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Improving Patient Retention After Botulinum Toxin Type A Treatment


Address correspondence and reprints requests to: Tina S. Alster, MD, 2311 M Street, NW Suite 200, Washington, DC 20037, or e-mail:


BACKGROUND Botulinum toxin treatments have been associated with consistently high patient satisfaction rates, but calculation of patient retention rates is not routinely performed. Retention measurements serve as critical indicators of clinical performance and can be optimized by evaluation of current office policies and implementation of strategies to improve patient retention.

PURPOSE To investigate the reasons why patients discontinue botulinum toxin treatments and to evaluate the effect of a single intervention intended to improve patient retention.

METHODS A retrospective chart review was performed of all patients who received botulinum toxin injections in a private cosmetic dermatology practice over a 2-year time period in order to determine the patient retention rate. Patients who had discontinued botulinum toxin treatment after a single session were surveyed to discern their reasons for terminating treatment. A change in office policy was instituted wherein all patients who received their first botulinum toxin treatment were required to undergo a 2-week post-treatment evaluation in order to determine treatment effect and to receive touch-up treatment as necessary. Retention rates were calculated over the 1-year period immediately after initiation of the new policy.

RESULTS The initial patient retention rate was 55%. The most common reasons cited for discontinuance of botulinum toxin treatments were procedural cost, patient's failure to reschedule, perceived lack of product longevity, and clinical effect falling short of expectations. After initiation of the mandatory 2-week post-treatment office evaluation, a 67% patient retention rate was achieved.

CONCLUSIONS Managing patient expectations of botulinum toxin treatments and mandatory post-treatment appointments for evaluation of the initial procedure increases the patient retention rate.