The Art of Saying No

Most cosmetic dermatologists and plastic surgeons have encountered a patient (or patients) with unreasonable expectations and know intuitively that these patients won’t be satisfied with the outcome of a requested procedure.

Still, it can be hard to say no, especially when the doctor around the block will likely say ‘yes!’

In these cases, saying no is the ethical thing to do, and saying no in the correct way can actually enhance your relationship with the patient. 

Dermatologists explain how they delicately and definitively say no when they must during a panel discussion that took place at the 2023 Merz Aesthetics’ MEXS Media Days in Barcelona.

Explain why the procedure won’t produce the desired results

It’s more than just a hard no, says Saami Khalifian, MD, a dermatologist and surgeon in San Diego, CA. “You have to facilitate an understanding as to why a procedure is not in the patient’s best interest,” he says. This helps build trust in the long run. If you tell the patient that you can’t or won’t perform a requested procedure, and the patient comes back in the future asking about a different treatment, and you say yes, they are more prone to listen to you, he says. “They see that it is not just a transactional relationship,” Dr. Khalifian says.

Use objective tools to document concerns

 Smith Arayaskul, MD, a dermatologist in Bangkok, Thailand starts his consultations with an analysis using QuantifiCare 3-D camera or the Antera 3D camera for evaluation of skin wrinkles, redness, or pigmentation. “Then, I explain to the patient what is the real skin condition that [they] have,“ he tells AestheticsWire.

Debunk ‘selfie’ consciousness

Some patients come to a cosmetic consultation armed with selfies or highly filtered social media images to illustrate what they do or don’t want. “Explain to the patient that the filter or front camera distorts the realistic condition by comparing it to well-standardized photography,” Dr. Smith says. “Try to explain and evaluate the pathophysiology and separate each problematic condition,” he says. Discuss expectations carefully, especially with patients who have expectations based on digital media or AI-generated imagery.

Consider referrals to a mental health specialist

Some patients may have body dysmorphic disorder, a mental health condition characterized by a preoccupation with a perceived flaw in physical appearance.BDD is best treated with therapy and or medication under the care of a mental health expert.