What did the surgical studies find about expectations and satisfaction?
That is an association, measured in surgical patients. It does not show that expecting more causes disappointment. Nor does it show that a lower expectation would have made anyone happier.
A composite, not real patients, shows what an association looks like. Two people leave with results a doctor would call similar. One expected a small change and is pleased. The other expected a large one and is not.
Avcu and Metin (2021) studied 183 people who had open septorhinoplasty, a form of nose surgery, at one centre in Turkey. The paper reports a post-operative "expectation coverage rate", roughly how far the result met expectation. It correlated with satisfaction at r = 0.907, where 1 would be a perfect link. Among cosmetic patients, the dissatisfied had scored higher on expectations before surgery: 92.17, against 86.15 for all cosmetic patients. The paper does not name its expectation scale, and it reports no p-value comparing the satisfied and dissatisfied groups.
Coverage and satisfaction were both rated after surgery and overlap in meaning, so part of that link may be the overlap. The paper is indexed as randomised, but its groups were formed by indication and outcome, which makes it observational. Its causal conclusion goes beyond the design.
A 2015 systematic review of 27 articles, searched to July 2014, listed nine possible negative predictors of satisfaction after facial cosmetic surgery, unrealistic expectations among them (Herruer). Fourteen of the 27 were reviews, expert opinions or a case study.
How far does this reach?
Everything above is surgical, and nothing in it tests injectables or biostimulators, so applying it there is an extrapolation. The main study is nose surgery at one centre in Turkey, a long way from a consulting room in the Klang Valley. The trials below enrolled mostly White, European or American participants, largely women aged 35 to 65, few of them Asian and none from Malaysia.
What does a realistic expectation sound like?
One way to put it: a realistic expectation starts from the process behind a result. How many sessions, over how many months, judged when, and in whom?
A manufacturer-funded randomised trial of poly-L-lactic acid, a biostimulator, for cheek wrinkles treated people until the correction was judged optimal, up to four sessions a month apart. Results were read at months 7, 9 and 12. Across the program and biostimulator trials reviewed for this series, the largest effects were measured in people who finished the whole course, judged months later. None of those figures says what one or two treatments deliver.
What about part of a plan? One study followed the same people from a single treatment to a planned combination. Satisfaction with the face was higher after one treatment than before, and higher again after the combination. The study had 61 people in France and Sweden and was funded by the manufacturer. The order was fixed, more product went into more areas at each later step, and participants were not masked. Satisfaction was a single question with no p-value. Obvious sagging was excluded, and there was no Asian group. No verified trial compares a whole-face plan with one or two of its parts.
One study suggests a part of a plan can be expected to give part of the change. A partial plan is a valid choice, with its own smaller expected change. Nothing here is a reason to do more than was decided. Choosing part of a treatment plan takes this further.
How can a doctor set expectations?
No study here shows how a consultation should run. A reasonable shape, built from the recall evidence and what the trials report, is a written plan. It gives the whole course in sessions and months. It says what each part is for, what it will not do on its own, and when the result should be judged. The patient says it back, which why we forget what was agreed covers.
The recall evidence is for recall: the research behind this series found no verified evidence, from non-surgical clinics, on whether a written plan or saying it back changes satisfaction.
What can you ask?
What is each part of this plan for, and what will it not do on its own?
How many sessions is that, over how many months, and when do we judge the result?
If I choose only part of the plan, what change should I expect from that part?
Where do the results I have seen quoted come from: how many sessions, judged how long after, and in whom?
Can I have the answers in writing?
For the first question, botulinum toxin, hyaluronic acid filler and biostimulators compared sets three treatments side by side. If the results you have seen were photographs, what a before-and-after does not show you is worth reading first.
Say what you expect to see, and by when. Then ask whether it fits.
