Aesthetic Medicine
Aesthetic Medicine


Shopping around

Dr Joshua Van der Aa is an injection-focused cosmetic practitioner specialising in rejuvenation of the peri-orbital area. He is a graduate of Leuven University’s medical school in Belgium. Before opening Dr Joshua Harley Street Aesthetics in 2020, he worked in some of the best-known, award-winning clinics in London and Europe. Follow him on Instagram: @drjoshualondon

T here’s no denying that there has been a spike in corrective procedures post-pandemic.Patients are coming into clinics looking to fix previous treatments, armed with stories of past experiences having received treatments not only in clinics, but also very worryingly, in beauty salons and even home-based salons.

The number of patients who receive their procedures from injectors who are not medical professionals, and who go to salons rather than clinics for their treatments, made me curious about what factors influence patients’ choices about where to go for their procedures, and what elements have the most value in their choice. These choices made by clients often indicate which type of business model works, and what drives patients into or out of a clinic.

While it’s nice to have a lot of new patients, if you don’t retain them and instead have a constant flow of new patients who visit once before changing practitioner, you won’t have a viable long-term business plan.


I put the question – “Have you ever switched injectors?” – to my followers on Instagram in a poll to see if I could figure out which factors it is that influence their decision to move from a doctor they previously had treatment with, first asking whether they had ever had an injectable treatment. While 68% of my followers answered “yes”, we have to bear in mind that this of course isn’t representative of and is higher than the total population due to the demographic of my followers. In reality, depending on the area, between 20 to 30% of people in the UK have dabbled in injectables. 1

Of those who said “yes”, over half of them (57%) had been having these treatments for more than two years, which indicated to me that they had probably had both multiple procedures and multiple injectors, leading to ask how many of those people had changed injectors since beginning to have injectable treatments. Of those who responded, 61% of people had moved away from their initial injector and had continued getting aesthetic treatments elsewhere.

61% is very high, and I believe a big part of the reason for that is patients going to big-name clinics with multiple doctors that have large social media followings to draw in patients. Often patients realise too late that sometimes, while these clinics have a big following and team of doctors, they lack important elements like aftercare and that personal touch you can find in smaller locations. This isn’t to say that all bigger or multiple-location clinics don’t care for their clients, but from my experience, smaller clinics with just one or two injectors tend to have a more hands-on approach to the relationship, which really helps them retain those patients. The approach to patients is often different, and in any clinic it’s important to see that the management team understands that the patient and how they are treated is the most important part of the business.

The aftercare service is a key element that clinics miss out on when they are not patient-focused. Making the time for a 15-minute check-up to address your patients’ concerns, reassuring them that what they are seeing is just swelling, for example, or that the treatment area looks like that because they may need a little extra toxin, can make a huge difference to whether that patient stays with you and your clinic or turns to someone else. While many people think that these followup appointments cost avoidable time and money, the reality is that if someone else is offering that service, you’re going to lose your patient to them.


Patients often present into clinics with unrealistic expectations thanks to social media platforms like Instagram. While it’s an amazing tool, we’re all aware that Instagram promotes an image to patients that just isn’t achievable, as they look at photographs and think they are reality, not realising there are filters, lighting and angles used to make the results look better than they are. Also, the majority of clinic beforeand-after posts on Instagram only show the result immediately after the treatment rather than a few weeks or even months down the line, when the true results can really be seen. This is a particular issue with treatments like eyebrow threads, especially with the “fox eyes” trend.

Three months down the line, the look the patient had when they walked out of the clinic has gone (though, when done badly, this is often severe and needs to relax anyway) – the results don’t last and clients don’t realise this because what they see on Instagram doesn’t show how the treatment settles, and therefore the reality of the results. Even when these threads are done well, the patient gets a very moderate, temporary lift, mainly due to the swelling of the procedure. Once those tissues settle and the swelling goes down, they glide back down because nothing was actually lifted by the threads.

“The aftercare service is a key element that clinics miss out on when they are not patient–focused”

However, the level of demand for the perceived look achieved by fox-eye threads is undeniable, so I wanted to see if I could develop a way to achieve it safely and with lasting, predictably reproducible results that would make my patients happy and retain their level of trust in me. This is when my signature treatment InclinEyes was born. Instead of using threads, I add volume using dermal filler to reposition the tail of the brow by injecting the orbital rim and temple, making a subtle change that can have a dramatic effect on the overall look of the eye. Unlike with thread lifts, by doing this alternative treatment results will be completely undetectable, which is what clients value more now than they did a few years ago – making changes without people being able to tell you’ve made them. You simply can’t achieve this with fox-eye thread lifts or get long-term results, which clients don’t understand because it’s not shown on Instagram.


As practitioners, it is our responsibility to not only tell our clients that certain looks aren’t achievable, but also to explain to them the reasons why we can’t give them that “Instagram look”. If we simply say, “I can’t do that for you”, they’ll just keep going until they find a practitioner who doesn’t tell them “no”. Instead, it’s important to take the time to explain why; why it won’t look like that after the swelling dies down or when they begin to have issues with lymphatic drainage, for example. When you take that little bit of time to explain the process and let the client know what they can realistically achieve with you, they’re more likely to stay with you.

By giving your patients this information before their treatment, they are aware of how results can vary, and are giving informed consent by going ahead with the treatment after being made aware of these elements. If they are not made aware prior to the procedure, they may come back with questions about why there is a bump on their lip, for example. If you were to just tell the patient they didn’t massage the lip properly, went to the gym too soon after treatment or another factor that can affect this, they will interpret everything you say as an excuse because the results are not what they had expected, and they weren’t given any information about this prior to the treatment.

Instead, make patients aware beforehand that issues like small bumps are nothing to worry about in the first four or five days following lip filler treatment, and that if they are still struggling with the same issues in four or five weeks, to please get in touch.

Give patients an extra level of confidence in you as their doctor with something as simple as an automatic email tailored to the treatment they’ve had that is sent out afterwards, letting them know that the line of communication is still open, and support is still there after their treatment.


Patients need to realise that aesthetic treatments are not “one size fits all”, nor are the doctors that deliver them. When getting plastic surgery, patients go to doctors that specialise in the procedure they want, whether that be rhinoplasty, liposuction, breast augmentation or something else. Why shouldn’t that be the same with non-surgical treatments? A lot of those who answered the questions on my Instagram poll said they moved doctors to see someone who specialised in a certain area, which is something I see myself with clients who come to me for treatments in the eye area, as this is what I specialise in, and go to other doctors for different areas of their face. I personally don’t see it as an issue when they chose to go elsewhere for a different procedure –I understand that the patient is being sensible in thinking about which doctor they choose to deliver their treatment.

Only 8% of respondents said pricing was the reason for them switching injectors, suggesting that they are willing to pay for excellent care and results. There are two ends of the spectrum with pricing; on one hand, you have clients being charged £700 for 1ml of filler, which, while I don’t know what the full service is that these practitioners offer, seems a very high price to me. However, with prices around this mark clients can at least be a lot more confident that the product they are being injected with is of high quality.

On the other side, you have practitioners charging low prices and giving out discount offers, which makes you question how they are making profit if they’re using a goodquality filler and suggests that they are in fact using substandard products. There are many elements that affect how you price your treatments, from oversaturated markets, to undergoing further training and increasing your skills, but the most important thing when putting a price on your treatments is making patients feel that you value them and see them as more than just an income stream.

This attitude should run throughout every element of your practice, and, coupled with high levels of training, expertise, experience and patient care, will ensure your patients remain loyal.

Patients’ top five reasons for switching injectors (365 respondents):

1. Bad results (36%)

2. Bad service (21%)

3. New injector is better (17%)

4. Location (12%) 5. Price (8%)


1. Attitudes towards Cosmetic Procedures – UK – February 2018, Mintel

This article appears in the November/December 2021 Issue of Aesthetic Medicine

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This article appears in the November/December 2021 Issue of Aesthetic Medicine