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Why the Best Aesthetic Consultation May End Without Treatment
ISAPS estimates that plastic surgeons performed close to 38 million surgical and non-surgical aesthetic procedures in 2024. As patients increasingly arrive with a treatment already in mind, Dubai dermatologist Dr Maya Khoury argues that care should begin with the patient’s needs rather than the procedure being requested.
Plastic surgeons worldwide performed 37.9 million aesthetic procedures in 2024, 17.4 million of them surgical and 20.5 million non-surgical, according to the International Society of Aesthetic Plastic Surgery, an increase of 42.5 percent over four years. Botulinum toxin led the non-surgical category with 7.8 million procedures, followed by hyaluronic acid fillers at 6.3 million.
DHA’s 2023 health-tourism figures provide the wider commercial setting. The emirate received more than 691,000 international health tourists in 2023, whose healthcare spending exceeded AED 1.03 billion. Dermatology accounted for 27 percent of reported specialty demand, second to dentistry, although the DHA figures do not separate medical dermatology from cosmetic treatment.
The Consumer-Led Consultation
Alongside this growth, aesthetic consultations have become more consumer-led. A June 2024 review in Plastic and Reconstructive Surgery Global Open supports a shift from a doctor-led relationship towards patients arriving with particular treatments or outcomes already in mind, often influenced by social media and wider beauty pressures, and it warns of the commodification of beauty and the conflicts of interest that follow. In a 2022 member survey, 79 percent of US facial plastic surgeons said that patients’ desire to look better in selfies continued to trend upward. Medicine is supposed to begin with an assessment.
Dr Maya Khoury is the founder and Medical Director of Le Rêve Dermatology Clinic in Dubai, where the DHA directory lists her as a Specialist in Dermatology. Her professional profile also lists membership of the American Academy of Dermatology. Khoury has publicly positioned Le Rêve around a less transactional approach to aesthetic medicine. In a 2023 KT Network profile published by Khaleej Times, she described the clinic’s work as upholding the integrity of aesthetic medicine, “seeking to de-commercialise medical procedures and treatments”, with the patient’s needs, rather than the procedure requested, as the starting point of care. In the same profile she argued that aesthetic medicine plays a genuine role in self-esteem, which makes the discipline of matching treatment to need more important, not less.
Assessment Before Agreement
Khoury’s emphasis on patient need raises a wider question about what a genuinely needs-led consultation should allow. The requested procedure may be appropriate, another approach may better address the concern, or the assessment may find that intervention is unlikely to provide meaningful benefit. A patient may have a genuine concern while requesting a procedure that is unlikely to address it, and part of the assessment is distinguishing goals grounded in a patient’s own features from expectations shaped by filtered images or passing trends. The 2024 review reaches a similar conclusion, recommending stronger informed consent, shared decision-making and closer attention to appearance anxiety. In that framework, a declined procedure is not poor customer service. It can be evidence that the consultation was treated as a medical assessment rather than an automatic route to a sale.
The Limits of Individual Restraint
The honest caveat is that a refusal carries no enforcement power. A patient declined by one practitioner may still seek the procedure elsewhere, meaning an individual refusal cannot establish standards across the wider market. The issue is also being discussed at industry level. Allergan Aesthetics published Moving the Needle on Ethics, a global report drawing on research and discussions with practitioners representing 13 countries. It examines overtreatment, transparency, practitioner training, social-media filters and psychological health. An individual refusal can, however, demonstrate a willingness to place clinical judgment ahead of completing a treatment.
In elective aesthetic treatment, many clinics may offer similar procedure categories, but the quality of assessment and willingness to recommend restraint can differ substantially. As procedure volumes continue to grow, the consultation remains the point at which commercial demand must be balanced against medical judgment. A clinic’s commitment to ethical care is tested not only by the treatments it performs, but by whether it is prepared to recommend an alternative, or no intervention, when that is the more appropriate outcome.
