“Doctor, I have the money ready. Just tell me when we can schedule.”
Camila was 26 years old, had perfect skin, and had just asked me to apply Botox to practically her entire face. Her mental budget: $2,400,000.
I took a photo of her with natural light and showed it to her.
There wasn’t a single visible line at rest.
“Camila, I’m not going to do any of that to you.”
That was the first of 43 times I said “no” during 2024. In total, I rejected more than $15 million in treatments that patients wanted but didn’t medically need.
This decision fundamentally changed my practice and taught me something disturbing: we’re creating an epidemic of dependence on aesthetic treatments in young women who don’t need them.
I’ll explain why rejecting easy money became my most important medical tool.
The invisible pressure that comes to my office
In the last two years, my patient profile changed dramatically.
Before, women aged 35-45 with already marked lines consulted seeking specific solutions. Now, 60% of my consultations are women aged 25-32 without real signs of aging, but convinced they “need” preventive Botox.
The influence of social media is devastating. They arrive with screenshots of 23-year-old influencers showing their “preventive treatments,” articles about how “prevention is better than correction,” and social pressure from friends who have already started treatments.
Camila confessed to me during consultation: “All my friends already get Botox. I feel like if I don’t start now, I’m going to fall behind.”
This isn’t a medical problem. It’s a psychological problem amplified by commercial marketing.
The cases that taught me to say “no”
Sofia, 28: the perfectionist
Sofia worked in digital marketing and had researched “everything about aesthetic medicine” for months. She arrived with a detailed list of treatments she wanted: Botox in forehead, glabella, crow’s feet, neck, and “micro-dosing” in the upper lip.
Her specific request: “I want to look the same as now, but without being able to make gestures that mark lines.”
During evaluation, her skin showed only completely normal dynamic lines. When she smiled, mild crow’s feet appeared. When she concentrated, the glabella marked slightly. At rest, her face was impeccable.
I explained that if I completely eliminated her ability to gesticulate, she would lose naturalness in her expressions. “That’s exactly what I want,” she responded.
That’s when I understood she wasn’t seeking aesthetic medicine. She was seeking total control over her image, something no medical treatment should offer.
Valentina, 25: the anxious one
Valentina arrived after seeing a viral video about “early signs of aging.” She had self-diagnosed lines that, according to her, appeared when she smiled “very hard.”
She asked me to apply “very gentle” Botox because she had read that “starting early makes it last more years without needing so much.”
During 20 minutes of evaluation under different types of light, I couldn’t identify a single static line. Her “smile lines” were the natural texture of skin when it contracts from normal facial expression.
I showed her photos of her face at rest and asked: “Where exactly do you see a wrinkle?”
She remained silent for several seconds. “Well, they’re not visible now, but when I laugh…“
“That’s called having normal human facial expressions,” I explained.
Isabella, 30: the influenced one
Isabella had seen the Instagram profile of an influencer who documented her “preventive treatments” since age 24. “She looks incredible and says it’s from starting early with Botox.”
She showed me photos of the influencer and asked for “the same preventive protocol.”
I explained that I didn’t know that person’s medical history, genetic factors, or real condition before treatments. “Copying another person’s protocol without specific evaluation is like taking someone else’s medication.”
During consultation I discovered that Isabella really had an incipient static line in the glabella from working many hours in front of screens. But the rest of her request (forehead, crow’s feet, neck) was completely unnecessary.
I proposed treating only that specific area. Her reaction was immediate: “But I want the complete treatment like her.”
The most difficult conversation I have weekly
When a young patient asks me for preventive Botox without real medical indication, I have a specific conversation I’ve perfected over years.
First, I show her face under direct natural light. “Make all your expressions: smile, frown, raise your eyebrows, gesticulate like when you talk.”
Then I ask her to completely relax her expression. “Now look at yourself without making any gesture.”
Invariably, her face looks perfect.
“Do you see any lines now?” I ask.
The answer is always the same: “No, but when I laugh…”
“That’s exactly what I expect to see in a woman your age. Lines that appear only when gesticulating are completely normal and healthy.”
Then I explain something no other specialist has told them: “If I apply Botox now, I won’t be preventing future wrinkles. I’ll be creating dependence on a treatment your skin doesn’t need.”
Why poorly understood preventive medicine is dangerous
Preventive aesthetic medicine makes sense when there’s something specific to prevent. If there are already incipient static lines, early intervention is intelligent. If there are only normal dynamic lines, intervening is creating a problem where none exists.
“Preventive” Botox in young skin without medical indication generates several problems:
Premature psychological dependence
Once you start using Botox regularly, your perception of your “natural” face changes. When the effect wears off, you look “worse” than before the first treatment, although objectively your skin is exactly the same.
Valentina returned two years after I told her she didn’t need treatment. She had gone to another place where they did apply it. “Now I can’t be without it. My forehead looks horrible when the effect wears off,” she told me.
Her forehead looked exactly the same as two years before, but she could no longer see it objectively.
Gradual loss of naturalness
Botox applied repeatedly in muscles that weren’t hyperactive can generate progressive muscular weakening. Over the years, this can result in less natural expressions or subtle asymmetries.
Unnecessary economic cost
A woman who starts preventive Botox at 25 will spend approximately $20 million on treatments over the next 20 years. If she had waited until 35 when she really needed it, she would spend less than half.
The questions I now ask in every consultation
My evaluation protocol includes specific questions that reveal if motivation is medical or emotional.
“What specifically bothers you about your face?”
If the answer includes “I look tired,” “I want to look younger,” or “I don’t like how I look in photos,” the problem isn’t medical.
If she responds “I have this specific line that won’t go away,” that does require medical evaluation.
“What do you expect to change in your life after treatment?”
Concerning answers include: “feeling more confident,” “my partner liking me more,” “looking better than my friends,” “never aging.”
No medical treatment should be the solution to fundamental insecurities or unrealistic expectations.
“Would you be willing to wait six months if I tell you it’s best for youcase?”**
This question reveals the level of emotional urgency. If the idea of waiting generates immediate anxiety, the motivation isn’t medical.
My current statistic: 40% don’t need immediate treatment
During 2024, of every 10 women between 25-35 who consulted for preventive Botox, 4 didn’t need any immediate treatment. They only needed education about normal aging and basic care routine.
3 more only needed optimized sun protection and annual follow-up. Without medical intervention.
2 had a specific area that did justify preventive treatment, but not the complete protocol they requested.
Only 1 out of 10 really needed the multiple treatment they had requested.
This statistic completely contradicts what the cosmetic industry and social media suggest.
What happened with the patients I said “no” to
Two-year follow-up of the 43 patients I rejected:
31 of them thanked me later. They followed my basic care recommendations and maintain excellent skin without treatments.
8 got treated elsewhere and now require regular maintenance. 5 of those 8 expressed they “wish they had waited.”
4 didn’t return for consultation and I don’t have follow-up on their decision.
The most memorable patient was Camila, the first of the year. She wrote me three months ago: “Doctor, thank you for telling me no. My friends who started when I wanted to can’t be without Botox anymore. They look weird when it wears off. I continue with my skin just as good, only spending on sunscreen.”
When it really is time to consider treatment
My medical criteria is specific and objective:
If lines are present when the face is completely relaxed, it’s time to evaluate treatment.
If they only appear during specific expressions, there’s still no medical indication.
If the main motivation is anxiety about future aging, the conversation should be about expectation management, not immediate treatment.
If there’s family history of premature aging and specific risk factors, medical follow-up is appropriate, but not necessarily immediate treatment.
Why some doctors say “yes” to everything
Rejecting patients is economically difficult. Each “no” represents immediate lost income and patients who may go to less selective competitors.
Commercial pressure in aesthetic medicine is enormous. Expensive products, luxurious facilities, and aggressive marketing require patient volume to be sustainable.
But I’ve learned something fundamental: patients who truly value medical honesty end up being the most loyal long-term.
Camila didn’t become an immediate client, but she became an active promoter of ALMO Clinic. She has referred 7 friends during these two years, all with real medical indications that did justify treatment.
The ethical aesthetic medicine we practice
At ALMO Clinic, our objective isn’t to apply the greatest number of treatments possible. Our objective is for each patient to receive exactly what they need, when they need it, with natural results that genuinely improve their wellbeing.
This means that approximately 15% of our consultations end with a recommendation NOT to do immediate treatment. Not because we don’t want to work, but because it’s medically correct.
Sometimes we reject treatment requests. Sometimes we recommend waiting. Sometimes we suggest more conservative alternatives. But we always put patient wellbeing before our commercial interests.
My European training taught me that long-term medical reputation is worth more than immediate income. One satisfied patient after 10 years is worth more than 10 dissatisfied patients after 1 year.
The question you should ask yourself before any treatment
Am I seeking to solve a specific medical problem or am I seeking to solve an emotional insecurity?
Medical treatments can resolve medical problems. They cannot resolve fundamental insecurities, social pressure, or unrealistic expectations about aging.
If your main motivation is “looking better than others,” “never aging,” or “feeling more confident,” the problem isn’t your skin.
If your motivation is “I have this specific line that bothers me” or “I want to prevent this area from marking more,” that is an appropriate medical consultation.
Your smartest decision
Are you considering preventive Botox and aren’t sure if you really need it?
At ALMO Clinic, the evaluation includes a completely honest conversation about whether treatment is appropriate for your specific case, your age, and your current condition.
Not everyone needs aesthetic medicine. And it’s perfectly fine not to need it.
Our job is to ensure you only receive treatment when it’s medically justified and will genuinely improve your long-term wellbeing.
An honest evaluation can save you years of unnecessary dependence and thousands of dollars in treatments your skin doesn’t need.
