When Aesthetic Treatment Plans Go Off Track
When I first started working in aesthetic medicine over 16 years ago, I believed that every treatment plan was as straightforward as a checklist: assess the patient, agree on the procedure, deliver the treatment, follow up on the treatment. Over the years, though, I’ve come to realise that even the best plans can veer off course. In many cases I’ve seen as an aesthetic expert witness, those moments of deviation have been important in preventing disputes.
When plans change
For example, a practitioner and patient agree on a conservative approach to mid-face volume loss, such as two sessions of hyaluronic acid filler, spaced a month apart. Everything is documented, consent forms are signed, and the patient seems happy. But on the day of the second session, the practitioner decides to go “a little heavier” in the cheeks, convinced that the extra volume would deliver better results even though the patient was looking for a subtle change. The patient leaves feeling swollen and unnatural, and what had started as a clear plan turned into confusion, discomfort, and eventually a claim of negligence. In court, the discussion might not be so much about the filler itself, but about why the plan changed without a fresh conversation or updated consent.
That kind of scenario exemplifies one of the most human challenges we face in aesthetics: we’re dealing with people’s faces, their confidence, and even their sense of identity. When we step into a consultation room, we shoud be conscious that every word matters. If we suggest a different treatment angle mid-procedure, we should pause, explain the why, and ask for explicit confirmation. It might feel too much in the moment, as no one wants to break the flow with “hold on, let me get you to sign another form”, but those pauses are where we safeguard trust, prevent misunderstandings, and protect ourselves from legal complications.
Legally speaking, courts can look closely at the treatment plan as a roadmap. Deviating from that roadmap without clear documentation is akin to driving off a known route without telling anyone. If something goes wrong, be it an adverse reaction, dissatisfaction, or a complication, the first question becomes: did the practitioner stick to what was agreed? If not, why not? Did the patient understand and agree to the new direction? Answers to those questions can determine if a case is viewed as a breakdown in communication and consent.
Communication is key
It’s also important to acknowledge the pressure practitioners often feel. Pressure to deliver incredible results, to compete in a market that thrives on dramatic ‘before and after’ photos, to respond to patients who come in hoping for more than what is possible. We’ve all been there. But every aesthetic practitioner must learn that staying true to an agreed plan isn’t just about legal safety, it’s also a professional commitment to responsible care. If a patient wants more, we schedule another appointment, we have another conversation, and we update our records.
From the aesthetic expert witness perspective, I’ve reviewed many treatment records where the clinic notes say one thing and the patient recalls another. These gaps become magnified under scrutiny. What could have been a simple note in the patient’s record becomes the foundation of a legal dispute. Of course, there are times when deviation from the plan is clinically necessary like a sudden adverse reaction, unexpected anatomical challenges, or a complication that demands immediate intervention. But even in those moments, documentation and communication are everything. If you ever need to pivot for safety reasons; stop, explain what’s happening, outline your proposed change, obtain consent, and write it all down. That sequence not only protects you legally but reassures the patient that their wellbeing is your highest priority.
I believe we can learn from mistakes to elevate our standard of care. When I review my cases as an aesthetic expert witness, I look for the moments where communication succeeded and where it failed. At the end of the day, aesthetics is as much about communication as it is about results.