Clients’ expectations, perceptions and knowledge of non-surgical anti-ageing treatments in the Free State and Northern Cape

Abstract

Background: In recent years, health, youth, and attractiveness have been closely linked, with a significant rise in demand for non-surgical anti-ageing treatments. Ageing is a natural and irreversible process, yet the desire to maintain a youthful appearance has persisted across cultures and throughout history. To address ageing concerns as fine lines, uneven skin tone, and changes in skin texture, many individuals are turning to treatments that avoid the risks and recovery time associated with surgery. This pursuit is reflected in the growing popularity of injectables, chemical peels, microneedling, and laser therapies, which offer clients accessible options for rejuvenation. As aesthetic practices expand in Central South Africa, it becomes increasingly important to understand the expectations, perceptions, and knowledge of clients, since these factors shape decision-making, satisfaction, and overall treatment outcomes. Therefore, this study aimed to determine the expectations, perceptions and knowledge of clients in Free State and the Northern Cape regarding non-surgical anti-ageing treatments. Methodology: A quantitative descriptive research design was employed in this study. Data collection was conducted using a newly developed, validated, and reliable questionnaire. Participants were recruited from beauty salons and medical aesthetics practices across the Free State and Northern Cape provinces, following specific inclusion criteria. A total of 154 participants, spanning a wide range of ages, took part in the study. The collected data were accurately captured and subjected to statistical analysis by a qualified statistician. Results and discussion: The study population was overwhelmingly female, with women comprising 95.5% of respondents and men only 4.5%. Age distribution reflected a client profile for non-surgical anti-ageing treatments, with the largest proportion of respondents between 35 and 44 years, followed by the age range of between 45 and 54 years. Representation declined steadily with advancing age, and only a small number of clients were older than 65 years. The overall participant age ranged from 18 to 85 years, capturing both younger and older clients seeking non-surgical anti-ageing treatments. Geographically, respondents were almost exclusively from the Free State (98.1%), with minimal representation from the Northern Cape (1.9%). In terms of treatment settings, the most frequently reported venues included therapists operating within doctors’ practices (25.6%), followed by dermatology clinics (22.7%). Expectations: Treatment experiences and preferences showed that chemical peels (58.4%), microneedling (44.8%), and Botox (33.1%) were the most tried treatments. When asked to identify the best overall treatment, microneedling emerged as the most preferred option (26.0%). Rankings confirmed microneedling’s favourable position, with 28.1% placing it as the top choice. Botox, however, was the most polarising: 23.5% ranked it highest, yet 34.0% ranked it lowest. Perceived effectiveness was the main reason for the preferences, with almost half of the participants identifying this as their primary decision-making factor, followed by combined considerations of cost, comfort, and downtime (25%). Most prominently, outcome expectations focused on visible change, with 42.2% of respondents expecting significant and noticeable improvements, and 38.3% anticipating an overall enhancement in appearance. Longevity expectations varied across treatments. For Botox, one third of the respondents (33.8%) expected results to last six months, while a further 24.7% anticipated it to last one year. The effect of dermal fillers were most often expected to last one year (39.6%). While longevity expectations underscored differences in clients’ beliefs about the duration of treatment effects, age-related expectations reflected divergent views on the appropriate timing for initiating non-surgical anti-ageing treatments. Age-related expectations indicated that 30 years was viewed as the most appropriate age to begin treatment (27.7%). Younger participants (18–24 of age) strongly favoured microneedling (75.0%), whereas older age groups showed greater uncertainty, with 30.2% of those aged 45–54 reporting no clear preference. Beyond longevity and age, motivations for treatment provided further insight into client expectations. Motivations were multifaceted, with participants most often aiming to address specific skin concerns (22.2%), improve texture (17.0%), or reduce wrinkles and fine lines (12.4%). Finally, the importance of natural outcomes was strongly emphasised, with 61.7% of respondents rating them as extremely important and 32.9% as very important. Collectively, the findings suggest that clients prefer treatments that balance effectiveness, longevity, and affordability with subtle, natural-looking results. Perceptions: Clients’ perceptions revealed how they judged treatment experiences in practice. Trust in professionals was high, with 68.0% of respondents reporting full trust in aesthetic professionals and 32.0% reporting moderate trust. Perceived effectiveness and onset of results varied across treatments: dermal fillers were most often linked to immediate improvement (31.2%), while Botox was associated with faster effects within 24–48 hours (45.4%). In contrast, microneedling and chemical peels were seen as having slower effects, with one week (30.5% and 33.8% respectively) most reported. Mood responses following treatment were strongly positive, as 46.1% of respondents reported feeling very happy and 40.9% happy, while only 13.0% experienced no change in mood. Safety concerns were moderate overall: 31.8% of respondents expressed moderate concern, 25.8% slight concern, while only 9.3% reported extreme concern and 16.6% reported no concern. Medication disclosure was widely regarded as important. The majority of respondents indicated they would disclose current medication use, most notably before Botox treatment (78.6%), chemical peels (77.9%), and microneedling (77.3%). Even for laser/IPL and dermal fillers, over 70% reported full disclosure. However, between 12.3% and 18.8% of respondents across all modality’s believed disclosure was unnecessary. Treatment perceptions also extended to frequency and sources of influence. The most common selections were bi-annual sessions (29.9%), monthly sessions (28.6%), and sessions conducted every three months (25.3%). Only 11.0% of respondents preferred annual visits, and very few opted for weekly or more-than-once-monthly sessions. Influencing sources reflected a strong reliance on professionals. Doctors (66.2%) and beauty professionals (64.9%) were the most influential, far exceeding family (20.8%), friends (21.4%), or social media (16.9%). Online reviews (37.7%) and before/after photos (51.9%) also played a notable role. Perceptions of outcomes aligned with a preference for subtlety, as 42.9% of respondents believed results should appear natural and not overdone, while 21.4% viewed treatments as part of a broader skincare routine. Disclosure of treatment choices was common, with 83.1% of participants reporting openness, though 11.0% considered treatment private and 5.8% avoided disclosure to preserve the impression of natural results. Perceptions of boundaries indicated that visible alterations of natural appearance (53.9%) and health risks (33.8%) were regarded as crossing acceptable limits, whereas high costs (9.7%) were less significant. Finally, barriers to treatment centred around cost (38.2%). Supportively, the findings demonstrate strong trust in professional guidance, positive emotional responses, moderate but present safety concerns, and a prevailing desire for natural outcomes delivered through balanced, accessible treatment approaches. Knowledge: In addition to expectations and perceptions, the study also explored clients’ knowledge of non-surgical anti-ageing treatments. Overall awareness was relatively strong, as Botox was most often associated with wrinkle reduction (90.9%) and fine lines (55.8%); dermal fillers with volume loss (79.1%); chemical peels with uneven skin tone (63.6%) and sun damage (58.4%); and IPL/laser treatments with red veins (51.3%) and pigmentation (48.1%). Microneedling was frequently linked as treatment option for wrinkles (56.9%), fine lines (49.0%), and uneven tone (45.1%). However, despite this general awareness, gaps became evident. Almost one third of the respondents with injectable experience (31.2%) could not identify the product name, and some incorrectly cited Juvéderm (3.9%) as Botox. Sources of information reflected this imbalance, as most respondents relied on beauty professionals (33.1%) or medical professionals (28.6%), followed by medical websites (24.9%), while social influences such as friends (6.9%) and social media (6.5%) played only a minor role. Although many respondents demonstrated accurate knowledge, for example, recognising that Botox is not permanent (81.2%) and distinct from fillers (75.3%), uncertainty persisted, particularly around filler permanence, injection zones, and laser safety, with more than 40% unsure or being misinformed. Botox-specific knowledge further illustrated this mixture of accuracy and misconception: while nearly half (45.5%) of the respondents rejected the view that Botox gives an unnatural look, over a third (34.4%) agreed and one fifth (20.1%) were unsure. Encouragingly, more than half of the respondents (53.9%) rejected the claim that Botox is toxic and dangerous, and 50.6% disagreed that once Botox treatment is started, it cannot be stopped. Most participants (77.3%) also recognised that Botox is used beyond cosmetic purposes, and 83.7% understood that it is not restricted to clients over 50 years. The findings suggest that although clients showed strong awareness in some areas, particularly regarding Botox and fillers, persistent misconceptions about treatment permanence, safety, and laser suitability highlight the need for clearer professional education and guidance. Conclusion: Client responses showed significant patterns in expectations, perceptions, and knowledge. Clear preferences were expressed for specific treatment types, with impressions shaped by a high trust in skilled professionals. However, uneven understanding and recurring misconceptions underlined persistent ambiguity, highlighting the critical importance of bridging knowledge gaps with reliable information, so that client expectations, perceptions, and choices align with the realities of safe, effective, non-surgical anti-ageing treatments practice.