The longest part of the client’s aesthetic journey may also be the part the industry designs the least.
Professional aesthetics devotes considerable attention to the appointment itself. Consultation, treatment selection, technique, product selection and client experience are all structured around the period in which the client is physically present. This makes sense: the appointment is where professional expertise is most visible and where the practitioner has the greatest opportunity to observe, assess and act.
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Yet the appointment occupies only a fraction of the client’s actual skincare journey. Once the client leaves, days, weeks or sometimes months may pass before the next professional encounter. During that interval, recommendations developed under professional conditions must function in everyday life, alongside established habits, changing schedules, product preferences, competing advice and the practical limits of what a client is willing or able to sustain.
We tend to think of this simply as the time between appointments. But that description understates its significance.
The missing middle is not simply a failure of follow-up. It is a failure of design. More importantly, addressing it does not necessarily mean communicating with clients more often. The greater opportunity may be to recognize what happens between appointments as a source of professional feedback: recommendations leave the treatment room, real life tests them, and what the practitioner learns can inform what happens next.
When a Recommendation Meets Real Life
There is a meaningful difference between the regimen a practitioner recommends and the routine a client ultimately lives with.
At the point of recommendation, a home-care plan may be entirely logical. Products have been selected for a reason, instructions have been explained and the sequence appears manageable. Yet the practitioner is evaluating the plan through the lens of professional knowledge, while the client must integrate it into a life that was already functioning before the appointment.
Research into treatment adherence in dermatology has identified multiple influences on whether people follow recommended care, including treatment complexity, communication, individual beliefs and practical circumstances. Medical dermatology and professional esthetics are not interchangeable fields, and evidence involving the management of skin disease should not be treated as direct evidence for healthy-skin practice. Nevertheless, the broader behavioral principle is relevant: a recommendation that is appropriate on paper is not automatically one that is workable in daily life.
For estheticians, this expands the question beyond whether a recommendation is technically appropriate. Its priorities must also be clear, it must fit reasonably into the client’s existing routine, and the client needs enough understanding of its rationale to navigate it once the practitioner is no longer present.
The between-appointment period therefore reveals something that cannot be fully known when the recommendation is made: whether it survives contact with real life.
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Why We Designed the Appointment, Not the Interval
The missing middle should not be interpreted simply as practitioner neglect. The gap is partly structural.
Professional aesthetics is operationally built around appointments. Appointments can be scheduled, priced, staffed and documented. Treatments can be taught, protocols refined, and practitioners can directly observe what is happening. Professional education understandably concentrates on these moments because they are the moments practitioners can most directly influence.
The period between appointments is different. It is dispersed, less visible and influenced by circumstances outside the practice. Much of it belongs, appropriately, to the client.
We have therefore built sophisticated systems around the professional encounter because it is the easiest part of the journey to organize.
Recognizing this does not mean practices should attempt to manage every aspect of a client’s skincare between visits. Nor is the obvious solution to fill the interval with emails, texts, reminders and scheduled touchpoints. Those tools may sometimes be useful, but frequency of contact is not the same as continuity.
The more interesting question is what should remain connected when direct professional control ends.
The Missing Middle Is a Feedback Loop
When clients return, practitioners commonly ask some version of, “How has your skin been?” Yet the period since the previous appointment can reveal considerably more than whether the client liked the treatment or followed the recommended routine.
Which recommendations became habits? Which ones disappeared? Was anything difficult to understand or unpleasant enough to avoid? Did the client simplify the plan, add products independently or interpret an instruction differently from what the practitioner intended?
These questions need not function as an interrogation of whether the client was sufficiently compliant. They can reveal how well the original recommendation performed outside the treatment room.
A technically appropriate product may still be a poor practical recommendation for a client who dislikes using it. A routine that appears simple to someone immersed in professional skincare may feel complicated to someone accustomed to two steps. Conversely, a recommendation may integrate so naturally into a client’s habits that maintaining it requires almost no effort.
None of this is fully knowable at the first appointment. The interval provides the missing information.
This changes the purpose of the next appointment. Rather than treating it only as the beginning of another service, the practitioner can also use it to close the loop on the one before it. Professional knowledge informs the initial recommendation; the client’s subsequent experience reveals how that recommendation functioned; and the next decision can be made with a better understanding of both the skin and the person caring for it.
Continuity, then, is not simply maintaining contact. It is allowing one professional encounter to learn from another.
From Compliance to Curiosity
This feedback-loop model also challenges the way practitioners sometimes think about adherence.
Clients ultimately decide what they do outside the treatment room, and professional guidance cannot eliminate individual responsibility. Yet describing someone as “noncompliant” can prematurely close an inquiry that might otherwise produce useful information.
Research examining practitioner communication and treatment adherence across healthcare settings suggests a complex relationship. Observational studies have often associated stronger communication with better adherence, while randomized evidence has been less conclusive. Better explanation, in other words, does not guarantee better behavior.
A more useful approach is to regard adherence as something that occurs at the intersection of the recommendation, the person receiving it and the circumstances in which it must be carried out.
Instead of asking only whether the client followed the plan, practitioners can ask why it did or did not become workable. This preserves client responsibility while leaving room to examine the recommendation itself.
If similar recommendations repeatedly prove difficult for clients to sustain, that pattern may be telling us something about the design of those recommendations, not simply about the people receiving them.
Continuity Without Overreach
Recognizing the missing middle does not mean filling it with practitioner involvement. Continuity should not become surveillance, dependency or another commercial opportunity.
Some circumstances warrant follow-up; others may require little more than clear guidance and an appropriate way for clients to raise concerns. The right level of contact depends on the treatment, the client, practitioner scope and the nature of the practice.
The same restraint applies to home-care recommendations. Paying closer attention to what clients actually do may reveal that a routine needs simplification rather than expansion, that an existing product is sufficient or that an unnecessary step is creating friction. Better continuity should make recommendations more intentional, not more extensive.
Over time, individual feedback can also reveal patterns within a practice. Repeated misunderstanding may indicate that an instruction needs refinement. Recommendations that consistently prove difficult to integrate may deserve reconsideration. These observations do not replace scientific evidence, nor should individual experiences be generalized into universal conclusions. They can, however, help practitioners identify friction within their own systems.
Professional expertise usually travels outward through assessment, recommendation and education. The missing middle introduces a return path: client experience provides information about how those recommendations function in the environment for which they were intended.
That information can sharpen the next professional decision.
Designing Continuity
What, then, are practitioners designing when they address the missing middle?
Not the client’s behavior. Not a universal communication schedule. Not a standardized protocol for every interval between treatments.
What can be designed is the connection between professional encounters.
Recommendations can be made with realistic execution in mind. Education can prioritize what matters rather than assuming that more information produces better understanding. Follow-up can be used selectively when it serves a professional purpose. Most importantly, the next appointment can incorporate what happened during the previous interval rather than treating the client’s home routine as static information.
Seen this way, the missing middle is not primarily a communication program, a retention strategy or an operational checklist. It is a different way of thinking about continuity.
Professional aesthetics will always be organized partly around appointments because the appointment is where practitioners can observe and intervene directly. The client’s life outside the treatment room is less visible, less controllable and, appropriately, largely their own.
But professional care does not need to control that period to learn from it.
A recommendation cannot be judged only by how sensible it sounds when it is given. It must also function when the practitioner is no longer there. When the client’s experience is allowed to inform the next professional decision, the interval between appointments stops being empty space and becomes part of an ongoing learning process.
We have become very good at designing the hour.
The next opportunity may be learning how to design what connects one hour to the next.
References
- Lo A, Lovell KK, Greenzaid JD, Oscherwitz ME, Feldman SR. Adherence to treatment in dermatology: Literature review. JEADV Clinical Practice. 2024;3(2):401–418. doi:10.1002/jvc2.379.
- Eicher L, Knop M, Aszodi N, Senner S, French LE, Wollenberg A. A systematic review of factors influencing treatment adherence in chronic inflammatory skin disease—strategies for optimizing treatment outcome. Journal of the European Academy of Dermatology and Venereology. 2019;33(12):2253–2263. doi:10.1111/jdv.15913.
- Keshtkar L, Ahmed S, Mohan S, Kulshrestha H, Nockels K, Harrell C, Highton P, Howick J. Examining the relationship between healthcare practitioners’ communication and patient adherence to treatment: a systematic review. BMC Health Services Research. 2026;26:458. doi:10.1186/s12913-026-14359-8.
- Haggerty JL, Reid RJ, Freeman GK, Starfield BH, Adair CE, McKendry R. Continuity of care: a multidisciplinary review. BMJ. 2003;327(7425):1219–1221. doi:10.1136/bmj.327.7425.1219.
