A specialist approach to cosmetic malpractice risk
PREPÆRE is a specialist risk management advisory focused on the psychological, expectation-related, and consent risks behind cosmetic malpractice claims.
We combine lived experience, practitioner insight, mental health expertise, medicolegal research and insurance-side risk thinking.
Our story
What began as a patient awareness project quickly turned into a deep investigation into why psychological risk in aesthetic medicine had never been addressed in a way that protects patients without placing unrealistic responsibility on practitioners.
The development of PREPÆRE’s Pre-Consultation Check-In™ brought together patient experience, practitioner insight, mental health expertise, medicolegal research, claims analysis, and insurance-side risk thinking.
The result is a specialist risk-management model built around the reality of aesthetic medicine: patients need better information, practitioners need a defensible role, and insurers need a way to manage a recurring source of claims.
Our philosophy
A safer aesthetic sector starts with better information, not better gatekeeping.
Elective cosmetic procedures are personal choices, and patients deserve the freedom to make those choices with clear information about all the relevant risks. That includes psychological risk, because mental state plays a central role in decision-making about treatment, expectations, and satisfaction with the results.
PREPÆRE is built on the belief that patient safeguarding should support autonomy, not override it. Practitioners do have responsibility here: they should understand common psychological issues in cosmetic patients, including BDD, and recognise visible warning signs where they appear. But they should not be asked to make mental health judgements they are not qualified to make or defend.
The right safeguard is a clearer consent environment: one where psychological risk is disclosed properly, patients have more context before deciding, practitioners have a safer role, and insurers are not left carrying the consequences of risks the industry failed to address early enough.
Our journey
The patient awareness gap
PREPÆRE began with the founder’s personal experience of body dysmorphic disorder (BDD) and cosmetic surgery. The original aim was to give patients something that was missing: clear, non-stigmatising, accessible information about the psychological side of cosmetic procedures. BDD was central to that early work because it is so common in cosmetic settings, often misunderstood, and rarely mentioned to patients.
The move to clinical practice
A standalone patient resource could only go so far. To reach patients at the point where it mattered, PREPÆRE had to involve the aesthetic practitioners seeing them before treatment, from injectors to cosmetic surgeons. That shifted the work from a patient information hub into safeguarding support, while building a clearer understanding of day-to-day practice and the constraints any workable solution would have to meet.
The search for an effective safeguard
The obvious starting point was psychological assessment adapted for cosmetic practice. If practitioners could identify patients at risk before treatment, they could respond more appropriately. PREPÆRE explored all the existing screening questionnaires, how they could be made easier to use, and what stopped them being adopted in real clinic settings.
The failure of self-report
The first major flaw was patient disclosure. In cosmetic practice, patients who want treatment have every reason to present themselves as suitable. That problem does not disappear because a questionnaire has been developed or validated for cosmetic settings; validation cannot remove the basic weakness of self-report. BDD makes this even harder because the person affected may not recognise the problem as psychological. Testing confirmed the issue directly: patients liked the questionnaire interface, but said they would not answer truthfully if their responses could affect access to treatment.
The burden on practitioners
The screening approach asks practitioners to use tools intended for mental health professionals to help them standardise diagnoses in clinical settings. Aesthetic practitioners are not qualified to assess psychological suitability, and clinic consultations are short, commercially driven, and focused on treatment decisions. Most rely on informal judgement, despite evidence that they are extremely poor at identifying possible BDD cases. Testing showed that any process that adds steps to a consultation will not be adopted.
The legal risk of suitability decisions
The legal research revealed a deeper problem: psychological screening asks practitioners to take responsibility for deciding whether a patient is suitable for treatment. If a claim follows, that decision has to be defended. The practitioner may be asked what tool they used, why they chose it, what qualifications they had, how they interpreted the result, and why they still decided the patient could proceed. The psychological screening approach turned out to be a medicolegal risk in itself.
The case for disclosure
Insurers recognised the problem: dissatisfaction with objectively good outcomes, expectation mismatch and consent failure are recurring claims patterns across cosmetic practice portfolios, yet there is no structured response. With legal and insurer input, PREPÆRE moved to a disclosure-led model. Because mental health factors and subjective motivations shape cosmetic decisions, the psychological risks should be disclosed as clearly as physical risks. Psychological risk disclosure should be a standard part of informed consent, without asking practitioners to screen, diagnose or judge suitability.