Introduction

During aesthetic medicine workshops, the focus is primarily on theory and various injection techniques. However, an essential part of our profession is sometimes overlooked: the initial consultation.

This consultation is crucial for laying the foundation for patient care. It allows us to understand the patient’s actual needs, analyze their face, and determine the appropriate treatments.

Before the Consultation

The patient contacts the front desk to schedule an appointment with the doctor. At this stage, the administrative file must be prepared:

• Clearly inform the patient of the cost of the initial consultation and the coverage or reimbursement policies applicable in their country.
• Have the patient complete the medical questionnaire: medical history, current treatments, allergies, pregnancy or breastfeeding, and any cosmetic procedures previously received.
• Obtain the necessary consent for the processing of medical data and for taking photographs, in accordance with applicable data protection regulations.
• Have the patient complete and sign the informed consent form for injections, after providing them with complete information about potential complications.

Medical Consultation

Medical Records

The doctor reviews the administrative records and greets the patient. The doctor then completes the patient’s medical record, which includes:

• Medical history: autoimmune diseases, bleeding disorders, cold sores, and cosmetic surgeries.
• Current treatments: anticoagulants, antiplatelet agents, and isotretinoin.
• Cosmetic history: injected products, dates, practitioners, and any complications.
• Temporary contraindications: pregnancy, breastfeeding, local skin infection, recent dental work or vaccinations, active disease.

Listening to the Patient and Their Expectations

This essential step allows the doctor and the patient to agree on expectations. The patient describes, in their own words, what bothers them and what they hope to improve.

A genuine discussion then ensues. The doctor seeks to understand what is troubling the patient, their motivations, the realism of their expectations, and whether they may be suffering from body dysmorphic disorder.

The doctor then determines what is and is not feasible, and explains the results the patient can expect. If the doctor believes the request falls outside the scope of aesthetic medicine, he or she may refer the patient to a plastic surgeon and explain the reasons for the refusal honestly and clearly.

Clinical Examination

The examination is ideally conducted while the patient is seated, under good lighting. The doctor performs a comprehensive analysis of the face: proportions (volumes), symmetry, and profile. It is important for the patient to have a mirror in hand so they can follow along with the analysis and understand it.

The overall condition of the skin is also assessed: skin type, elasticity, sagging, wrinkles, spots, redness, and any scars.

Next comes the photo session. These photos serve as a baseline in the cosmetic medical record and help document progress following treatment, particularly in cases where the patient is dissatisfied. It is therefore essential to take high-quality photos.

Standardized photos: front, three-quarter, and profile views, with the same lighting and framing each time.

Treatment plan and estimate

The doctor proposes a personalized treatment plan based on the patient’s request, a discussion, and an analysis of the face. He takes the patient’s budget into account and sets priorities to achieve optimal results and maximum satisfaction.

He specifies the technique, the product and its quantity, the expected result, and the duration of the effect. He also discusses potential side effects and downtime.

If alternatives are available, they are discussed with the patient so that the patient has all the necessary information to make an informed decision.

Reflection period

The doctor informs the patient about potential social exclusion, common side effects, and rarer, more serious complications. He explains that the result is not guaranteed, but that touch-ups are possible for a limited period (often four weeks) in the event of asymmetry or a lack of effect.

Once all information has been provided and the informed consent form for the injections has been signed, the treatment can be performed the same day, or the patient may take some time to think it over.

Performing the Treatment

Regardless of the product used, the procedure follows a consistent protocol.

1. Thorough makeup removal and disinfection.
2. Anesthesia if necessary: topical or local, depending on the technique (cannula or needle) and the area being treated.
3. Injection or procedure, in accordance with safety guidelines: inject small amounts or administer boluses at specific points, then systematically check the condition of the skin and symmetry as you proceed.
4. Traceability: Record the product name, lot number, quantity, and treated areas in the patient’s chart. Affix the lot labels.
5. Always keep a supply of hyaluronidase in the refrigerator to address any potential vascular complications.

Instructions and Follow-Up

Once the treatment is complete, the results are reviewed with the patient in front of a mirror, and instructions are provided. It is important to keep these instructions simple and not overwhelm the patient with unnecessary information.

• Instructions for the first 24 to 48 hours: Avoid makeup, intense exercise, saunas, and massaging the treated area.
• Signs of urgent complications requiring the patient to return to the office: severe pain, blanching or mottling of the skin, or visual disturbances.
• Schedule a follow-up appointment after two to three weeks, including comparative photos and a possible touch-up, but only after the initial treatment. This follow-up is not necessary for regular patients.
• Schedule follow-up appointments based on the treatment’s duration of effect to ensure long-term patient care.