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Even the most savvy, skilled, and experienced cosmetic doctors have unhappy or dissatisfied patients, and online review forums can give them a megaphone.

There are many reasons that a patient could be unhappy after a procedure, including unforeseen complications, a poor outcome, unrealistic expectations, cost, underwhelming office communication, or psychiatric factors such as body dysmorphic disorder.

Together with your staff, you can identify potentially problematic patients before you treat them.


Your staff sees things you don’t. Patients may treat staff members poorly but be sycophantic when they meet you.


You will never be sorry about the patients you didn’t treat, only those you did and shouldn’t have. Consider saying no to prospective patients who express unrealistic expectations from the get-go such as one who says, “I want to have surgery, but I don’t want anyone to know and can only take 5 days off.” You may also want to avoid patients who want to look like a celebrity, who want surgery for reasons such as a job promotion or divorce, or who are not telling their spouse or family about their surgery.

Beware of patients who don’t listen, who interrupt, or who do all the talking and none of the listening. Think twice about treating individuals who berate previous surgeons but compliment you during the consultation.

Together with your staff, develop a strategy to screen patients. If something seems off, act on it.


When you inevitably encounter an unhappy patient, work to de-escalate the situation. Several strategies can help.

No. 1: Timing

The best time to see an unhappy patient is at the end of the day when the office is empty. Seeing them in the middle of a busy day is a setup for failure.

No. 2: Document Everything

Review the chart, photographs, and procedures before you enter the room. Take photographs at every meeting and meticulously document any concerns in the presence of a witness.

No. 3: Keep Your Cool

It is hard to be criticized or berated by a patient. Exhibit restraint. Don’t express contempt.

No. 4: Find Common Ground

Agree with the patient in some manner. Jonathan Sykes, MD, a facial plastic surgeon based in Beverly Hills, California, calls this reflective listening. Let the patient vent and agree with how they feel. It is important that the patient feel heard, understood, and accepted. This can defuse their anger, promote or regain their trust, and open up discussion of possible remedies to achieve patient satisfaction.

Dr. Sykes also points out that doctors are “big in the room” when they are doing consultations, talking about their skills, and recommending procedures. This must be reversed when dealing with an unhappy patient. The doctor should be “small in the room.” This means that, when discussing problems with an unhappy patient, humility is a virtue.

No. 5: Show Respect

Take patients’ complaints seriously. If somebody says something negative about you or your practice, look in the mirror because the problem may be internal.

Don’t engage in doorknob discussions—conversations where you are talking to the patient while your hand is on the doorknob (Figure). This is exiting a room, not communicating.

Figure. Holding the doorknob while conversing with patients detracts from the conversation.

Avoid the temptation to rush to fix the problem. Instead, ask what you can do to make the patient happy. Some may just want an apology. Others may want a revision, refund, or reparation.


A busy practice is going to have the occasional dissatisfied patient. Often, the problem began with a failure on your part to spot red flags or set realistic expectations before surgery. These are things we learn with experience. Although I forget many of my cosmetic victories, I remember every single one of my defeats. Sometimes, the hardest but most important thing to say is, “I’m sorry, but I can’t accept you as a patient because I don’t feel that I can meet your expectations.”

This article is based on a presentation from Cosmetic Surgery Forum (CSF) 2022:

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