Less Is More? Treatment Intensity and Patient-Reported Outcomes in Minimally Invasive Aesthetic Medicine: A Narrative Review

Background: In recent years, aesthetic medicine has progressively prioritized conservative treatment volumes, subtle enhancements, and skin quality improvement over volumization. This study evaluates patient-reported psychosocial outcomes, satisfaction, and regret rates following minimally invasive aesthetic procedures using validated instruments. Methods: A review was conducted in accordance with PRISMA guidelines. PubMed, Scopus, and Cochrane Library were searched for studies reporting outcomes using validated PROMs (FACE-Q, GAIS, Decision Regret Scale, BDDQ, DCQ and COPS) with a minimum follow-up of 6 months. Studies evaluating facial botulinum neurotoxins, hyaluronic acid fillers, and biostimulation treatments were included. Given the heterogeneity in study design and outcome reporting, findings were synthesized narratively with descriptive comparisons across treatment modalities. Results: Increased treatment intensity was not consistently associated with greater satisfaction, and higher dose or volume often corresponded to more dissatisfaction and regret. The evidence for this pattern was stronger for botulinum toxin and hyaluronic acid fillers; weaker for biostimulators and preliminary for post-GLP-1 facial changes. Conservative approaches were associated with favorable PROMs, and unrealistic expectations, body dysmorphic disorder, and insufficient pre-treatment counseling were the principal predictors of poor outcomes. Conclusions: Patient satisfaction was not proportional to treatment intensity, particularly when results were perceived as unnatural or overcorrected. This relationship appears associative rather than causal, as patients receiving more intense treatment may differ in expectations, history, and psychological profile. A PROM-driven, patient-tailored approach seems more likely to produce durable satisfaction and minimize regret.