Patients should accept the most appropriate treatment

I have a number of patients who have come to see me requesting treatments around their eyes and on their face. However, I cannot always help them because I do not think it is in their best interest to undergo cosmetic aesthetic treatment.
If I think that I can possibly make their situation worse, I advise against treatment. This is especially the case if the patient has had multiple previous treatments and procedures, often in different centres and even different countries. They will come to see me because they are not satisfied with the previous surgeon’s work or with their face and around the eyes in general, and they want more doing to fix the previous treatment.
I have had one patient recently who was only in their 40’s and who had Botox, fillers in the tear troughs, in the cheeks, in the nasolabial folds, in the lips, brow lift, ear surgery, nose surgery, cheek implants, eyelid surgery twice and wanted me to do more treatments. I examined the patient’s face and found them to have had all the things that they told me they had had and noted that as a result of their age and the previous aesthetic treatments they did indeed have some hollowing of their eye sockets and their temples.
However, I did not feel I could add anything to what they had already done and I also had some concerns that they should discuss their feelings about their face with a psychologist before a surgeon did further aesthetic treatment. I wondered whether in their search for perfection they were not developing an element of body dysmorphic syndrome.
I explained this to the patient that although some Restylane fillers could be used to help the hollows I felt that they had had quite a lot of treatment and that I was not the best person to do further treatment for them as I thought they would be disappointed and that their expectations were higher than what I could provide them with. I recommended that they see other specialists and wrote a full report.
Patients pay for an aesthetic consultation or medical consultation between £150 and £250 and expect me to provide treatment. Sometimes I have to provide them with the options and explain the risks of each and advise that they consider doing nothing, and instead that they should just wait for things to settle. Or I advise them to see someone else who can better assist them.