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Reading Your Client

By: Steven H. Dayan, MD and Terri A. Wojak
Posted: September 25, 2008, from the October 2008 issue of Skin Inc. magazine.

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Bitter Betty. This client has spent thousands of dollars on treatments and products from another provider and didn’t see results. She is skeptical that all cosmetic providers are out to get her money. You really have to make a positive impression on this client to gain her trust. First of all, check Betty’s expectations: If they are not realistic then it is better not to treat her. If you do decide to treat her, refrain from selling products and add-on services the first visit; this would only scare her away. Start out with a treatment that will give her an immediate result. Provide samples allowing her to prove to herself that the products will make a difference. Betty will appreciate your conservative commitment to her well-being. Documenting improvements with before-and-after pictures can be helpful.

Too-friendly Fran. The client who repeatedly tells you that you are the best and that she feels privileged to work with you should come with a warning. Likewise, someone who keeps sending you or your team gifts is also concerning. Too often, this client wants to befriend you or a staff member. Be careful because Fran may have ulterior motives. Especially in medical spas and practices, if you open the door to this person, she may expect discounts, personal favors and more. Don’t travel down this road. Always maintain a healthy and professional separation from clients. Never give the client personal information about yourself—be friendly, but always bring conversations back to their skin care. Also, document all gifts, cards and phone calls on their chart.

Esthetic-shopper Sharon. This client flatters you, says that she has been considering treatment for the past year and has been to five of your competitors. Now she is ready and wants to hear your opinion. When Sharon is just about commit to a service, she needs to check something and promises to get back to you the next day. She may come for repeat consultations without committing to an actual service and she can be difficult to please. Don’t aggressively talk this client into getting services. Give her all the information and let her make the decision. If Sharon immediately undergoes a cosmetic treatment, she may have second thoughts or regrets afterward. The No. 1 way to destroy your career is to have unhappy clients saying bad things about you to others.

Passive-aggressive Patty. This is the client who comes in and seems compliant with your recommendations. She signs all the consent forms and appears to be the model patient, a pleasure to treat. Unfortunately, Patty doesn’t follow after-treatment recommendations. She will be nice and thankful in front of you, but behind your back she will speak negatively of you to your team members and others. Additionally, Patty may be on the Internet telling stories about you. You would have never seen this coming. It is hard to weed out this client because she is deceptively nice face to face. You must encourage this client to tell you her needs and desires. Reiterate all the possible side effects of the treatment and how to care for her skin at home following the treatment. Make sure all consent forms are signed and attempt to obtain before-and-after pictures—they can be lifesavers.

Wendy wants it all. This client often comes in and says she wants or needs every treatment that you offer. You need to be highly sensitive to identifying whether Wendy suffers from a medical condition resulting in a distorted body image. Body dysmorphic disorder (BDD) is a very serious psychiatric condition that needs to be handled by a medical professional. This client is extremely critical of her physique, despite the fact there may not be any noticeable disfigurement or defect. If you encounter someone that you think may have this disability, do not treat her. Immediately refer the client to the appropriate medical personnel. We estimate that 5–10% of the patients in our practice exhibit some aspect of this disease. Unfortunately, just about all cosmetic providers have worked with at least one of these patients and, in hindsight, wishes they hadn’t. The BDD client usually has had multiple procedures by other cosmetic providers and has never been satisfied, but is convinced you will make everything better. Wendy often fixates on her nose, skin and weight, and will frequently examine herself in the mirror, although some BDD clients completely avoid it. Patient questionnaires are available to physicians that can be used to better identify BDD sufferers, however, if you intuitively feel uncomfortable treating someone, listen to your gut.

Treating the psyche