Patients take months to choose a plastic surgeon. How long does follow-up run?

Who this is for

This is for the physician or medical professional who owns a plastic surgery practice or med spa that performs procedures requiring a consultation. It is also for the operations lead who tracks each consultation to a booked surgery and runs follow-up with patients who leave undecided.

What we found

A consultation that has not booked after a few weeks often gets counted as lost. If more patients now see two or three surgeons and take months to decide, some of those consultations are still open. Those patients also show up in consultation conversion, the share of consultations that go on to book surgery.

The American Society of Plastic Surgeons (ASPS) says many patients now meet two or three surgeons and spend months deciding. Typically, marketing vendors schedule follow-up for up to three months if the patient does not book. If at 90 days the patient still is not scheduled, the patient is recorded as a loss. Yet a surgeon the society interviewed reports patients may return a year or two after the initial consultation.

What do plastic surgeons say about patients slowing down during the research and clinician selection phase?

The society says more patients are putting extra steps between interest and a booked surgery.¹

It writes that patients no longer decide after one appointment. They "may meet with two or three surgeons" and "spend months researching their options." Some may even return for a secondary consultation with the same clinician before feeling informed and ready.¹

The article says a second opinion "is becoming less of a response to uncertainty or a red flag."¹

The surgeon quoted, Dr. Noël Natoli, says "it's very common [at her practice] for patients to return a year or even two years after an initial consultation." She sees this even with paid (not complimentary) consultations. Those are common for in-demand procedures and surgeons, and they help ensure the surgeon meets patients who are serious about surgery.¹

The Aesthetic Society reports total surgical procedures overall up 2.9% from 2022 to 2023, and up 10.2% from 2019 to 2023. Its two-year dataset covers more than 150,000 procedures by 762 surgeons, drawn from CosmetAssure's database of elective surgeries.²

Consultation fees are also known to shift who books a first visit, which shows up in conversion rate and segmentation analysis.

How many plastic surgeons did patients consult before choosing one?

The Brazilian survey in this review counted consultations, and it found that half of patients had only seen a single surgeon before choosing one (50.5%). This study, published in Revista Brasileira de Cirurgia Plástica, surveyed 101 patients in Brazil about their methodology for choosing their plastic surgeon.³

In the same survey, 47.5% said their first consultation with the chosen surgeon lasted between 30 minutes and an hour.³ In the US, standard patient behavior is to book two or three consultations, especially in competitive markets. Patients compare quotes, bedside manner and overall anticipated satisfaction.^1,4

Other studies look at why patients pick the surgeon they do. A 2013 study in the Aesthetic Surgery Journal covered 250 consecutive patients. It reports 69.3% citing the quality of preoperative information and 65.4% the patient-physician relationship.⁵

In the same study, 40.8% consulted a surgeon because a general practitioner (GP, PCP or primary care doctor) recommended that surgeon by name.⁵

What do cosmetic surgery patients research between a consultation and a booking?

Two sources from different sides of the industry found most patients going online themselves to match their goals with clinicians.

Kantar Health ran a 2018 survey for Allergan (acquired by AbbVie in 2020), the maker of aesthetic products including Botox, Juvéderm and CoolSculpting. In it, 64% of surgical cosmetic patients said they always research cosmetic providers online before selecting one.⁶

Among online sources, 46% of surgical patients named at least one website that compares or rates providers.⁶

A retrospective study published in The Surgery Journal in 2021 reviewed 100 patients who had aesthetic facial plastic surgery between July 2019 and May 2020. In this cohort, 70% used online before-and-after galleries on physician websites or social media to decide on surgery. Each also had photos taken and digitally altered to show a predicted result. That helped the conversation about what the surgeon thought was a realistic outcome.⁷ AI tools now make these previews too; we reviewed them in AI before-and-after renders.

Why do some surgeons want a waiting period before cosmetic surgery?

Some surgeons want slower decisions written into consent. A 2023 survey of society members in Plastic and Reconstructive Surgery Global Open drew 364 respondents.⁸

Of those, 281 (78.9%) felt there should be a cooling-off period, a set gap between consultation and surgery. Its length, they said, should vary with the procedure.⁸

The paper cites guidance for a two-stage consent. The first is a consultation at least seven days before surgery, and the second is on the day of the procedure, to ensure alignment and consistency.⁸

For breast augmentation, the paper proposed a cooling-off period of at least 10 and preferably 14 days between consultations.⁸

Where a practice follows guidance like this, at least one return visit is part of the clinical path. The usual sequence is then a first consult, a second consult, then surgery. Of course this second consult takes surgeon time, so scheduling and whether the second appointment carries a fee vary widely by practice.

State rules may also play a role when it comes to free or discounted visits. For example, Maryland's regulation on physician advertising bars ads for free or discounted examinations when the patient is charged for resulting services within 72 hours. Emergencies are exempt.⁹

How long do marketing vendors follow up with undecided patients?

Most of the follow-up advice here comes from companies that sell marketing or follow-up services. Most of it concerns inquiries that have not yet reached a first consultation.

Catherine Maley, who publishes marketing advice for plastic surgery practices, wrote in 2021 about internet leads that did not book right away. By her account, 48% never follow up, and the average first follow-up for those that do comes 72 hours after the inquiry.¹⁰

She adds that 25% of practices make two contact attempts, and that 64% have no organized way to follow up at all.¹⁰

Across the three vendors, follow-up on an inquiry runs from the same day to three months. Ignitvio's cadence is the longest: one day, three days, one week, two weeks, one month and three months.⁴

The same vendor credits "Marketing Donut's research" with finding that 63% of people requesting information won't buy for at least three months.⁴

Patient Acquired reports an 89% "reminder-engagement benchmark in certain workflows."¹¹

Practice Growth Co. is the one vendor we identified that has written about patients after a consultation. Its founder, Mike Funkhouser, describes a plastic surgery practice booking 40 consultations per month from Meta campaigns. That practice converted 25% of consultations to surgical cases.¹²

In this cohort, the practice experimented with a structured nurture sequence for people who had attended and not booked. Its consultation-to-booked rate moved from 25% to 38% over three months, with the "same ad budget, same consultation volume, same surgeon."¹²

One must also consider how the practice defines its metrics. These include time from first consultation to booking, how many book after a year or more, how many see the same surgeon twice and how many miss a consultation. The more specific and consistent these are, the more fruitful such experimentation may be. For example, a conversion count that closes three weeks after a consultation would record a patient who returns a year later as a new patient. That booking is never tied to the consult that may have aided the decision.

A few pieces of advice from the research. First, keep follow-up going beyond three months at decreasing frequency, since returns may come a year or two later. Second, consider a secondary method of measuring consultation conversion over at least a year, even as a supplement to your primary short-term conversion rate. Third, pay attention to the criteria patients weigh: the surgeon's explanation of the procedure and the surgeon's own before-and-after results. In the 2013 study, 69.3% cited the quality of preoperative information, and in the facial surgery study 70% used galleries to decide.^5,7 Finally, you must benchmark the current state. Account for seasonality, for patients who consult for one procedure and book another, and for whether fast bookers turn out to be higher lifetime value patients.

About this review

We read 12 sources in October 2026. They were two society publications (ASPS and The Aesthetic Society), four peer-reviewed studies, one manufacturer-sponsored survey, one state regulation and four vendor pages. Each data point is given under its own publisher's name, with no gap or ratio computed between sources.

The Aesthetic Surgery Journal data points come from an indexed summary of the 2013 article. The sources cover patients in the US, Brazil and France, members of a surgeons' society, and vendors' own clients.

Fractional Aesthetics is a growth strategy practice for aesthetic medical businesses.