To the Editor, Cosmetic dermatology focuses on skin improvement for aesthetic purposes, and entails meeting specific patient needs using an armamentarium of products and techniques, including injectables, surgical procedures, and laser, light, and energy-based therapies. Patients may know exactly what perceived defect they would like corrected, or they may be generally interested in rejuvenation, and may defer to the physician's judgment regarding appropriate interventions. In either case, the relationship is personal and individual. 1 By definition, there are no medically necessary interventions which need to be performed in accordance with established or required protocols. This individual approach is empowering and validating. Patients and physicians have freedom to craft a treatment plan that meets with the approval of both. Patients feel they are treated as individuals, and physicians may exercise creativity, often devising approaches that they have pioneered or mastered.However, there are limitations to a tailored approach. As cosmetic treatments proliferate, this can result in increased costs; variable outcomes; avoidable adverse events; uncertain standards of care, with patients unsure what they are likely to get; and patient dissatisfaction, as outcomes touted by manufacturers, and observed by patients in friends and relatives, may not be those that they themselves experience.