Unhappy cosmetic patients can cause many problems for aesthetic dermatologists. You may have to refund services or address a negative social media review. You may also find yourself emotionally spent from a draining conversation regarding unrealistic expectations from treatment. Yet I’ve found in my years of practice that many times you can identify from the onset which patients may not be satisfied with their results and take steps in advance to best care for the patient and protect your personal and professional wellbeing.
As you establish rapport with your cosmetic patients, look for five red flags that, at the very least, should cause you to pause before proceeding with treatment:
1. The Anxious Patient
These patients are easy to deal with, but you will want to reassure them and break down what they are anxious about before proceeding with treatment. Are they scared of needles? Worried about being over frozen or looking too done up? Maybe they have had a bad experience in the past. Figure out what they are anxious about. For this type of patient, I do not perform the treatment that day. I give them information and tell them to wait until they are comfortable and confident before returning to the office. I also recommend they do their own research before selecting a treatment.
2. The Unrealistic Patient
These patients are looking for a result that is not possible to achieve or an immediate result when that is not feasible. These are usually patients who come in with photographs of celebrities or from when they were drastically younger and are looking to achieve those results. For this type of patient, you must be honest. Managing expectations is the most important element for this patient. Depending on the reason for the visit, I would say the gold standard is always plastic surgery, so if you are looking for the most dramatic result, plastic surgery would be the best option. I make sure they know that the treatments I provide don’t give the same results as plastic surgery, but still can enhance and improve their appearance naturally.
3. The Body Dysmorphic Patient
Everything bothers these patients. Small nuances that you aren’t appreciating on the exam are a big deal to them. Patients who have done multiple treatments and they are still not happy, or they find something else that bothers them about their appearance may fit in this category. I say to them, “Everyone has features that bother them and I understand that, but the features we don’t like may not be obvious or they may look worse to us than is actually the case.” I like to use that line a lot. We must be realistic with these patients — either that’s not the right treatment or it’s not going to look the best. We still need to validate these patients that these issues bother them, but we need to point out that these features are not noticeable or obvious to others.
5. The Very Demanding Patient
These patients are not going to be happy with anything you do. These are the patients you want to stay away from. Say something like, “I don’t think I can accomplish the effect that you’re looking for.” I always try to refer to a more specialized provider, if possible.
6. The Best Deal Patient
These are patients who shop around for the best deal. They might talk about prices of other injectors or even mention Groupon deals. In addition, they may say they can only purchase a certain number of units of the product. With these patients, you will need to explain your pricing and the value of your practice. Explain that you can’t give them the desired result unless you use the full amount of product. Remember that these patients are unlikely to be loyal to your practice, so it’s not worth haggling with them.
Even with patients who don’t have any red flags, a cosmetic patient can still walk away unhappy. It’s important to set expectations with every procedural treatment. With procedures that can provide hit or miss results, explain that you can do the procedure but that the patient may not be completely satisfied. I use this approach when offering PRP injections. What works for one person may not work for another. If the patient is willing to try it, that’s great, but I always explain that there are no guarantees with any cosmetic treatment.
When treating icepick acne scars, I set the expectation that these are extremely heard to treat, and they are never going to go away completely. The goal is to blend the scars in and make them not as noticeable. With other procedures, I say Rome wasn’t built in a day. Sometimes I give percentages – patients like that. I try to downplay the anticipated results – under promise and overdeliver.
The most important thing to remember is to have an open and honest discussion during the consultation. You always want to acknowledge what the patient is saying or asking for, but the key is relaying honesty at the start. It’s ok to not treat a patient who is unrealistic in their expectations or anyone who you do not feel comfortable treating based on their behavior. If you do embark on treating them, you must be mindful of any potential issues that can arise.
Remember: If you are uncomfortable treating the patient, don’t treat them. If your goals are not aligned, it will cause you more grief in the end. Make sure you document everything that is discussed, especially expectations of treatment improvement and goals. While I have been surprised by unhappy cosmetic patients, most often these patients were very demanding from the first visit. If you can develop a rapport with the patient, and feel comfortable and confident in yourself, even if they are unhappy about a service or treatment, they are more willing to stick with you and work with you.
