“What can we do about this?” as my client is pointing at a feature is one of the most common questions I hear in the treatment room. But before I answer, I want to know something else: What does the client actually want to change, and why?
A client may see a wrinkle, a dark spot, or a change in facial contour. As practitioners, we have to look beyond what is immediately visible. The most effective corrective plan starts with understanding what is happening beneath the surface, what is realistically within our scope to address, and what approach makes sense for that individual.
Advanced skincare correction does not begin with a device, a peel or a product. It begins with a conversation.
Start With What They Love
One of the first questions I ask is: “What do you love about your skin or your appearance?”
I do not want the consultation to begin with a list of everything the client dislikes about themselves. Starting with what they love changes the tone of the conversation and reminds both of us that correction should be about enhancing confidence and what they already love about themselves and not creating new insecurities.
From there, I ask: “If we could work on one or two things together, what would you want those to be?”
A client may have several concerns, but they may not all be equally important to them.
This is where I listen.
The consultation is not an opportunity for me to demonstrate how much I know. It is an opportunity to understand my client’s goals before I educate them about what I am seeing.
Contribution by Tiffany Underwood
Tiffany Underwood is the Director of Education for FACTORFIVE Skincare, a licensed esthetician, and the founder of SkinCo. With a background in biology, product formulation, and advanced esthetics, she blends science and innovation to deliver results-driven treatments while empowering professionals to stay connected to their “why.” Inspired by her own journey with cancer, Tiffany also founded Tiff Tiff’s Chemo Bags, a nonprofit providing comfort to those undergoing chemotherapy. Guided by the belief that “when you feel good, you do good,” she is dedicated to helping others feel beautiful in their skin, inside and out.
Listen to the Concern, Then Explain the “Why”
Once I understand what my client wants to address, I want them to understand why they are seeing it.
Clients often describe what they see in simple terms: “My skin is sagging.” “I have spots.” “My face looks older.” Those observations are important, but they do not necessarily explain what is happening underneath.
For example, a client may come in concerned about jowling and assume the solution is simply to “tighten the skin.” Skin laxity can contribute to the appearance of jowling, but facial aging is more complex than a change in the skin alone.
Age-related changes can involve collagen and elastin, facial fat compartments, soft-tissue support and underlying facial structure. Redistribution and descent of facial fat, combined with changes in tissue laxity and structural support, can alter facial contour.
That distinction changes the conversation about what an esthetic treatment can realistically accomplish.
I can work to improve the health and appearance of the skin, support collagen remodeling and improve qualities such as texture and hydration. But I cannot replace significant lost structural volume with a facial treatment.
That is where education and realistic expectations become part of good skincare.
Understanding the “Why” Changes the Treatment Conversation
The same approach applies to expression lines.
A client may come in concerned about forehead or glabellar lines and ask what they can do to make them disappear. I can discuss daily sun protection, appropriate home care and modalities such as microcurrent to support overall skin quality.
But I also want to explain why those lines are there.
Forehead and glabellar lines are influenced by repetitive muscle movement. Over time, that movement can contribute to the formation and deepening of dynamic lines, particularly as the skin’s collagen and elastin support changes with age and cumulative environmental exposure.
I can improve the quality of the skin surrounding those lines, but I cannot stop the underlying muscle movement with an esthetic treatment. If reducing that movement is the client’s primary goal, I may recommend a consultation with a qualified medical provider regarding a neuromodulator.
I do not view that referral as taking something away from my treatment plan. I see it as making the plan more complete.
A neuromodulator can temporarily reduce the muscle activity contributing to dynamic lines, while a comprehensive skincare plan can support the health, hydration, texture and overall quality of the skin. Sun protection remains essential because cumulative UV exposure contributes to collagen degradation and visible aging.
The Right Treatment for the Right Problem
I do not believe the most aggressive treatment is automatically the best treatment.
The question I ask is not simply, “What treatment works for this concern?”
It is: “What treatment makes sense for this client, with this skin, at this point in time?”
Two clients can present with the same concern and require completely different approaches.
For example, two clients may both present with hyperpigmentation. One may have a healthy barrier, consistent sun protection and an appropriate home-care routine. Another may be exfoliating aggressively, rarely using sunscreen and presenting with inflammation or barrier disruption.
Their concern may look similar, but their skin is not in the same place.
Before selecting a corrective modality, I want to understand the condition of the skin, the client’s current routine, treatment history, tolerance, lifestyle and ability to maintain the results at home.
Sometimes the best first treatment is not the most aggressive one. Sometimes the skin needs to be stabilized before correction can begin.
When a “Spot” Is More Than Just a Spot
Pigmentation is another example of why assessment matters.
Clients frequently tell me they want to get rid of their “spots.” My job is to slow the conversation down and understand what those spots may represent.
Here in the South, cumulative UV exposure is an especially important consideration. Years of sun exposure can contribute significantly to visible pigmentation and uneven tone. But not every dark spot has the same cause, and not every pigmented lesion should automatically be treated cosmetically.
This creates an opportunity for education around daily broad-spectrum sun protection, appropriate home care, professional treatments and long-term maintenance. We can also consider factors such as inflammation and post-inflammatory hyperpigmentation when relevant to the client’s history.
And sometimes the most important decision is knowing when something should not be treated in the treatment room and instead needs evaluation by an appropriate medical provider.
Correction requires us to recognize the limits of our scope as much as it requires us to understand our capabilities.
Knowing When to Refer Is Part of Being a Good Practitioner
I do not see referral as admitting that I cannot help a client. I see it as knowing when another professional can provide something that I cannot.
If a client’s primary concern involves significant facial volume loss, for example, I can explain what I can realistically accomplish through skin-focused treatments while also discussing that a qualified medical provider may be better equipped to address structural volume changes.
Depending on the client’s goals and circumstances, that may mean referring them to a qualified nurse injector, physician or plastic surgeon.
The same applies when a concern falls outside my scope of practice or when I see something that warrants medical evaluation.
The goal is not to make every concern fit into the treatment I offer.
The goal is to use the right tool for the right problem.
That kind of collaboration ultimately benefits the client and builds trust.
Ultimately, I do not view a corrective treatment plan as something that is written once and never changes.
The skin changes. The client’s priorities change. Their tolerance, lifestyle and response to treatment can change. That means I continually reassess.
What worked? How did the skin respond? Is the original concern still the priority? Is the client ready for the next level of correction, or does the skin need more time?
I also remind my clients to be patient. We did not age overnight, and we did not develop our “spots” overnight. Meaningful correction takes time, consistency and maintenance.
The consultation, therefore, is not something that happens only at the first appointment. It becomes an ongoing conversation and I believe that is where trust is built.
When a client knows I am listening to what they want, rather than looking for the next thing to sell them, they become more comfortable trusting my recommendations. When I can explain why they are seeing a particular change, what I can realistically improve, what may require another provider and what will take time, they become an educated partner in their own treatment plan.
That trust goes both ways. I can make better decisions when I truly understand my client’s goals, concerns, lifestyle and expectations.