How to tell a patient that they are overdone

Dr Tim Pearce

June 30, 2022

How would you handle this situation? Someone you know – a friend, family member, or patient – has clearly overdone it with their aesthetic treatments. They think they look amazing, but you think otherwise.

As aesthetic injectors, this is a dilemma that you may face. None of us want to cause harm to our patients by telling them the truth, even though they are already harming themselves by overdoing treatments, so how do you address this quandary?

In this blog, Dr Tim Pearce will discuss ways that you can let the person know that you feel they have had too much cosmetic work done without damaging your relationship, especially with friends and family; and how to constructively inform a patient whilst maintaining their trust and confidence in you.

Do you feel anxious about causing complications? Many clinicians feel so overwhelmed with the thought of causing a vascular occlusion that it stops them growing their aesthetics business. Dr Tim is currently hosting a webinar series to help you overcome your fear of complications so that you can uplevel your knowledge, and increase your CPD-certified learning to build a successful aesthetics business. Sign up here >>

Why is it tricky to tell someone the truth if they have overdone their aesthetic treatments?

Intuitively, we are aware that there are multiple factors that go together to make someone happy. Therefore, it is possible that someone could be over treated and happy, but if you tell them that they are over treated, you could make them less happy, or unhappy, and then you have done harm to them. This is what makes it so tricky because you do not want to take that risk of being the bearer of bad news, even if you are correct, for fear of harming your relationship, because no one likes to be criticised. This alone stops many people from speaking up, whether to friends, family, or patients.

How to approach telling a patient they look ‘overdone’

Firstly, you need to be clear about your ultimate goal. For Dr Tim, the only reason why you would or should do this is because you have the other person’s interests at heart, and they are aware that this is your motivation.

Firstly, you need to be clear about your ultimate goal. For Dr Tim, the only reason why you would or should do this is because you have the other person’s interests at heart, and they are aware that this is your motivation.

The decision-making process is complex – Dr Tim believes that we are all trying to orient ourselves using different methods or models – aesthetic, social, and psychological.

The aesthetic model

Taking the aesthetic model on its own, your only justification for telling someone that they are overtreated is simply that you are stating fact: they are overtreated – you are technically correct and therefore feel that you can tell them whatever you like, without concern for how it may affect them psychologically. You have the aesthetic rules on your side, it is black and white. There are practitioners in the aesthetic sector who will use this as their sole justification for opening their mouth, but there are other considerations.

The social model

With the social model, your justification to decide to tell someone that they are overtreated is that other people are not reacting well to them; this is a valid concern. The ability for humans to collaborate with other humans is vital to our survival, so if your concern is that the individual is no longer able to socially interact and collaborate well with others because they look so overdone, then it is a valid reason to interject. However, you must also consider the psychological justification.

The psychological model

If the patient is very happy and loving life, but some people do not like their face, it could still be, on balance, better for them to be overtreated. If they were to have no treatment at all, it could knock their confidence, thus, despite no one having an issue with their face, they would not be collaborating well because they do not look like a confident person.

Many aesthetic practitioners will use this psychological anomaly as a justification for over treatment –

“if the patient is happy, I will overtreat them; because as long as they are happy, I can justify my particular intervention”.

This view, along with the other models, are too narrow to use in isolation in your decision-making. We must combine all three into the medical model.

Using the medical model of decision-making in aesthetic practice

The medical model involves making decisions with your patients’ overall health at the centre of your decision-making, and it is no different when it comes to how you approach telling a patient that they are overtreated. Download the essential guide to the medical model for cosmetic procedures.

Obviously, if the person is not your patient, but a family member, for example, your mother or aunt, perhaps, then it can be problematic and difficult because they are not seeking your advice. How do you tell someone, or try to guide someone, or influence them, when they are not asking for your help, and in their world, everything is fine?

You can think about it in the same way that you would approach a consultation, explains Dr Tim. You start by exploring their relationship with their face, you are not being judgemental, simply curious. Ask your overtreated family member, what it means to them to have had that treatment. What do they love about the result?

This approach should get them to open up and be positive about your interest. Phrasing your questions well, with genuine curiosity, can get them talking about the subject. Your next step is to influence them.

Dr Tim’s top tip for doing this is to ask for their permission first to avoid offence, rather than just offering your unsolicited observations. If you create a situation where you ask for someone’s permission to give them some feedback, they are likely to be more open to receiving it and taking your concerns on board. Once you have their permission, you still need to think about how you deliver your feedback.

Dr Tim’s next top tip – and this works for managing people within a business too – is to approach this using the ‘shit sandwich’ concept – starting with something good, filling with something bad, and ending with something good.

For example, you may say something along the lines of –

[GOOD] “I think you have maintained your appearance really well and I love that you have done ‘certain treatments’,

[BAD] “but I think your lips are a little overtreated,

[GOOD] “however, if you correct that you will look amazing for your age.”

This tactic should preserve the relationship with the individual and make them feel that you genuinely care about them, whilst also giving them the message that they need to hear. Make sure you are genuinely on their side and not simply criticising them; most people will be grateful if your advice is good, and you have done it in the right way.

If they are your patient, it is often easier, and it is implicit in the arrangement that you are there to give them advice, but again, it must be structured carefully so avoid causing harm.

Dr Tim’s top tip is to be humble in your consultation. Humans are complex and what makes them happy is complex – plenty of people have body modifications, tattoos, and other expressions of individualism that make them happy, but are not part of the medical model, including the way some aesthetic treatments are performed. A person who looks very obviously augmented, could, in theory, be better off for it. If you are concerned, you can use Dr Tim’s body dysmorphic and body modification check list.

Be humble when engaging with your patients, investigate them carefully, separate out the psychological, social, and aesthetic justifications for their look and try your best to always act in people’s best interests, and be delicate.

Have you got any friends or family who are overtreated and you are desperate to say something but too fearful, or you have tried to tell them and want to share how it went – good or bad? Dr Tim would love to hear your experiences. You can find Dr Tim Pearce on Instagram if you have a question on complications in medical aesthetics that you want him to answer.

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Aesthetics Mastery Show

Dr Tim shares more about how you can constructively inform a patient whilst maintaining their trust and confidence in the latest episode of the Aesthetics Mastery Show.

Response from Lip Filler Practitioners

The show has had interesting response from aesthetics professionals and prompted some great discussions:

“I recently had a tough conversation with an overdone person seeking treatment from me. As you say, it is a very delicate topic to discuss, specially when there are some BDD signs… Things got a bit intense at some point but I stood firm in my position not to perform the treatment she wanted done by telling her I didn’t believe it was in her best interest and I couldn’t deliver the results what she was looking for. She finally left disappointed. Definitely gave me a lot to think about afterwards.”

Valeria Saavedra

“I’m curious when you get the opposite reaction than you thought such as they still want the service. Do you tell them no?”

l3EAUTY and Glamour Magick

“Absolutely tell them no and using anatomy, proper proportions, explain why you they aren’t ready for more filler.”

Fluffy Kittens

“In our practice we encourage a natural look and keep within the natural proportions. Absolutely yes you can push these boundaries but not so far that’s going to cause them psychological harm which could be from the responses from others. If it’s not something that sits right from your boundaries then you say no. Remember it’s your work they’re going to say when someone asks them who did your treatment. Kind regards Mary. Clinical advisor for Dr Tim”

Dr Tim Pearce

“I had a new patient consult a couple of days ago. Her lips were so awful that I was worried about other patients in the waiting room thinking that was my work. She is a sweet lady and indicated that she wants me to be her provider going forward. I worked my way into to asking about the lips, as she has had many procedures. She was injected by a well known and highly successful plastic surgeon in our area, with silicon! I am simply beside myself. It is the worst lip augmentation I have ever seen in my patient population. I am embarrassed for her, but she didn’t express any concern over it. I guess I just have to let that one go, because other than a highly invasive surgery, I don’t think that there is anything that can be done. I’m sad that I feel embarrassed to have her as my patient, because I have a very natural aesthetic for myself and my patients. Any other suggestions? Thanks for the shit sandwich suggestion. I have been getting a lot of new patients that should be dissolved, and I will use that technique more mindfully!

“Also, she seemed quite happy in general. ¨̮ She did not complain about any of her previous work, but I am certain that people must be horrified.”

Randee Kuehler

“Good evening Randee. This is such a tricky situation and our best advice would be not to take on any treatment with this lady. There is clinical risk when treating near silicon. There is high incidences of granulomas and they tend to be the worst complications. We would recommend that you use this evidence to avoid causing her psychological harm rather than the criticism of her appearance which you can not fix if she is happy with it. Kind regards Mary. Clinical advisor for Dr Tim.”

Dr Tim Pearce

Read more and join in the debate on our YouTube channel.

Further resources

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Dr Tim Pearce eLearning

Dr Tim Pearce MBChB BSc (Hons) MRCGP founded his eLearning concept in 2016 in order to provide readily accessible BOTOX® and dermal filler online courses for fellow Medical Aesthetics practitioners. His objective was to raise standards within the industry – a principle which remains just as relevant today.

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