Most aesthetic clinic content is written about what the clinic does. We thought it would be more useful, and more honest, to write about what we will not do. Saying no is part of clinical practice, and the things we turn away are often more revealing about how we work than the things we agree to.
I am Shontelle, the registered nurse at Silk Clinical Aesthetics. This article is a clear list of the situations where the answer at our clinic is no, with the clinical reasoning. None of this is hidden. We tell patients these things in the consultation. It is just easier to read about it before you book.
Patients We Turn Away
Patients Who Are Pregnant or Breastfeeding
We do not perform cosmetic injectable treatments on patients who are pregnant or breastfeeding. The clinical evidence does not support the safety of these treatments in this population, and the cautious answer is to wait.
This applies to anti-wrinkle injections, all dermal fillers, skin boosters, polynucleotides, and PDO threads. It also applies to most energy-based treatments where the clinical position on pregnancy is unclear.
We are happy to plan a treatment schedule around a pregnancy or breastfeeding period. We will not work around it.
Patients with Active Skin Infection or Compromised Skin in the Treatment Area
We do not treat through cold sores, active acne breakouts, dermatitis, or any infection or significant inflammation in the planned treatment area. This applies particularly to lip filler in patients with a history of cold sores, where we may recommend prophylactic antiviral medication and a delay until the area is settled.
This is straightforward infection control. The risk of introducing or spreading infection through the skin is small but not zero, and waiting a few days or weeks resolves it.
Patients Whose Goals We Do Not Agree With
We will say no to treatments that we do not believe will produce a result we are willing to put our name to. The most common examples:
- A request for a frozen, expressionless result. We do not aim for that result. If that is what you want, we are not the right clinic for you.
- A request for an exact celebrity face or a face from a photograph. Filler does not transfer one face onto another. We will not treat to match a reference that does not match your bone structure.
- A request for filler volumes we believe are excessive for the patient's anatomy. Adding more product than the face can carry produces results that look obviously filled and that age awkwardly.
- A request for a treatment we believe is the wrong tool for the concern. If the issue is skin laxity, more filler does not fix it. If the issue is volume loss, skin tightening alone does not fix it. We treat the cause, not the request.
Patients with Body Dysmorphic Concerns
We are not psychologists, and we do not diagnose. But aesthetic medicine has a clear pattern of patients whose concerns are not proportionate to what the rest of the world sees, and where treatment is unlikely to improve how they feel about their appearance.
If a patient describes an obsessive focus on a specific feature, has had multiple previous treatments without satisfaction, expresses distress out of proportion to the visible concern, or describes a goal that we cannot identify a clinical basis for, we will pause the conversation. Sometimes the right answer is to refer the patient to a GP or psychologist for assessment before any further aesthetic work. We do not do this to be unkind; we do it because treatment in this scenario rarely helps and often makes the situation worse.
Patients Who Cannot Give Informed Consent
We require patients to understand the nature of the treatment, the realistic outcomes, the risks, and the aftercare requirements. We do not treat patients who are intoxicated at the appointment, patients who are in active emotional crisis where the treatment decision should be deferred, or patients under 18 for cosmetic injectables.
For patients under 18, we provide consultations on skin and topical concerns where appropriate, with parental involvement. We do not perform injectable treatments on under-18s for cosmetic purposes.
Patients with Recent Cosmetic Work We Have Not Reviewed
If you have had injectables elsewhere within the previous few weeks, we may decline to treat the same area until the previous work has fully settled and we have had a chance to assess what was done. This is not a judgement of the previous practitioner. It is so we are working on a clear baseline rather than guessing what is underneath.
Treatments We Will Not Provide
Permanent Fillers
We use only hyaluronic acid filler and other reversible products. We do not use permanent or semi-permanent fillers (such as silicone or polyalkylimide gels), and we will not work in patients with permanent filler in the planned area without specialist input. The clinical experience with permanent fillers includes long-term complications that no aesthetic clinic can confidently manage.
Treatments Outside Our Scope
We do not perform surgical procedures. If you are a candidate for surgical lower blepharoplasty, surgical facelift, or any other surgical intervention, we will say so and provide an appropriate referral. We will not perform a non-surgical version of a treatment that is unlikely to produce the result you want when surgery is the correct intervention.
Cosmetic Treatments Without a Consultation
We do not treat patients on first contact without a consultation, even for treatments that may seem routine. Anti-wrinkle injections in a returning patient with a known plan can sometimes be booked directly, but a new patient or a new area always involves a consultation first.
"Specials" or Discount-Driven Treatments
We do not run pressure-style promotions or same-day-only deals on cosmetic injectables. We do not use price as the lead in our communications. If you have arrived at our clinic because of a discount, that is not the version of us you are getting.
Treatments We Limit Even in Suitable Patients
Lip Filler in Larger Volumes
We have a conservative house position on lip filler. We will not treat lips with volumes we consider disproportionate to the patient's facial anatomy. Most lip filler appointments at Silk place 0.5 to 1 ml. Some place less. We do not treat lips with multiple syringes in a single sitting.
For more on this, see How Long Do Dermal Fillers Really Last?.
Tear Trough Filler in Patients Who Are Not Good Candidates
Tear trough filler is one of the treatments where the wrong patient produces some of the most visible filler complications. We assess for fat herniation, skin quality, midface support, and pigmentation, and we will decline tear trough filler in patients whose anatomy predicts a poor result. For more, see Tear Trough Filler: When It Works and When It Makes Things Worse.
Multiple Areas in One First Appointment
A first appointment for a new patient usually does not involve multiple injectable areas at once. We prefer to address one area, review at two weeks, and add other treatments in subsequent sessions. The result is more controllable and the recovery is easier to manage.
Why this Matters
The clinical case for saying no is straightforward. Treatments performed in the wrong patient, or with the wrong goal, produce results that the patient is not happy with and that we are not happy with. Both of us lose. The conversation is harder than the booking, but it is the right conversation.
The harder issue is commercial. A clinic that says no to certain bookings turns away revenue. We are aware of this and we accept it. The patients who come back to Silk over years are the ones who appreciated being told no when no was the right answer, and we would rather build that practice than the alternative.
If you have read this far and recognised yourself in any of the categories above, we are not writing about you to make you feel uncomfortable. We are writing about it so that the consultation feels predictable, not surprising. If we say no in your appointment, this article is the explanation.
What "No" Looks Like in Practice
In a consultation, our no usually has three parts.
First, we explain what we have observed in your assessment that leads to the answer. This is specific, not general.
Second, we explain what we suggest instead, if anything. Sometimes the suggestion is a different treatment. Sometimes it is to wait. Sometimes it is to address something else first. Sometimes it is a referral.
Third, we explain that you are free to seek treatment elsewhere if you prefer, and we will not be unkind about it. Some clinics will treat what we will not. That is between you and them. We do not pressure you to stay.
For more on what to expect at your first appointment generally, see What to Expect at Your First Cosmetic Appointment at Silk Clinical.
Frequently Asked Questions
What if I have been treated for the same thing at another clinic and want to continue?
We will assess and decide based on what we see. If we agree with the previous plan and feel the treatment is appropriate, we will continue it. If we do not, we will explain why and what we suggest instead. Continuity from another clinic is not a reason to override our clinical assessment.
Can I book a consultation if I am not sure whether you will treat me?
Yes, and that is often the right approach. The consultation is not a commitment to treatment. It is an honest assessment of what is appropriate. Some patients leave without booking a treatment, and that is fine. The consultation is a service in itself.
Will you tell me if you think another clinic would be a better fit?
Yes. If we genuinely believe a different practitioner or a different specialty would serve you better, we will say so. Most often this involves referrals to dermatology, plastic surgery, or oculoplastic surgery for concerns outside our scope.
Do you treat men?
Yes. Our patient profile is predominantly female but a meaningful portion is male, and the same standards apply.
What if I disagree with your assessment?
Tell us. The conversation is open. Sometimes you have context we do not, and the conversation changes our recommendation. Sometimes we hold our position. Either way, you are not committed to anything during a consultation, and you are free to seek a second opinion.
Will saying no cost you patients?
Sometimes. We accept that. The patients who come back over years are the ones who valued being told no when no was the right answer, and that is the practice we are building.
Filed underclinical standardspatient selectioninformed consentSilk Clinical
