Dr Imaan Joshi

Yep that’s how much medical aesthetics can typically cost.

Why?
- overheads, insurance & training of the person assessing you & providing the treatment plan (consultation fee)
- machines are expensive as are consumables - cartridges, products etc
- there’s no insurance for entirely optional care
- as procedural doctors/physicians pay a LOT in insurance annually compared to non physicians.

But also - what would I have done differently?
- start with the consultation
- no obligation to do anything if budget is a problem.
- doing 2/3 of the suggested treatment may not get you the outcome you want so consider if you’re actually saving money at all.
- timing matters; 4 months to a wedding removes a fair bit of slower options that may be budget friendlier.
- some, like the $3600 for non surgical volume, are semi permanent, if done well & last years.

All of this comes down to preparing patients for the consult and then giving them time to think & to mull.

It’s not possible to advise on typical costs with such a broad brief “I want to get nicer skin” or “I look sickly, I want a glow up” are very vague.

With thanks to Milly Rose Bannister for sharing her experience.

I’m so grateful to people like .2.shine for sharing so candidly the downs of her surgical journey.

I do think we are in a strange time in which aesthetics including surgery, is so normalised on our feed as no big deal that when something doesn’t go to plan, we are …shocked; upset; outraged.

Sometimes we look for someone to blame, we think about suing, asking for our money back &/or we think about moving doctors.

I see the full spectrum of these emotions as I try and guide *my* patients post surgery with less than ideal outcomes, off the ledge. Or to talk to their doctor.

It’s a timely reminder that in the best cases, surgery results in ~ 80% improvement & in many cases, less.

It’s a considerable investment of time, energy and money for entirely optional procedures so…I encourage my patients to talk to me; take their time; ask for recommendations while recognising that it’s not a guarantee of fit.

Your anatomy and biology is the thing that may ultimately not play ball and it’s important to really understand and accept this.

It’s the flip side of the same conversation we have in clinic weekly around non surgical procedures- and how much improvement is realistic after 40-60+ years of not much especially if they want to stop as soon as they see results.

A lot of this work is about mindset change.

I get the flip side - time, energy, money. It’s easier…

My privilege to be entrusted with the ability to order tests, to prescribe medications & to be trusted with confidential information is not something I take lightly.

Nor is it something I take for granted if there’s a real risk of harm to you.
- eg I don’t prescribe MHT outside a 45-60 min initial consultation in which we go over results, tests and plan for the next 3-6 months till I see you.
- eg I don’t prescribe antidepressants without a 45+ minute initial consultation & then ongoing regular followup if I’m not seeing you for therapy.
- it’s not fair for me to order tests & expect another doctor to interpret these for you or to act on them. That’s my legal responsibility.

It’s ok that you think it’s “just” a script or a referral. It’s not that I’ve found in 2026 it’s a very slippery slope- and it’s been feeling unsafe for some time now at which point I realised - “It’s me! Hi! I’m the problem it’s me!”

I like and follow

But I wonder if this is a step too far & why people end up having procedures- often irreversible - that they later regret.

We are not retail salespeople as healthcare professionals. The patient is not always right. They often are seeking our advice & guidance.

So let’s give them that. Not “whatever makes you happy (today)” that make cause harm or even regret tomorrow.

The stakes for discretionary medical treatment should be so much higher than “whatever makes you happy (if you can pay for it.”

“Young faces are full of fat, while young bodies are slim.” is a common saying, alongside “After 40, you choose either your face or your body.”

I write about conversations we have in clinic anonymously. When I have the same conversation multiple times in a day or a week, I talk about it here.

Facial fat looks good. It retains youthful contours. In non surgical and surgical procedures we replace the volume lost due to ageing so I am baffled at the rush to pursue a slim body at the expense of a face that looks significantly older or as Rosie O’Donnell says it after 20kg weight loss, “Like my face was melting”.

I honestly think it’s the latest version of perception drift except it has real consequences for how you’ll age in terms of frailty.

It seems everyone is on weight loss drugs to lose weight; some illegally.

In my patients it’s showing on their faces, skin quality, & not in a good way. To which they say “well just add more…”

Except when you’re spending $3-8k pa to maintain your weight budget becomes an issue for what’s needed to help your face & skin even if surgery isn’t on the table (yet).

It’s a slippery slope I’ve seen several people go down over the years. Like perception drift and filler blindness, they can’t see it until one day THEY CANNOT UNSEE IT.

Till then I do what I can to support, remind, nag… and keep them safe - from sarcopenia; from osteopaenia; from frailty in the pursuit of numbers on a scale that some have never been even as young adults & not since 🤰.

Related to that, these drugs like most other human issues, are intended for longterm use. Stop them and most people will return to baseline within a year or so.

So. 😑…

We humans are terrible at remembering, much less paying attention day to day to appearance.

I see it all the time in medical aesthetics “I don’t see anything” “I know I’m meant to have it quarterly but I only need it once a year “

And in dermatology “There’s been no change” until we see photos 3 months apart, assuming they show up.

So now we discuss the cadence & when we review it.
No sooner. No later. When we agree we will.

If that doesn’t work it’s ok but I’m not the doctor for you.

This week I had two patients ask to cancel/delay their appointments because they didn’t think they needed more yet. One asked for my opinion & I said “come see me anyway since you’ve reserved my time.”

She came & guess what? She was ready as expected & we had a fruitful consultation about next steps.

If you want me to be your doctor please treat me like one and listen to me. Otherwise I may not be right for you.

I charge for my time. I don’t work for free & I don’t expect you to.

I see people usually after they’ve spent often, thousands elsewhere with reportedly little to no results for a concern.

I begin with a paid consultation. 30- 90 minutes depending on the type.

Because without correct assessment & diagnosis you’re shooting blind. And spending thousands with no real chance of success.

So at Skin Essentials we begin with what every medical student learns to do- comprehensive history; exam if appropriate to arrive at likely diagnosis & *then* treatment plan.

People rush to treatment without understanding cause & that sets you up for failure & far more wasted money and time than the time honoured way med school teaches us.

Start with the basics first. You may save money too.

Patients come to us for honest advice.

We may or may not offer the service they want or need.

At that point, in medical aesthetics we have two choices- say yes and take the money. Or say no & refer or educate on what they may better need. (Side note- everything in medical aesthetics is a want, not a need).

I sleep better knowing I consult to see if I can help you & saying no & upsetting you than taking your money.

Funny that it even needs to be said…