The Unhappy Patient

By Dr Qian Xu / 03 Aug 2018

Dr Qian Xu explains how new practitioners can avoid an unhappy patient and provides tips on how which to deal with one should the situation arise.

Have you ever had that heart-sinking moment when you receive communications from a patient you had treated a couple of weeks ago saying, “I’m not happy with the result, you need to sort it out otherwise I want my money back”? Although this is a scenario that none of us want, I can guarantee that it is something that all of us will come across at least once in our aesthetic careers.

Despite all of your good intentions and doing the best treatment that you can, sometimes the patient is still unhappy with the result. This can be very upsetting and can really damage your confidence. As if that’s not bad enough, if your patient is really unhappy, they could give you a negative review on your social media sites, speak badly of you to other people within the specialty, or even decide to take legal action. Needless to say, this would be devastating for you and your business. Being able to deal with the unhappy patient effectively is a vital skill you need to learn, and often this is not something that is covered in your foundation training. In this article, I will talk about three common scenarios in relation to the unhappy patient and explain my management approaches.

I would always encourage you to select patients that you can build a long-term relationship with

When you should say no 

I believe that the most effective way to reduce the number of unhappy patients you treat is to learn to say ‘no’ to the wrong patients. This will be really difficult to do when you are first starting out because getting patients through the door is not easy, and you will want to do whatever it takes to keep them. It’s a bit like looking for a partner when you are single, if you just go for the first person who comes along and try to make it work, there is a good chance that one or both of you will be unhappy and the relationship won’t last. 

I would always encourage you to select patients that you can build a long-term relationship with, for example, patients who share your values and understand what you tell them. It does mean it’s a slower way to grow your business, however it also means that your business will be built on solid foundations and will last for the long term.

As a general rule of thumb, I would avoid treating those who:

• Have unrealistic expectations and lack insight into how they can’t be achieved

• Do not understand what you are trying to explain to them

• Have already been over treated

• Are difficult to get on with

• Go from practitioner to practitioner and do not stay loyal to any one person

• Do not have a realistic budget for your treatments

I also believe that body dysmorphic disorder (BDD)1 is an area that needs to be treated with extreme caution because this is something that you are likely to see quite a lot in your aesthetic practice. BDD is a mental health condition characterised by obsessive worries about perceived flaws of one’s body, which other people cannot see. Individuals often develop compulsive routines to deal with these worries, such as regular mirror checking or picking their skin. The severity of BDD symptoms can vary from day to day and among individuals – even in the same person. According to an article published by Bjornsson et al in 2010, BDD is relatively common, with a prevalence of about 2% in the general population and can be as high as 53% in the cosmetic surgery (including surgical and non-surgical) setting.2

In my experience, this is a group of people you should definitely not treat because evidence has shown that cosmetic procedures do not make them feel any better about themselves even though the procedure was a success in the eyes of the practitioner.3 Furthermore, you could make their BDD worse.4 What they need is psychiatric input, not aesthetic procedures. Therefore, it is really important to screen for BDD, and there is an easy-to-use online screening questionnaire you can use from The BDD Foundation.

If BDD is indicated, then it is your duty not to treat them. By saying no to the wrong patients, you will not only save yourself a lot of unnecessary hassle, but will be acting in the best interest of those with BDD or BDD traits. This will mean that you will have more time for the right patients who will value your time and expertise.

I believe that the most effective way to reduce the number of unhappy patients you treat is to learn to say ‘no’ to the wrong patients

When you are happy but they are not

So, what if you have been selective, but you still get a patient who is not happy with what you have done, even though it was some of your best work? This can and will happen from time to time.

What you need to do first is to talk to your patient, listen to what they have to say and understand what it is they are upset with. You need to understand exactly why they are not happy. Maybe they weren’t 100% sure about the treatment in the first place; maybe a friend made a negative comment about them after the treatment or maybe the results weren’t as dramatic as they had hoped they would be. It’s also important to find out what they are expecting you to do about it. Never assume that they want a top up or their money back. Most of the time, they just need to be listened to and know that you are prepared to make things better for them.

Once you have understood why the patient is unhappy, then you can discuss the solutions. Often, this means educating the patient better about what is realistic, and if there is nothing drastically wrong, you can talk about what you can do differently in the next treatment. It is possible that they may not want another treatment with you, and they may ask for a refund. If they feel very strongly about it, it may be better to just give them the refund and let them go. However, in my experience most patients will appreciate the fact that you took time to understand the problem and that you are taking steps to resolve the issues.

There is no one-size-fits-all solution, so be guided by what they are expecting, as to what solution you offer. Personally, even if I have done nothing wrong, I would still offer some gesture of good will, such as a free skincare product or the next treatment at a reduced cost. If the situation is handled well, the patient will have more respect for you, and could become one of your most loyal patients. Even if they are still unhappy about the result and will not come back to you again, they will hopefully be less likely to post terrible reviews about you online. You see, just because a patient is unhappy about their treatment result, it doesn’t necessarily mean they are unhappy with you.

When you have got it wrong

Sometimes, you just have to own up to the fact that your treatment didn’t work quite so well. Becoming a great injector, for example, will not happen overnight, and to expect all of your treatments to turn out perfectly is just unrealistic. However, you shouldn’t let the fear of getting something wrong stop you, because the only way to get better is by doing and learning from mistakes. Having said that, it is vital that you have had appropriate training on how to inject safely to avoid complications and know how to deal with them if they arise.

I believe that if the patient is unhappy because your technique wasn’t good enough, then it is your responsibility to correct it at your own cost. It means that you might be running your business at a loss initially, but view the situation as money spent on education and think of this as an investment. By bettering yourself, you will significantly increase your earning potential for the future. In my opinion, learning from real life situations is the best way to learn and the pain of having to spend your own money to correct mistakes will hopefully mean that you will not make the same mistake twice.

Taking responsibility for your own actions and being willing to sort out any issues that arise is what will make you stand out above the crowd. Most patients are reasonable and they understand the risks, and if you show that you care and see them through a problem, they will come back to you again.


The topic of ‘the unhappy patient’ is complex, and I have only scratched the surface in this article. A lot of complaints can be avoided by selecting your patients carefully and managing their expectations. When you do get an unhappy patient, rather than taking things personally and getting upset, offer a solution, reflect on it and try to find ways to avoid it next time. It’s also good to network with other practitioners, so that you can share your experiences and support each other. I would advise joining aesthetic communities; there are many on Facebook such as the one I run, the Aesthetics Practitioners Community closed group, or organisations such as BCAM and BACN. I’d also recommend attending as many events as you can to help you connect with other practitioners.

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