The forgotten plan
This is the pattern, in my own words: "patients sometimes are recommended a program, but only choose 1 or 2 because of reasons like budget or whatever reason they may have, what happens is that they forget that they were supposed to have a whole program, and then now they expect the same results with just 1 or 2 treatment modalities" (Dr Ong Jin Khang).
Memory is one problem in that sentence. Expectation is the other.
How much of a plan do people remember?
Less than you would hope, and the forgetting starts within days. In one US study, patients were phoned about a week after 189 recorded cardiology and nephrology visits. They recalled about half of the decisions (49%) correctly without a prompt, another 36% only with a prompt, and 15% wrongly or not at all (Laws, 2018). In a skin surgery study, patients given ten possible complications recalled about a quarter of them, at 20 minutes and again a week later (Fleischman and Garcia, 2003).
Neither study was in aesthetics, and both followed patients for days. They show only that forgetting is ordinary. The figures also shift with how recall is tested.
Where do the results people quote come from?
Results in studies come from people who finished the whole course, judged months later.
One trial of poly-L-lactic acid, a biostimulator, for cheek wrinkles gave up to four sessions a month apart and read the results at months 7, 9 and 12. Eleven of the 97 people treated had two sessions or fewer, so "the course" meant treatment until the correction was judged optimal (Fabi, 2024). HARMONY, a well-known whole-face study, read its results at month 4. Seven of the 100 people treated were left out: four had not received every product and three stopped early (Weinkle, 2018; Cohen, 2022).
Product makers funded both. None of these figures describes what one or two treatments deliver, so I have left the outcome numbers out: they would set the expectation this piece is trying to manage. A before-and-after needs the same care, as what a before-and-after does not show you explains.
What does part of a treatment plan give?
One study followed the same people from a single treatment to the full plan (Cartier, 2020). Sixty-one people aged 35 to 50 were randomised at three private clinics in France and Sweden. Each first had one treatment: botulinum toxin type A for the frown lines, or hyaluronic acid filler for the nasolabial folds or cheeks. Full-face combinations followed at months 6 and 12. Satisfaction with the face rose after the single treatment, and again after the first combination. Blinded physicians judged most faces better after that combination than after the single treatment.
That is the evidence behind the first line of this piece, and it is thinner than it sounds. The order was fixed, and each later step put more product into more areas. Participants knew what they were having. Satisfaction was one question, and the single-treatment time point was not a registered outcome. Obvious sagging was excluded and there was no Asian group. The funder employed three of the eight authors. In one study, then, one treatment gave a real but smaller change than the combination that followed.
Does any study show a whole plan working better?
Not in the evidence reviewed here: none of it compares a whole-face plan with one or two of its parts. HARMONY had no control group and no single-treatment arm. In a companion paper, its authors wrote that without a control group they could not tell whether the changes came from the treatments or from other factors (Cohen, 2022). The case for treating the whole face rests on single-arm data and on research into how we take in a face as a whole.
So the claim here is about expectations. Few studies measure what one or two parts give on their own, so expect less than the results you have seen quoted, and ask what your part is for. The three questions worth asking any aesthetic doctor are a fair place to start. Expecting less passes no judgement on the choice.
Why does the size of the expectation matter?
In surgical studies, people who expected more were more often unhappy with the result. Among 183 people having nose surgery at one Turkish centre, the groups who ended up dissatisfied had scored higher on expectations beforehand (Avcu and Metin, 2021). A review of facial cosmetic surgery lists unrealistic expectations among nine possible negative predictors of satisfaction (Herruer, 2015). About half of its 27 articles were reviews, opinions or a case study.
These are associations, found in surgery. They do not show cause, and applying them to injectables or biostimulators is an extrapolation. What they support is modest: a wide gap between what was expected and what was received goes with more dissatisfaction. Know what you expect before you start.
What helps: the plan on a page, said back
Ask for the plan in writing: each part, what it is for, what it will not do on its own, and when the result will be judged. Then say it back in your own words.
The support is modest. In a review of 34 studies, written material given after a consultation improved recall in four of seven studies and made no difference in three (Watson and McKinstry, 2009). Those trials mostly covered consent risks for surgery, so they say little about multi-session plans. Saying it back rests on less. In one small study of 50 lung biopsy patients, those asked to recite the risks until they got them right recalled them better four hours later. It cost up to five extra minutes (White, 1995).
If the plan changes, so does the expected result. Add a treatment or drop one, and write the new expectation down too.
What these studies cannot tell you
The people in the combination and biostimulator trials were mostly White, European or American, and largely women aged 35 to 65. Hardly any were Asian, and none were from Malaysia. The recall and expectation studies came from cardiology, nephrology and surgery. None measures a non-surgical aesthetic plan.
Expect the part you chose.
