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Expectations and Financial Consent- what is that anyway??


Common, recurring themes that come up when I am discussing treatment with patients is that of expectations, and cost.

  1. When I meet people for the first time, or they contact me to chat, if inexperienced, most are unaware of the basics –
    1. the difference between anti wrinkle and filler treatment for example.
    2. What each does and how it works.
    3. How long each may be expected to last.
    4. Different types – permanent, semi permanent and temporary
    5. Animal vs non animal origin
    6. Brands and costs
    7. Who the injector is (I often have to ask if they had to have a Skype consult to determine who the injector may have been), some of which is covered in my post last week

I spend a fair bit of time, during the initial obligation-free, no-cost consult, discussing

  1. your face, because every face is different- injectables are not a One Size Fits All approach
  2. your concerns
  3. what you think would help with your concerns
  4. your budget
  5. what I see, to help with your  concerns
  6. the amount of product you are likely to need, and the cost.

So. What does appropriate financial consent mean and involve?

  1. a guide to how much anti wrinkle or filler a person is likely to need in TOTAL, even if we only use a fraction of that on the day.
  2. the amount of time over which that product is likely to be needed- usually 3-6 months initially and then for maintenance, around 3-6 months and then yearly.
  3. how much may be expected in terms of maintenance to help you decide if it is worth investing in.
  4. how much they need to budget for if they wish to retain the lip volume/ cheek volume/ wrinkle free areas.
  5. whether realistically this is something they wish to undertake, or spend on a holiday instead.

Sometimes, I get it wrong, and it is not obvious till we have begun and I see product being sucked into someone’s cheeks, or their chin, or their temples. In that case, I think it is important to be honest.

Without this information, it is not really informed financial consent. Sometimes people may be tempted to cut corners, to haggle, to ask for discounts, or to budget, and to get “half of what you say I need”. I understand the desire for that, I truly do.

My response is still – “My job is to tell you what I think you need, and what the cost of that is likely to be. It is not to fit within a budget that will not give you the results you want, if your budget, or your expectations are unrealistic. Likewise, I don’t haggle because this is not just about the product, but about the service. If someone cannot value that, then we probably are not a good fit and you should keep looking for another injector.”

Let me share some examples with you, especially around the area of fillers.

Most people understand the principle of wrinkle relaxants- it’s a lot of money, but it’s relatively straightforward, with few things that can go wrong, and it gives you the most bang for your buck. Effects kick in as early as 2-3 days, peak at around 14 days and last around 3-4 months when a topup is needed. It gives you a refreshed, rejuvenated look that people notice and it’s immediate gratification.

Frown lines, 30s

Fillers are a bit different.

Work with filler, done well, takes time, good knowledge of facial anatomy and the effect though immediate, grows over time and serial treatments to avoid an odd looking face; the hallmark of fillers, if done well, is so subtle, only you and your injector knows that you’ve had anything done. People mainly notice you look fresh, less tired.

That is the desired outcome BUT it may not be worth it to many, to spend thousands, to simply look “fresh”. It is more a delayed gratification.

By the time most people notice enough that bothers them, they’ve left it too late and need decent volumes of fillers- around 2-3mls in someone in their late 20s and 30s. Upto 8mls or more over 6+ months in someone in her 60s. So financial consent at the beginning is essential- there is no point charging someone for 2mls and $1200 if you know they’re unlikely to follow through with further treatment they need in 3 months. Fillers build on each other and each layer and can last for a year or more.

Some examples:

Post 0.5/0.5ml thick filler

Lady in her late 40s post 0.5ml to affected areas on each cheek.

29yo with 0.5/0.5ml thick filler

29 yo busy mum looking tired due to dark hollows under her eyes- 0.5ml to each cheek area initially.


Lady in her 40s worried by her deep smile lines. Before and after 2mls to her cheeks, 1ml each side.


Lady in her 50s with significant midface volume loss- she was terrified of looking fake, but over 4 months, managed to restore some youth to her tired looking face with a total of 5mls of thick filler.


Woman in her 30s, tired mum with dark undereye circles and bags; terrified of fillers. Before and after 1ml each side of medium filler.


Woman in her 50s wanting to smooth and soften her accordion/laugh lines.

These are just some examples of people I see regularly. Most of these patients don’t want to look fake- they are professionals, with careers- they want to look subtly refreshed and rejuvenated and to feel better about the quality of their skin. Filler is a great way to achieve that as the product stays under the skin for 6-12+ months per treatment session and reduces need for more potions and lotions. Additionally, the process of injecting these products acts in a similar fashion to microneedling and other techniques, stimulating more natural collagen production- win/win!

So if you’ve been considering fillers, and are hesitant, book in to talk to me- or email me!



  • Dr Imaan Joshi has been working as a doctor since graduation from the University of Sydney in 2001. She spent years between 2004-2011 as a surgical trainee before switching to a different speciality program for work-life balance. She is passionate about her work in Medicine and especially about procedural Medicine, and loves her work as a Cosmetic Physician. When she isn't working, she is busy focusing on an active life with her family, which includes 4 active children! Dr S Imaan Joshi BSc, MBBS, FRACGP


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