The Contraindication Talk: How to Reschedule a Client Without Losing Them

A client books a peel, takes half the day off work, sits down in your chair and mentions casually that she started Accutane two months ago. You have about four seconds to decide who you are as a professional.

Contraindications aren’t a memorization problem — they’re a confrontation problem. You already know the answer; you just don’t want to say it out loud to someone who’s already got her jacket off. This episode covers the seven contraindications that actually ambush you mid-appointment, how to head them off before the client leaves her house (including a pre-care text you can copy word for word), and the four-beat script — name it, why, when, what instead — worked through five real scenarios.

This episode is general education for licensed professionals, not medical or legal advice. Always work within your own scope of practice and your state’s rules.

Read the full transcript

Four seconds to decide who you are as a professional

A client walks in for a peel. She's been on your books for three weeks. She took half the day off work. She's so excited to see you. She sits down in your chair, you're doing your intake, and she says casually, just like it's nothing: "Oh, I started Accutane about two months ago. Is that okay?"

And now you have about four seconds to decide who you are as a professional. Because there are two versions of you in that moment. There's the version who thinks, she just took half the day off, she's going to be so annoyed and disappointed, it's just a light peel, I'll just go gentler. And then there's the version who says the hard thing.

Today I'm going to talk about being the second one — having those hard conversations. And more importantly, I'm going to hand you the exact words to say, so that the hard thing doesn't cost you the client.

It's not a memorization problem. It's a confrontation problem.

This episode came out of a conversation I keep having with newer estheticians — and with people who have been licensed a decade, it doesn't matter. It's always some version of: I knew I shouldn't have done that treatment, but I did it anyway, and now I'm dealing with it.

Nobody talks about that part. We talk about contraindications like it's a memorization problem, like you just need the list from esthetics school and you're all set. But it's not a memorization problem. It's a confrontation problem. You know the answer. You just don't want to be the one to say it out loud to a woman who's already got her jacket off.

The client I turned away last weekend

I was prompted to do this episode because a client came into my practice this last weekend. She had filled out her intake forms a few weeks prior, and she let me know: hey, since I last saw you and filled out those forms, I went to the dermatologist, I have an infected cyst on my face.

I'm so glad she told me — but I would have noticed right away. I looked at her, there was definitely something going on in her skin. I saw a little bit of bruising, I saw some inflammation. She told me she had an active infection she was currently taking antibiotics for.

We'd scheduled her appointment because she had an event coming up the next weekend, and that's why we booked it for that weekend, so she could be nice and ready for the event. And I felt so bad. But I asked the questions. Are you currently on a cycle of antibiotics? Looking at it, it does look a little bruised. And I had to do the hard thing.

She had been looking forward to this appointment for weeks, and I didn't want to have to turn her away. My brain did go to the first version — well, maybe I can just do this, or maybe I can skip that and just do this. Because we want to satisfy our clients, right? But the more important thing I realized is that I cannot put my client in any harm. I do not want to spread this infection further on her face, and I don't want to catch anything myself. But my concern is more with her.

So I remembered my soft skills and explained to her: you know what, I don't want this to affect the rest of your face. Let's wait for the inflammation to go down, let's wait until you're done with that round of antibiotics, and let's make sure there's nothing going on in your skin. I'm so sorry to do this. I'm going to send you home with some samples so you can do things yourself and get ready for your event.

I did feel bad. But at the same time, I needed to say that to her — because what if something had happened? It would have come back to me, and then I would have felt even worse.

So I'm going to cover four things today. One, a quick reframe on what a contraindication actually is, because I think we teach this wrong. Two, the ones that sneak up on you — the ones clients don't think to mention. Three, how to prevent the ambush entirely with what we send them before they get to you. And four, the verbiage. Word for word. Screenshot it, tape it to your mirror, I don't care.

Split the list in two: absolute and relative

In school you probably learned contraindications as one big list. Do not do this, do not do that. And it lives in your head as a wall of no. I want you to split that list in two, because it changes how you talk about it.

Absolute contraindications are the never ones. Not today, not with a gentler product, not if she signs a waiver. Active herpes outbreak in the treatment area. Undiagnosed lesion — anything you look at and think, hmm. Active infections. Recent surgery in the area that hasn't cleared. These are hard stops, and the answer is no.

Relative contraindications are the "not like this, not right now" ones. She's on a medication that thins the skin. She got a sunburn on Saturday. She had filler on Thursday. She's using a prescription retinoid and didn't stop it. These aren't the nevers. These are the reschedule-or-modify.

Here's why that split matters so much. Almost every conversation you're dreading is a relative contraindication — which means the conversation isn't "I can't help you." It's "I can't help you today, and here's when I can." That's a completely different sentence. One of them sounds like a rejection, and that's the one we dread. The other one sounds like expertise, and that's what we are. We're experts. Clients can hear the difference. I promise you they can.

The ambushes that show up at 2 p.m. on a Tuesday

I'm not going to read you the entire textbook list. You already have that. I want the ones that actually show up at 2 p.m. on a Tuesday.

1. Isotretinoin (Accutane)

There's microdosing now, where people think, well, it's a microdose, so I don't fit the contraindications that traditional Accutane use does. So what are we going to do? Are we going to go by what the person says, or by what this trend of microdosing is, or are we going to go to our own knowledge and expertise?

My rule: not during, and not for six months after — for waxing, for resurfacing, or for anything aggressive. If a client wants to push back on that, they're welcome to bring me a written clearance from their prescribing dermatologist, in writing, and I'm going to put that in her file. If I have the medical clearance and they insist, sure.

Specifically with waxing, this is not a gray area for me. That skin will lift. I've seen it. It's not worth it.

2. Neurotoxins and filler

Things like Botox, Dysport, any kind of filler. The standard is two weeks before you do facial massage, extractions, microcurrent, or anything with real manual pressure or heat in that area. You don't want to be the person who migrated someone's filler.

The kicker is that clients do not think to tell you this. In their head, injectables happened at the other place with the other person and have nothing to do with your facial. You have to ask directly. Not "any recent treatments?" — they'll say no. "Have you had any injectables, Botox or filler in the last month?" You have to ask that specifically. It should be on your consultation card, and if it isn't, ask verbally and confirm the information with them. This is why it's so important to do the consultation every single time.

I get a lot of "oh, my doctor said it was okay." All right, that's cool — give me the note. If it's been less than two weeks, I'm going to want to see that note, or I'm not going to do those things. All my facials include facial massage if they're not contraindicated, plus extractions, microcurrent, heat, pressure — I'm going to do all of that. And I don't want to be the one who gets the blame if they think something went wrong with the injection. "Well, you were the last one who touched my face, so it's your fault." I don't want that on me.

3. Retinoids, prescription and over-the-counter

Tretinoin, tazarotene, adapalene — and also the over-the-counter stuff somebody got from a brand they can't pronounce.

The standard is to discontinue five to seven days before a peel or a wax, with a minimum of three days. It's a general rule and it's not always the same for everybody. I always ask: is it prescription? Because then I'll definitely want seven days before anything, even before I superficially exfoliate with an enzyme. You can even go two weeks if you want to. If they're on a prescription tretinoin with, say, a hydroquinone, I want that two weeks. And it's not just before the treatment — it's after, too.

If it's over the counter, things are getting stronger over the counter, so ask the questions. What percentage is it? What brand is it? You can do a quick bit of research on your own to find out and know your ingredients. Just know that those five to seven days before a peel or wax or exfoliation matter, because otherwise you're going to undo whatever they're trying to do.

4. Recent sun exposure and sunburn

We're still in the midst of summer, and if you're in California that means nothing anyway, because it's hot and people are still out and about.

A compromised barrier, elevated inflammation, post-inflammatory hyperpigmentation — it's all waiting to happen. If someone got real sun in the last 48 to 72 hours, or if there's any pink at all, you're going to reschedule that appointment. And an active tan from a beach trip is not baseline skin. There's no such thing as a base tan.

A client who comes in with a sunburn or recent sun exposure is also a great opportunity to talk to them about sun protection, and maybe even send them home with a couple of products that can help soothe their skin.

5. Cold sores

Here's one of the hard stops. An active lesion anywhere near the treatment area is an absolute no. And I'm going to emphasize near the treatment area, because if somebody comes in for an eyebrow wax and they've got a cold sore on their lip, that is near the treatment area. I'm still not going to touch it. I'd still recommend they reschedule that appointment.

They'll say, oh, well, it's my brows, the cold sore is down here. It's still an active infection. We don't want to make anybody feel bad, so you explain to them why. But we can't do something just because we're afraid to disappoint somebody.

Cold sores are very common and nothing to be ashamed about. A lot of people have them. A history of cold sores is a relative one — that's a conversation about prophylactic antivirals from their doctor before any resurfacing, because heat and trauma can absolutely trigger an outbreak. So an important question on your consultation card is: do you have a history of cold sores? Because if they do, and you see something that might look like one, you can put two and two together.

6. Pregnancy and nursing

This depends entirely on the modality. Plenty of things are perfectly fine, but certain peel agents, certain actives and most electrical modalities are completely off the table. Know your scope, know your product line's guidance, and when in doubt get the OB's clearance. Electricity — definitely not.

With nursing clients, you should be able to use an electrical modality, but be careful with your peel agents, actives and essential oils, because those are processed by the body and can be passed on to the baby. Again, when in doubt, get the OB's clearance.

7. Blood thinners and anything that increases bleeding

This is the last one, and the one that gets missed the most. Prescription anticoagulants, obviously — but also aspirin regimens, high-dose fish oil and vitamin E.

This matters a lot for extractions, for dermaplaning, or for anything with needles. A lot of people don't know that fish oil and vitamin E are blood thinners. So if we're doing modalities that involve healing or possible blood exposure — needles, extractions, dermaplaning — let's err on the side of caution. Dermaplaning really shouldn't draw blood, but stuff happens. All of that goes in the category of medications, supplements and vitamins somebody is currently taking, which is what we talk about during the consultation.

Honorable mentions

Uncontrolled diabetes with impaired healing. Autoimmune conditions in an active flare. A recent chemical peel or laser from somebody else — always ask what they've had done and when. A history of keloids. Active eczema, psoriasis or dermatitis in the treatment area; if somebody has psoriasis on their arms and you're working on their face, I think you're okay, and the same with eczema. And very recent lash extensions with anything steamy.

How to prevent the ambush entirely

This is the part that actually saves you. The best contraindication conversation is the one you have before the client leaves her house.

If you're finding this stuff out in the treatment room, you've already lost. That client last weekend — I'd already got her intake forms, but I lost, because they weren't recent. And I'm kind of telling on myself here: I was going to get to the consultation with her. She volunteered the information before I got there, but she was already undressed and lying on my table. My fault.

Once they're there, they're committed, their defenses are up, and everything is going to be harder. So, three things.

1. Your intake form is not a formality

Most intake forms ask "any medical conditions?" and clients write no, because they're thinking about diseases, not their skincare routine. Your form needs to ask specific, plain-language questions. Don't ask "are you taking any medications?" — ask in more detail.

Ask: are you currently taking, or have you taken, isotretinoin in the last 12 months? Throw in Accutane, because that's what it's better known as. Ask about the injectables by name. Ask about retinoids by name, and include the over-the-counter ones. Specific questions get honest answers.

And reconfirm at every single visit, not just at intake. People's lives change between appointments. This person wasn't pregnant in March.

2. Send pre-care 48 to 72 hours out

This can be automated if you have a booking system. If you don't, and your client allows you to text them, do that — or send an email. Not the day of. Forty-eight to 72 hours out, so there's still time for them to tell you something and for you to move them if you need to. Put it in your booking software so it goes out automatically and you never have to think about it.

The pre-care text, word for word

"Hi [name], looking forward to seeing you on Saturday for your facial. Quick prep so you get the best result. Please stop retinol, tretinoin and any exfoliating acids five days before. No waxing, threading or laser hair removal in the area for two weeks. No injectables like Botox or filler within two weeks. Avoid direct sun — no sunburn or new tan. And please reply to let me know if anything's changed: any new medications, pregnancy, cold sores, or a recent treatment somewhere else. Even small things matter so I can keep your skin safe. See you soon."

That last line is the whole thing. So I can keep your skin safe. You're not interrogating them, you're protecting them. Saying it that way helps people volunteer information they'd otherwise just sit on.

3. Set the rescheduling expectation in writing

Somewhere in your onboarding, your welcome email, your booking page or your policies, say a version of this:

"Occasionally I'll need to adjust or reschedule a treatment based on what I see the day of, or a change in your health or medications. This is a good thing — it means I'm treating your skin, not just running a service. There's never a penalty when we reschedule for safety."

That is excellent client care, and they can't get it from somebody online. You're helping them understand the guidelines for a successful treatment, and you're letting them know they're supported. It's your due diligence, and it prevents the awkward conversation in the treatment room.

Put it in writing, because half the reason clients hide things from you is that they're afraid of getting charged. "I didn't want to say anything because I didn't want to cancel on you last minute." "I didn't want to say anything because I didn't want to get charged." That's why you send this beforehand.

The verbiage: name it, why, when, what instead

This is what the whole episode is about. The structure that works every time is four beats. Name it. Explain the why in the same sentence. Give the timeline. Offer the alternative.

She's on Accutane

"I'm really glad you mentioned that — thank you. I'm not going to do the peel today. Accutane changes how your skin heals, and a peel on that skin has a real risk of scarring and pigment changes, and I'm not willing to gamble with your face. Here's what I'd love to do: let's get you back on the books six months after your last dose. And today, if you want, I can do a hydrating, non-exfoliating facial instead — because I promise you, your skin is dry right now, and it will feel incredible."

You're addressing what's going on without making them feel bad, because a lot of the time people don't know these things are contraindicated. And you're still saying yes to the guest. You're only saying no to the service they came in for, and you're explaining why. No feelings are hurt. You're providing an alternative rather than just turning somebody away, and it makes it clear you know what you're talking about and you're responsible in your treatment room.

Look at what happened there. She's not going home empty-handed. She's not embarrassed, because you thanked her for telling you. And that really matters, because you want her to tell you next time.

She had filler four days ago

"Okay, so we're going to move your facial. When you've had filler, that product is still settling for about two weeks, and the massage and pressure I do in a facial can shift it. You paid good money for that, so I'm not touching it. Let's push you out to [specific date right at the two-week mark] — and you're going to love it more anyway, because everything will have settled."

"You paid good money for that, so I'm not touching it" reframes you from obstacle to advocate in one sentence.

She didn't stop her retinol

"Hey, so I'm seeing you're still on tretinoin — no worries at all, this happens a lot. But your barrier is thinner than it looks right now, and if I put a peel on top of that we're looking at a lot of unnecessary irritation and possibly some dark spots afterward. So let's do this: stop the retinol on Friday, come back next Thursday. And I'm going to do a really nourishing barrier facial today so you're not leaving with nothing."

Saying "this happens a lot" takes the shame out of it immediately. And a client who feels stupid is a client who doesn't rebook.

You see a cold sore starting

This is the one people are scared of, because it's visible and it's always a little awkward. Some people have feelings about their cold sores and are embarrassed — which is exactly why this one matters. It's a common thing.

"I want to point something out. I'm seeing a spot here that looks like it might be a cold sore starting. I'm going to hold off today, because heat and exfoliation can spread that and make it a lot worse, and I really don't want that for you. Let's get you rescheduled once it's fully healed. And if you get these regularly, ask your doctor about an antiviral you can take before your appointments — a lot of my clients do that and it works really well."

One thing we did not do there is diagnose it. We said "a spot that looks like it might be a cold sore starting." And we referred out, because you're not prescribing — we can't do that. We have to stay in scope. You're not accusing; you're telling them why it could get worse. When you frame it as "I don't want that for you," they're immediately on board. Sometimes they genuinely don't realize. You just let them know, and you do it in a caring way.

She came in sunburned

"So I'm going to be honest with you — I can't do this treatment on sun-exposed skin. Your skin is already inflamed and healing, and if I add exfoliation to that, you've got a real risk of hyperpigmentation that could take months to correct. And that's the exact opposite of what you're paying me for. So let's give it two weeks."

"That's the exact opposite of what you're paying me for" does so much work. It connects the no directly to their goals, and it shows them you care about those goals.

The phrase for everything else

Keep this one in your back pocket: "I could do this today. I don't think I should. And you're paying me for my judgment, not just my hands."

You can say that for any contraindication — and when in doubt, refer it out. That's the whole job.

Document everything

Every time you reschedule for a contraindication, put it in their chart, in their notes, in their SOAP notes. What you observed, what the client disclosed, what you decided to do, what you recommended, and the date. If you referred out, note that too. If you asked for a doctor's note, note that too.

I know charting is no one's favorite. But your notes are the only version of this that exists in six months — and the one time you need them, you will really need them. Keep a pad of paper by your treatment area and take shorthand notes until you have time to sit down and put proper notes into your system.

Why this builds trust instead of losing clients

Every time you've been afraid to reschedule someone, the fear underneath is that they won't come back, that they'll be annoyed. That's why we sometimes don't pay attention to this stuff — we don't want that for our clients, and we're not confident in our responses.

But here's what I've watched happen instead, over and over. Turning a client away for her own safety is the single most trust-building thing you will ever do. She's going to go home and tell people: my esthetician wouldn't do my peel because of my medication, she rescheduled me and we did something else instead. That's a referral machine. That's somebody telling their whole group chat that you're the real deal and you know your stuff.

The esthetician who treats through a contraindication is the one who loses the client. Not right away — but the first time something goes wrong, that client is gone, and she's going to tell that story instead.

You are not a service dispenser. You're the person standing between your client and a bad outcome. So act like it, even when she took half a day off work.

Your homework

Go look at your intake form this week. Just pull it up. Does it ask about isotretinoin by name? Does it ask about injectables by name? Does it ask about retinoids, including the over-the-counter ones? Does it get reconfirmed every visit, or are you only doing it once?

Then fix the one that's missing. That's the whole assignment. Just make it better.