Most Aesthetic Disappointment is Caused by Lack of Continuity between Treatments, Regardless of Devices Used and Skilled Injectors. Most aesthetic disappointment is caused by lack of continuity between treatments, regardless of the devices used and skilled injectors. Even the best clinical work will have an aesthetic that keeps drifting because of lack of continuity between treatments.
Care planned across years instead of across visits relies on four components of care, assessment inputs, treatment sequencing, maintenance design and review points.
Why continuity, not technique, decides the outcome
As aging occurs in layers with decreasing collagen density, increasing amounts of brown pigment, a flushed skin color and decreasing fat pads in the cheeks, the various factors of aging can change at different rates. Thus, while a single modality can treat one or two factors of aging, those factors that are not treated will continue to change, thus creating an ever widening gap between the features that have been corrected and those that have not, even though each individual treatment was very successful in correcting the features that were treated.
The cost of unstructured booking
Treatments that are done on an as-needed basis also waste a lot of clinical capacity. For example, someone books a resurfacing treatment in July, and by the time the treatment is to take place in the fall, the optimal time for recovery from the resurfacing has long since passed. Someone who returns for a neuromodulator treatment at 7 months has allowed full muscle recovery, and therefore full retraining of the muscle by that time. Therefore, all of the benefit of the consistent dosing of the muscle will be lost.
The assessment a multi-year plan rests on
What can be permanently changed? What can be slowed down? And what needs to be maintained on an ongoing basis? All of these things can be individually priced and scheduled out for the client.
- Standardized photography under fixed lighting and head position, repeated at every review, ideally with cross-polarized and UV capture for subsurface pigment and vascular mapping
- Fitzpatrick type alongside a realistic assessment of post-inflammatory hyperpigmentation risk, which drives energy device selection more than type alone
- Cumulative sun exposure history and current photoprotection behavior
- Medication and supplement review, particularly retinoids, anticoagulants, isotretinoin history, and GLP-1 use, which changes facial volume trajectory
- Stated priorities ranked by the client, not inferred by the practitioner
Separating goals from complaints
A complaint is typically a current problem that needs to be fixed. A goal, on the other hand, is typically amorphous and unstated. Thus, the patient with nasolabial folds wants to look less tired. Thus, in addition to treating the nasolabial folds, one must also add in midface support and periorbital correction to reach their goals. These complaints and goals must be recorded for each patient and reviewed at each follow-up visit to stay on track and not get stuck treating complaints instead of working towards your goals.
Sequencing treatments across the calendar
Another way to look at work is to look at how you can structure a treatment plan to work in phases or in steps to eventually reach a goal for the patient. So for example, you could be working to stimulate collagen for a period of time and then transition to a plan to add volume, and then to a plan to decrease pigment. Each step of the way can have its own end point, and can be something that the patient can see and work towards.
| Phase | Typical duration | Representative work | Review trigger |
| Correction | 3 to 6 months | Resurfacing, pigment and vascular treatment, acne control, initial neuromodulator dosing | Photographic comparison at completion of the series |
| Consolidation | 6 to 12 months | Collagen stimulation, structural volume decisions, scar and texture refinement | Twelve month assessment against original goal |
| Maintenance | Ongoing | Scheduled neuromodulator intervals, light resurfacing, home regimen adjustment | Annual review, or any change in health, weight, or medication |
Seasonal constraints worth planning around
Deep peeling treatments, such as ablative or deep non-ablative peeling, can only be done during lower UV months. Therefore, the scheduling of these types of peeling treatments can be determined by counting back the number of weeks prior to the intended date and time of the treatment for the appropriate amount of time to complete a priming treatment (i.e. A tyrosinase inhibitor or a retinoid) prior to the peeling treatment. Counting forward in time from the date and time of the peeling treatment would allow for the appropriate amount of time for the peeling treatment to heal without conflict with travel or other significant events.
Structuring maintenance so people actually return
As with any service that requires repeated treatments to produce lasting results, maintenance fails when economics and friction get in the way of good sense and sound clinical practice, which is one reason a Jacksonville medspa that builds recurring visits into its own scheduling is worth seeking out. Design the commercial structure to match the clinical interval of repeat treatments.
- Book the next appointment before the current one ends, at the interval the modality requires rather than the one the client suggests
- Price recurring treatments as a subscription or banked credit so the decision is made once
- Bundle home care into the plan, since topical adherence carries a substantial share of maintained results
- Set an explicit review month each year, independent of treatment appointments, so the plan gets evaluated rather than repeated
Choosing a provider and setting review points
I also want to make note that the capability of a provider greatly varies. In part this is due to the level of involvement of the supervising physician. A good medspa in Jacksonville will have a variety of devices to choose from. But the variety of devices also has to do with the range of skin types that the provider can treat. The medspa should also have a good standardized before and after image gallery. And the clinic should have a clear policy on how to deal with complications that arise on site.
What a genuine review looks like
Annual reviews would include comparison of current photographs to the original photographs taken as a basis for the plan of care and restatement of the original goals. In some cases, you will find that the best thing to do is to stop a particular treatment that has peaked and will not provide further benefit. It is worth your while to find a provider who will tell you this.