “Taking the time to evaluate your patient’s desire for treatment from a psychological point of view, is so worth it. The better your understanding of what they want and, most importantly, why they want it, the better your treatment plan will be. By spending this extra time to decipher what they really hope to achieve – which can be at odds with what they’re actually asking for – the more successful the outcomes should be. 

“Sometimes, what you discover will mean you have to refuse treatment or delay it, which can be tricky. It is, however, part of maintaining your professional integrity and something you shouldn’t be afraid to do.” 

Don’t underestimate the value of honing your consultation skills  

When it comes to patient discourse and clinical consultations, Dr Emily confesses, “I actually think it's the hardest part to learn and the hardest part to get good information on. A lot of it is more about learning from other people's mistakes, learning from the experience and wealth of knowledge that's out there.” 

You can find some helpful insights in our article, Perfect Your Aesthetic Patient Consultations. 

She continues, "How well you can handle this side of practice has the biggest impact on how much you enjoy your job. I think a lot of medical practitioners moved into aesthetic medicine to reduce stress, to work in an environment where you're dealing with positive scenarios, to have a better work life balance.  

“Unless you understand how to comfortably deal with all sorts of different types of patients then you can just bring that stress and poor work-life balance with you into aesthetic medicine.” 

How to conduct a thorough clinical consultation is covered in all Harley Academy filler and botox courses aimed at healthcare professionals starting out in aesthetics. We believe this is a fundamental part of your development as a safe, responsible and ethical practitioner.  

Examples of challenging psychological drivers for aesthetic treatments 

These are just a few examples of patients’ reasons for having treatment which may indicate this route is not for them. Further exploration is required so you can make your decision as to whether treatment is appropriate or not. 

• “I hate how I look; I can’t stop thinking about my appearance” - This type of statement suggests there may be elements of body dysmorphia at play. Treating could reinforce unhealthy behaviours and go against their best interest. They’re also unlikely to be happy with the results due to unrealistic expectations and more complex psychological challenges 
• “My friends have botox so I want to” - This could be a case of societal or peer pressure, explore further to find out if this is the patient’s sole driver or if they have other reasons for wanting treatment. You need to be clear there is no external coercion 
• “I feel invisible/unattractive” - This type of statement indicates low self-esteem and a patient who may want treatment simply to gain external validation. Consider whether the patient is relying on external changes to address internal psychological struggles 
• “I don’t want to look old – I need to stay young-looking, it’s part of my identity” - Whilst ‘anti-ageing’ is a goal for many patients, tying their identity to looking young suggests they may have deeper concerns that need exploring. Talk about their fears of ageing and how the procedure fits into their broader mental and emotional needs 
• “I want to look just like [celebrity]” - Not only does this type of statement show a lack of understanding as to what injectables can do, it also suggests a fixation on unattainable beauty standards. Wanting to look like someone else also hints at low self-esteem or discomfort with themselves.  

“In the above scenarios, treatment is unlikely to be a good option as there are indications that their concerns run deeper than they’re expressing,” notes Dr Emily. “Determining their true reason for seeking treatment will help you to decide how to proceed. Be guided by their responses, your ethics around patient-centric care and your gut feeling. Don’t discount your intuition - as medics, we often develop a ‘sixth sense’ about when things feel off.” 

Dr Emily’s tips for managing challenging patient expectations 

“The main way you can help patients is to explain, explain, explain,” shares Dr Emily. “Talk them through the limitations of treatments and what could go wrong. Make sure they have a good understanding of what you’re saying. This is an essential part of the informed consent process.  

“As long as you ensure your patient feels like you’ve listened to them, have heard what they’re looking for and why, you should set a good scene. From here, offering your honest, medical opinion and explaining it clearly so they know you have their best interests at heart, is the best way to proceed.” 

She concedes that there will always be difficult cases, however. “With the best will in the world,” she says, “you can do all that perfectly and still might not have managed their expectations. 

“Some patients walk in the door with unachievable, unrealistic expectations. In some cases, there's nothing that you can do to change that. When this happens, you need to be able to see the situation for what it is and decline treatment. The more experienced you become, the better you’ll become at sensing when there’s an issue – sometimes even before they get to see you in clinic.” 

If it becomes untenably challenging to have this conversation about refusing treatment in-person, you can always invoke the ‘cooling off’ period.  

Medical bodies generally recommend offering patients a ‘cooling off’ period after their consultation as best practice. This allows them to fully digest and reflect on what you’ve said. They can then make an informed decision about whether they want to proceed with any plan you may have put forward, if they’d like to look at alternative options or they may decide they don’t want treatment after all. 

Don’t be afraid to turn patients away 

Never be afraid to turn a patient away because you worry that you’ll lose business. If there’s an issue that means the patient may be suitable at a later date, offer to reschedule them and explain the delay. Where there may be more appropriate treatments than the one they want but aren’t suited to, you can explore the options, then ask them to go away and consider these. 

Dr Emily says, “A patient who understands why you’re telling them the treatment is unsuitable for them will appreciate your honesty and integrity. Of course, they may be emotional about it in the moment as they’ll likely be disappointed. But if they continue to push you to perform the treatment when you’ve explained why you’re not comfortable doing so, this further confirms your decision. 

“Patients who push for treatments they’ve been told they aren’t suitable for are not patients you want. These tend to be the patients who won’t be happy with any results, no matter how good they look. This, again, comes down to the evaluation of their psychological drivers behind having the treatment.  

“In these instances, you’re best referring them to a mental health professional – though this needs to be done with extreme sensitivity. 

“I would encourage practitioners to have a low threshold for actually saying that a treatment isn't right for that person, always bearing in mind that it's not right for them at that point in time. You don't necessarily need to rule them out completely. And if possible, you can always suggest an alternative either from yourself or from a colleague or another clinic that you have a good relationship with.” 

How Dr Emily handles rejection discussions 

Dr Emily shares, “These discussions are usually somewhat awkward but they’re definitely something I've got better at, and more comfortable with over the years. It is a skill you can learn. I used to be terrified of saying no - I definitely made some blunders.  

“But now, I start by making sure I’ve forged some sort of good relationship or rapport with them, even if it's just a single encounter before I give them bad news. That way they know it's coming from a good place, and I genuinely have their interests at heart. Then I just explain wholeheartedly and candidly why I can't treat them, which is because I care about this equally.” 

Set and maintain your professional boundaries 

She notes, “Some aesthetic practitioners, especially when they’re starting out, allow their own boundaries to get pushed by certain patients. Patients that have a very strong driver for treatment are highly motivated to get this treatment. They think they're going to get it ‘or else’ and they have high expectations of the results. Not only what they'll look like, but what those results will do for them in their life. They might think this result is going to fix their relationship, get them that job, change their self-esteem - so they can be very pushy.  

“Practitioners with less experience might drop subtle hints that maybe this isn't the right way to go. They’ll say that maybe they aren't comfortable doing this treatment. But unless they take that bold step of being explicit in saying no, they can find their own boundaries crossed and can end up doing treatments they're not comfortable doing. Sometimes, this can be the start of a downward spiral of problems and a very stressful situation for both parties. 

“You definitely don't want to be worried about lost business in terms of revenue. There are always more patients out there and the difficult patients, if you do choose to treat them, end up costing you money. It takes years to build a reputation and a few minutes to ruin one. 

“You work hard to earn your status as an ethical, transparent clinician– investing in the best aesthetics training, taking your time with appointments rather than squeezing in as many patients as possible with little consultation time. Don’t risk all this for the sake of appeasing someone you know is not right for treatment.” 

All information correct at time of publication