Persona non grata: Identifying patients unsuitable for aesthetic dermatologic procedures

The rapid growth of aesthetic dermatology has been accompanied by an increasing demand for cosmetic procedures and heightened expectations for treatment outcomes. Although aesthetic procedures aim to enhance appearance, dermatologists are tasked with ensuring patient safety and adhering to ethical medical practices. In certain situations, refusing treatment may represent the most appropriate clinical decision. The term persona non grata, originally used in diplomacy, serves as a useful metaphor in aesthetic dermatology to describe patients for whom cosmetic procedures may be unsuitable due to ethical, medical, or psychologic concerns. We discuss situations in which dermatologists may need to decline aesthetic procedures and highlight specific patient profiles that require caution. We examine ethical considerations, including informed consent, patient autonomy, and the physician's duty to avoid harm. Additionally, we focus on psychologic aspects, particularly unrealistic expectations, social media-driven aesthetic demands, and psychiatric comorbidities like body dysmorphic disorder. Recognizing these high-risk situations is crucial for maintaining professional integrity and minimizing complications in aesthetic practice. Finally, we review legal safeguards for patients who may not be suitable for aesthetic procedures. Fundamental principles of responsible aesthetic dermatology include careful patient selection, comprehensive medical and psychologic assessments, and clear communication.