In this guest blog from Dr Rupert Critchley, director and founder of VIVA Skin Clinics, we explore the importance of consultations and consent within the aesthetics industry.
As all good practitioners know, consultations are important in the world of aesthetics. After all, you need to understand what results your patient is looking to achieve. This may seem straightforward, but that isn’t where a good consultation ends; to make the most of this initial meeting, there are a number of things to consider.
As the famous Will Rogers saying goes, “You’ll never get a second chance to make a first impression”, and this is certainly true of a consultation with a first-time client. It can be a daunting, nerve-wracking experience for them, so creating a relaxing atmosphere is paramount. Taking the time to explain your training, knowledge and experience will help put them at ease and build trust.
You can follow this by asking what brings them to your clinic, what bothers them and what their reasoning is for undergoing treatment. Initially asking open questions and leading up to closed questions is a good way of encouraging the patient to open up, building a picture of what they want to achieve and why. Finding out about their lifestyle habits and skincare routine is also all part of a detailed consultation.
Furthermore, this initial communication is your opportunity to ask about their past experience with aesthetic procedures – whether they have had treatment before and about any bad experiences or allergic reactions is integral to good, responsible practice.
By this stage you should have started to establish whether the client is a suitable candidate for the proposed treatment. Pregnancy, breastfeeding or concerns about body dysmorphic disorder may be reasons to defer treatment, decline it or seek further assessment, depending on the procedure and the patient’s circumstances.
Finding out their desired results is important, but as an experienced clinician you should be casting an objective eye over what can realistically be achieved whilst maintaining natural-looking results. It is your responsibility to be honest and explain your clinical opinion to the client.
The patient may think they know what they want, but you should always be looking at the problem area from all angles. Rather than simply asking what treatment they want, you should be looking at the bigger picture and taking a holistic approach towards their procedure. To get an understanding of this, it is a good idea to discover how they want to look from an emotional perspective.
The patient may want to look less angry, tired, saggy or sad and you need to establish the best way of achieving this, even if the solution isn’t necessarily the specific procedure they initially asked for.
Giving honest advice is all part of educating your client. You need to make sure they have a strong understanding and realistic expectations of likely results. Explain the benefits, material risks and reasonable alternatives, including no treatment. Where a medicine is proposed outside its licence, explain this where relevant to the patient’s decision; for dermal fillers, consider the product’s intended use. It is your job to share your knowledge so they are well informed before treatment.
Explaining any pain or discomfort they may experience, what sort of aftercare will be involved and how long results may last should also be thoroughly discussed. Most of these things will differ from patient to patient as everybody has varying pain thresholds, different reactions to products and longevity of results. It is therefore important to explain these variations to every client.
These discussions should be documented so that if any concerns crop up at any point, you have a reference point to refer back to.
It’s important to remember that the patient’s consent does not oblige you to provide treatment. As mentioned previously, during your consultation you should consider their psychological needs and expectations alongside clinical suitability. You should be looking to identify concerns such as possible body dysmorphic disorder early, and work within your competence when deciding whether further assessment is needed.
A screening questionnaire, such as an appropriate version of the Body Dysmorphic Disorder Questionnaire (BDDQ), may support initial identification of concerns, but it does not establish a diagnosis or replace clinical assessment. Always remember that you do not have to treat the client – you both need to be comfortable going ahead and have a shared understanding of expected results. Occasionally, you may feel a certain amount of pressure to administer a treatment that just isn’t suitable for the client.
Although this can be difficult, it is important not to be swayed in these situations and to stay in line with your professionalism and moral compass.
Electronic consent and record systems can make consultation notes and patient information easier to store and retrieve as your client base grows. However, moving away from pen and paper does not automatically make records secure. Choose systems with appropriate access controls, backups and data protection arrangements, and make sure that your records remain accurate and accessible when needed.
After consultation, you should allow ample time for the client to decide whether to go ahead with treatment – this is a big decision for them and not something to rush. Giving them time to think supports an informed decision. A cautious, staged approach may be appropriate, particularly for a patient having treatment for the first time. The treatment plan and amount of product should be based on the individual assessment, the product and the agreed outcome, rather than a standard volume for every patient.
A staged approach also allows time to review the result and the patient’s response before considering further treatment. It does not remove the risks of complications, which should still be discussed.
Before and after photos are essential reference points for both the practitioner and the client. A good practitioner should take photos from different views, including front, side and oblique profiles, where relevant to the treatment. It is also important to consider photographs with different expressions – a lot can change with expression so this needs to be addressed in the first instance. Obtain appropriate permission and store the images securely.
To summarise, consultations are more than just a brief chat before treatment. They are an essential aspect of patient care that requires sensitivity, responsibility and the ability to build a rapport with clients. Developing trust and confidence and maintaining integrity should always be at the forefront of a reputable practitioner’s mind. Listen to what the patient wants while explaining what is suitable and achievable; remaining true to your practice and principles is the key to developing long-lasting patient relationships.
Dr Rupert Critchley is the lead clinician, founder and director of VIVA Skin Clinics. A medical doctor since 2009, he has developed a passion for aesthetics and established a practice focused on non-surgical treatments. Dedicated to working with dermal fillers and developing his techniques and consultation methodology, Dr Rupert also personally trains other aesthetic practitioners.
A good aesthetic consultation starts with listening to the patient’s concerns, motivations and expectations. Review their medical and treatment history, assess suitability and discuss realistic outcomes, material risks, alternatives and aftercare. Give time for questions and reflection, check understanding and record the discussion before obtaining consent. Be prepared to decline unsuitable treatment.
Start by asking open questions about what has brought the patient to your clinic, what concerns them and what they hope treatment will achieve. Give them space to explain in their own words. Then use more specific questions to explore their expectations, previous treatments and relevant medical history.
Explain clearly and sensitively why the requested treatment is unsuitable, linking your reasoning to the patient’s circumstances and clinical assessment. Discuss appropriate alternatives, including no treatment, without pressuring them towards another procedure. Record the discussion and your reasons for declining, and arrange further assessment or referral where appropriate.
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