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Introduction
Non-surgical cosmetic procedures (NSCPs), such as Botox, Restylane dermal filler and laser treatments have been the fastest growing aesthetic and cosmetic services over the past five years (The American Society for Aesthetic Plastic Surgeons (ASAPS), 2015). Offered by plastic surgeons as an add-on service, these procedures are seen as a way of retaining and acquiring new customers - a profitable gateway to more invasive (and costly) procedures (D'Amico et al. , 2008). From the perspective of the plastic surgeon, these services provide a natural extension to their business, as they require little more than a treatment room and a nurse injector on site. Plastic surgeons are also able to leverage the credibility of their medical practice when offering these procedures, reducing the perceived risk to their clients, who may have seen these services offered by other, less expert sources, such as medical spas (medispas) or laser clinics (Bajaj, 2012; D'Amico et al. , 2008).
Customer relationship marketing (CRM) techniques, such as reminder letters, targeted advertising, cross-selling and price promotions, are means of maintaining an active client database in an industry with limited follow on purchase (for a discussion, see American Society of Plastic Surgeons (ASPS), 2015a; Direct Marketing Association (DMA), 2013). Although these CRM practices are adopted by many service-based businesses (i.e. hairdressers, pet-stores and dentists), the services provided by plastic surgeons are unique because they carry the risk of unintended consequences, such as complications arising from treatment, long recovery times or adverse results (Swanson, 2013). Further, the services cannot be easily reversed or refunded, because they result in semi-permanent changes to a patient's aesthetic appearance. When these factors are considered alongside the fact that patients who repeat their use of plastic surgery or NSCPs are likely to be self-conscious of their body image (Swanson, 2013; Atiyeh et al. , 2008), they highlight a significant risk within plastic surgery. For instance, body dysmorphic disorder, the "excessive concern with an imagined or minor defect in physical appearance" (Pavan et al. , 2008, p. 473), has been found to be more prevalent among individuals who have plastic surgery than among the general population. Therefore, CRM practices geared toward retaining existing clients and increasing the frequency of their treatments are likely to have adverse effects on...