The consultation: what happens, and what to ask

Why the consultation is the appointment that matters

Almost everything that goes wrong in non-surgical aesthetics is decided before a needle is opened. The wrong treatment for the wrong problem, an unrealistic expectation nobody corrected, a contraindication nobody asked about, a plan built around a package rather than a face. All of that happens in the consultation, or fails to happen there.

It is also the part of the process that gets compressed first, because it produces no revenue on its own. A fifteen-minute appointment that includes treatment did not include an assessment.

The injection takes four minutes. The decision takes forty, and it is the part you are actually paying for.

What should be asked

A proper history is not a form you tick in a waiting room. Expect questions about:

• Medical conditions, particularly autoimmune and neuromuscular conditions.
• All medicines, including anticoagulants, and supplements such as fish oils and high-dose vitamin E.
• Allergies, including to local anaesthetics and, for some treatments, to fish.
• Pregnancy and breastfeeding.
• A history of cold sores, keloid scarring or poor healing.
• Every previous aesthetic treatment, what was used, where and when. This matters more than people realise, particularly for filler, which does not vanish on schedule.
• Recent or planned dental work, vaccinations and significant illness.
• What you have tried already and what happened.

Expect also to be asked what specifically bothers you and why now. That is not small talk. It is how a practitioner works out whether the treatment being requested will address the thing that prompted the appointment, and whether treating it is likely to help.

What should be examined

Your face should be looked at properly: at rest, through a full range of expression, from the front, in three-quarter view and in profile, sitting upright, in light that resembles the light you actually live in.

Assessment lying flat under a bright overhead lamp misrepresents everything. Volume redistributes when you lie back, shadows change completely under a downward light, and a plan made in those conditions will be a plan for a face nobody else ever sees.

Photographs

Standardised photographs should be taken and kept: the same position, the same distance, the same lighting, the same background, a neutral expression, no make-up where possible. They are the only way either of you will be able to judge the result afterwards, and they protect both parties if there is a disagreement. Ask whether you can have copies.

What should be said

A good consultation produces a specific plan and states its limits. That means:

1. A clear statement of the anatomical findings, in plain language.
2. Which treatment addresses which finding, and why not the alternatives.
3. What will not change, stated explicitly.
4. The realistic result, described rather than promised.
5. The risks, including the serious ones, and what the protocol is if they occur.
6. The recovery, described accurately rather than minimised.
7. How many sessions, over what period, and what maintenance looks like.
8. The cost of the whole plan rather than of one appointment.
9. What happens if you are unhappy.

It should also include, where relevant, a recommendation to do nothing, to treat something else first, or to seek a surgical opinion. A practitioner who never gives any of those answers is not assessing anyone.

Two-stage consent and the cooling-off period

For anything significant, the better model separates the consultation from the treatment. You are assessed, given written information, and go away to decide. You return for treatment on a different day.

This exists because consent given while somebody waits with a prepared syringe is not meaningfully free. It also gives you time to check the practitioner's registration, read the risks properly, and notice whether you actually want the treatment or simply did not want to disappoint anyone.

Warning signs inside the consultation

• The conversation is mostly about packages and price rather than about your face.
• Nobody examines you in movement.
• No photographs are taken.
• Risks are mentioned briefly and dismissed as things that happen elsewhere.
• You are told what you need before you have finished explaining what bothers you.
• Additional areas are suggested that you had not thought about and had not mentioned.
• A discount appears when you hesitate.
• The consent form arrives at the same moment as the needle.
• Your questions are answered with reassurance rather than with information.

Any one of these can happen in a good clinic on a bad day. Several together describe how the clinic operates.

How to prepare so you get the most from it

• Write down the one or two things that actually bother you, in your own words, before you go. It is remarkably easy to lose them under someone else's list.
• Bring a full list of medicines and supplements.
• Bring the dates and details of any previous treatment, including what product was used.
• Take a photograph of yourself at home in ordinary light, straight on and in profile.
• Take the twelve questions from the clinic guide with you.
• Decide in advance that you are willing to leave without treatment, and say so early if it helps you hold that position.

The last one is worth taking seriously. A consultation you attend having already given yourself permission to walk away is a different conversation from one you attend having already decided to buy.