A treatment becomes a product the moment the person buying it stops asking what it's for.
That shift has happened quickly. Fifteen years ago a patient came in with a concern and left with a plan. Now a significant number arrive with a purchase already decided — a syringe count, a named device, a package. The consultation has quietly become a checkout.
I don't think patients are to blame for this. We built it. The industry discovered that concerns are hard to sell and products are easy, and it optimised accordingly. Loyalty schemes. Bundles. Monthly memberships. Language borrowed wholesale from retail, applied to prescription medicines and surgical procedures.
The obvious objection is that accessibility is good, and there's truth in it. Aesthetic medicine used to be the preserve of people who could afford Harley Street and knew how to find it. Wider access has not been a disaster. Most treatments most of the time go perfectly well.
What commodification actually removes
But commodification does something specific and damaging: it strips out the part of the encounter where someone decides whether to treat at all. A product has no threshold. You either buy it or you don't. A treatment has an indication, and an indication means there are people who shouldn't have it.
I turn away a meaningful fraction of the people who come to see me. Not because I'm principled about it — because in a lot of cases the honest answer is that the thing they've asked for won't achieve what they want, or that they've already had enough. That conversation is impossible to have inside a retail frame. You can't tell a customer their purchase is inappropriate.
The second casualty is time. Products get faster, because speed is a competitive advantage in retail. Treatments shouldn't. Much of what I know about a face comes from seeing it twice, months apart, and observing what the last intervention actually did rather than what I assumed it would do. Compress the interval and you lose that information permanently.
Where this goes
What I'd want to see is not less access. It's a clearer separation between the two things a clinic sells. Skincare is a product. Membership is a product. A prescription medicine injected near an artery is not, and calling it one changes how everybody behaves — the practitioner and the patient both.
My honest expectation is that it gets worse before regulation catches it, and that the correction comes from complications rather than conscience. That's how it has gone in every adjacent field. I'd rather be wrong.