What Patients Want vs What Clinicians Notice: A Global Survey

A large online survey of more than 14,000 adults and over 1,300 aesthetic physicians in 18 countries, including Canada, compared what people worry about in their faces with what physicians think they worry about. The answers did not always line up. Under-eye concerns, cheek volume, skin quality and, for men, hair were more important to the public than physicians appeared to realize. For patients, the lesson is simple: say clearly what bothers you most.

Why this was studied

A consultation works best when the person and the clinician are aiming at the same goal. If a clinician assumes someone is mainly bothered by frown lines when their real concern is tired-looking eyes, the treatment may technically succeed but still disappoint. The researchers wanted to measure how closely the two groups' priorities match.

What the researchers did

A market research company ran an anonymous internet survey in late 2018. It included 14,584 "aesthetically conscious" adults, about 70% women, with an average age of 41, and 1,315 physicians who regularly see aesthetic patients, including dermatologists, plastic surgeons and family physicians. Both groups answered questions about facial concerns, the words they associate with an attractive appearance, the right age to start treatment, and barriers to treatment.

What they found

Among the public, the concerns most often rated as very or extremely worrying were under-eye bags and dark circles, crow's feet, forehead lines, uneven skin texture or tone, acne or redness, hair concerns and sagging skin, each worrying roughly 30% to 36% of respondents.

Some of the clearest gaps were these:

• Under the eyes. About 31% of the public ranked under-eye bags among their top five concerns, but only 16% of physicians said they discussed them with patients.
• Cheek volume. A quarter of respondents ranked loss of cheekbone volume highly, compared with 3% of physicians reporting it as a discussion point.
• Men and hair. About 35% of men were highly concerned about hair, but only 5% of physicians said male patients raised it.
• Skin quality concerns were also underestimated by physicians.

Language differed too. When describing an attractive face, the public more often chose words like "natural" and "clean," while physicians leaned toward "symmetrical." Physicians tended to suggest starting treatment younger, in the 20s and 30s, than the public did. Respondents also rated fear of needles, safety and unnatural-looking results as bigger barriers than physicians thought they were.

How strong is this evidence?

This is a large survey, which makes it useful for spotting broad patterns, but surveys measure opinions rather than outcomes. Points to keep in mind:

• Who answered. Respondents chose to take part online and were selected as interested in appearance. Fewer than 10% had had injectables, so the results may not reflect experienced patients.
• Who was left out. Non-binary people and adults under about 21 were not included.
• Wording. Not everyone knows what terms like "glabellar lines" mean, which can affect answers.
• Funding. The survey was sponsored by a major manufacturer of injectable products, whose staff helped interpret the data, and most authors reported ties to the company.
• Age of the data. It was collected in 2018, and attitudes may have shifted since.

What it means for you

The survey also hints at why these gaps exist. Physicians mostly see people who have already decided to seek treatment, often for well-known concerns such as frown lines. People with other worries, like dark circles or thinning hair, may assume nothing can be done, or that it is not an aesthetic issue, and never mention it. That can leave a clinician with an incomplete picture.

The main message is about communication. You know best what bothers you, and a good consultation starts there. Some ways to make sure your priorities are heard:

• Lead with your top concern in your own words, even if it seems minor or hard to describe.
• Use a mirror or photos to point to exactly what you notice.
• Say what you do not want, such as looking "done" or changing a feature you like.
• Raise your worries about needles, safety or cost. These are common, and a clinician can explain what to expect, including numbing and recovery.

Some common concerns, such as dark circles or thinning hair, have medical causes that should be checked first, and some are better served by skincare, sleep or a family doctor than by injectables. Our articles on dark circles and your first injectables consultation may help you prepare.

It is also reasonable to expect a clinician to be honest when a concern is outside what aesthetic treatment can change. Under-eye darkness, for example, can be due to pigment, thin skin, shadows from volume loss, allergies or lack of sleep, and each has a different answer. Hair-related concerns in both men and women may need blood tests or a scalp assessment before any treatment is considered. Hearing "this is not something injectables will fix" can be the most useful part of a consultation.

Questions to ask at your consultation

• Based on what I have told you, what would you focus on first, and why?
• Is my concern something treatment can realistically change?
• Are there non-injectable or medical options I should consider?

Frequently asked questions

What if my clinician suggests treating something I had not noticed?

It is fine to ask why, and fine to say no. Suggestions should always be explained and connected to your goals, not added on.

Is there a right age to start?

No single age fits everyone. This survey showed physicians and the public disagree on timing, which is a reminder that treatment should depend on concerns and goals, not age alone.

Does "natural" mean the same thing to everyone?

Not at all. Describing what natural means to you, perhaps with photos of yourself from a few years ago, can help.

A consultation at HealthPark Medical Aesthetics begins by listening to your priorities, then explaining which options, if any, fit them.

Source

Fabi S, Alexiades M, Chatrath V, et al. Facial aesthetic priorities and concerns: a physician and patient perception global survey. Aesthetic Surgery Journal, 2022. Read the study