I just looked down at my phone and realized I’ve spent the last hour in a void. It was on mute. There are 13 missed calls staring back at me, a silent testament to a world that was trying to reach me while I was busy thinking about the silence. It’s a jarring feeling, that sudden rush of realizing you’ve missed the most important signals because you were tuned into the wrong frequency. This is exactly how it feels when you walk out of a high-end cosmetic office and realize that, despite the 43 minutes you spent talking, nobody actually asked you how you were doing. Or rather, they asked how your skin looked to you, but they never asked what was happening beneath it.
I’ve been thinking about this a lot lately, mostly because the lines between medicine and retail have become so blurred that they’re practically invisible. You walk into a room, and instead of a stethoscope or a focused light, you’re handed a laminated menu of services. There’s a ‘coordinator’ there-not a nurse, not a doctor, but a person with a very sharp highlighter. They start circling ‘Value Packages’ and ‘Spring Glow Bundles’ before they’ve even seen your face in anything other than the soft, flattering lobby light. It feels efficient. It feels like shopping. But your face is an organ, not a handbag.
If the first person you talk to is more interested in your credit limit than your medical history, you aren’t in a medical office. You’re in a showroom.
A real consultation-the kind that actually respects the complexity of human biology-should feel much less like a sales pitch and much more like a physical exam. It should be rigorous, perhaps even a bit tedious. If they aren’t asking about your medications, your history of sun exposure, or your tendencies to scar, they aren’t planning a treatment. They’re just processing an order.
The Metaphor of the Foundation
I remember talking to Sam N. about this. Sam is a cemetery groundskeeper I’ve known for about 23 years. He’s 63 now, with hands that look like they’ve been carved out of oak. His job is the ultimate end-of-the-line reality check. He doesn’t care about the aesthetic of the headstones as much as he cares about the density of the soil. He once told me that 53 percent of the problems he deals with come from people trying to put 300-pound monuments on ground that hasn’t been properly surveyed.
Foundation Failures (Sam N. Data)
‘They want the heavy marble,’ Sam told me while leaning on his shovel. ‘They want the gold inlay. But they don’t want to hear that the drainage on this particular slope is garbage. So they buy the expensive stone, and three years later, it’s leaning 13 degrees to the left because nobody checked the foundation.’
That conversation stuck with me. We do the same thing with our skin. We want the ‘heavy marble’-the aggressive laser, the newest filler, the chemical peel that promises to erase a decade in 23 minutes. But if the person ‘selling’ it to you doesn’t check the ‘drainage’-your skin’s underlying health, your immune response, your vascular structure-you’re just paying for a monument that’s going to sink.
“So they buy the expensive stone, and three years later, it’s leaning 13 degrees to the left because nobody checked the foundation.”
The Power of ‘No’: Candidacy vs. Transaction
In a proper medical environment, like Anara Medspa & Cosmetic Laser Center, the physician-led model ensures that the initial conversation is rooted in diagnosis rather than a transaction. It’s about determining candidacy. This is a word that the retail model hates. ‘Candidacy’ implies that the answer might be ‘no.’
That ‘no’ is the sound of a professional taking responsibility for your safety. When a clinician spends time looking at the 83 different factors that contribute to your skin’s current state, they are building a map. They are looking for contraindications. They are looking for reasons why a treatment might fail or, worse, cause harm. If they skip the medical history, they are flying blind with a very expensive, very hot laser.
Chasing ‘Yes’ and the Tension of Convenience
I’ve made the mistake of chasing the ‘yes’ before. We all have. We want the quick fix because the 13 missed calls in our lives make us feel like we’re always behind, always needing to catch up to some idealized version of ourselves. We think that if we can just buy the right package, we’ll be ‘fixed.’ But medicine doesn’t work in packages. It works in increments. It works in response to the specific, unique chemistry of your body.
The Paradox of Modern Care
I find myself annoyed by the paperwork in a doctor’s office-the 33 questions about things that seem irrelevant-yet I am deeply suspicious of any cosmetic provider who doesn’t make me fill it out. We want retail convenience but medical safety.
I’ve seen what happens when the retail model wins. I’ve seen people with hyperpigmentation that was worsened by the wrong laser because the ‘consultant’ didn’t know how to identify their specific Fitzpatrick skin type. I’ve seen the 43-year-old woman who ended up with a $373 bill for a treatment that did absolutely nothing because she was a poor candidate from the start. These aren’t just ‘bad reviews.’ These are clinical failures disguised as bad luck.
When you sit down for a consultation, look at the room. Is there a sink? Are there medical instruments? Or is it just a desk with a computer and a series of framed posters showing 23-year-old models with perfect jawlines? If the environment is designed to make you feel like you’re at a high-end makeup counter, your brain will naturally switch into ‘buying mode.’ You’ll start thinking about the cost-benefit analysis of the ‘Tier 3’ package. You’ll stop thinking about the fact that someone is about to use a medical device to alter your cellular structure.
Digging for the Truth
Sam N. once showed me a plot where the grass wouldn’t grow, no matter how much seed they put down. He’d spent 13 days trying to figure it out before he realized there was an old concrete slab buried 3 inches underground from a building that had been torn down 83 years ago.
“You can’t grow anything on top of a lie,” he said.
[You can’t grow anything on top of a lie.]
That’s what a sales-pitch consultation is. It’s trying to grow a result on top of a lie-the lie that one size fits all, that history doesn’t matter, and that everyone is a candidate for everything as long as their check clears. A medical exam, by contrast, is the process of digging down to find the concrete slabs. It’s the process of uncovering the truth of your skin so that whatever is built on top of it actually lasts.
Reclaiming Patient Status
Protected by Return Policy
Protected by Oath
We need to stop being ‘customers’ in the medspa space. We need to reclaim our status as ‘patients.’ It sounds less glamorous, sure. ‘Patient’ implies a certain level of vulnerability and a need for care. ‘Customer’ implies power and choice. But in the realm of cosmetic lasers and medical-grade injectables, the ‘customer’ is often their own worst enemy. The ‘patient’ is protected by the Hippocratic Oath. The ‘customer’ is protected only by the return policy-and good luck returning a botched laser treatment.
The Right Details Matter (The 23 Ways)
In a consultation, the ‘right things’ are the small details: the way your skin reacts to pressure, the history of your hormonal shifts, the 23 different ways your lifestyle affects your healing capacity. Pay attention to the inventory of questions, not the inventory of products.
If you find yourself in a room where the only thing being examined is your wallet, get up. Go find a place where they treat your face with the same gravity that Sam N. treats the earth. Find a place where the consultation feels like a medical exam, because that’s the only way to ensure that what you’re buying isn’t just a temporary glow, but a lasting, safe transformation. After all, you only have one face. It deserves more than a highlighter and a laminated menu.