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What’s Important?

  1. Aesthetic practitioners may encounter patients who present with cosmetic concerns secondary to psychological distress or psychiatric illness. Identifying and appropriately managing these patients is critical to protecting the interests of both patients and providers.

  2. To address challenges and issues during the clinical visit, providers can utilize a variety of techniques to set personal boundaries, screen for psychiatric disorders, and effectively communicate with dissatisfied patients.

What’s New?

  1. The advent of various technological advancements and widespread social media use can adversely impact individuals seeking cosmetic treatment.

  2. Individuals who seek out aesthetic dermatology practices may be more likely to meet substance-related disorder criteria for cosmetic interventions.

What’s Coming?

  1. Research is ongoing to better understand and manage aesthetic-related effects of social media use, racial morphing, and cosmetic addiction.


Interpersonal dynamics are an important component of the aesthetic dermatology visit. Given the elective nature and societal complexities of many cosmetic procedures, the development of positive patient-provider relationships is foundational to conducting a successful clinical experience. Though the majority of the provider-patient encounters go smoothly, aesthetic providers should recognize that some patients present with cosmetic concerns secondary to psychiatric disorders. Dermatologists, plastic surgeons, and other clinicians may be forced to manage psychopathologies in patients with low insight and self-awareness. These patients can present a variety of psychosocial challenges that may affect clinical practice. Learning how to effectively set personal boundaries, screen for common psychiatric disorders, and recognize emerging technology-associated developments in aesthetic trends can improve outcomes for both patients and providers. This chapter provides an overview of psychosocial challenges in aesthetic dermatology and discusses techniques that aesthetic providers can utilize to address and manage these significant, yet underrecognized issues.


Consistently high stress levels have a variety of physiological effects on the body, including poor skin health.1 When compounded by the presence of mental health comorbidities, psychological stress may lead affected individuals to turn to aesthetic professionals to seek cosmetic solutions. Such patients can be very challenging as while they present for the treatment of a cosmetic concern, in reality, they may be suffering from a psychiatric disorder that requires a completely different line of treatment. In some cases, patients may self-perceive significant cosmetic imperfections despite the lack of recognition by others. This creates difficult situations in which patients hold unreasonable expectations of treatment outcomes, disregard time limitations during clinical visits, and violate personal boundaries between themselves and their aesthetic providers.

While the nature of the mental health appointment varies greatly from the average cosmetic appointment, the structured framework used by mental health professionals can be applied to aesthetic appointments. For patients who routinely arrive late, their appointments should still end at the scheduled time to not infringe upon the next patient’s appointment time. Regardless of start time, it is crucial that the aesthetic clinician be as efficient and boundaried as possible. ...

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