Patient consent and consultations - Hamilton Fraser


In our latest 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 out of this initial meeting there are a number of things to consider.

Starting the conversation

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, expertise and experience will put them at ease and build trust- particularly important as the reputation of aesthetic practitioners is becoming increasingly tarnished.

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 skin care routine is also all part of a comprehensive 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 good candidate for treatment – there may be certain reasons as to why you shouldn’t go ahead with the procedure such as if the client is pregnant, breastfeeding or is showing signs of body dysmorphia.

The holistic approach

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 expert 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.

Educating the client

Giving honest advice is all part of educating your client. You need to ensure they have a strong understanding and realistic expectations of likely results, whilst considering all ‘off label’ uses of filler and Botulinum Toxin. This is integral to customer satisfaction and it is your job to pass on your expert knowledge to ensure they are well informed prior to treatment.

Explaining any pain or discomfort they may experience, what sort of aftercare will be involved and how long results will 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 continuously refer back to.

Beautician injecting filler into facial wrinkles of male client


It’s important to remember that it’s not only the patient who needs to consent to treatment – as a practitioner you need to consent too. As mentioned previously, during your consultation you should always be conducting a psychological evaluation to ensure you are happy for the patient to go ahead with treatment. You should be looking to identify red flags such as body dysmorphia early. A recommended assessment tool for the screening of body dysmorphia is the BDDQ, which will help with initial identification. Always remember that treatment is at your discretion and you do not have to treat the client – you both need to be comfortable going ahead and have a mutual 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.

Keeping up to date with the times, it is also a good idea to move away from traditional pen and paper consent forms and towards electronic methods to ensure safe and secure online storage, saving a lot of hassle when it comes to accessing data. This also ensures consultation and patient information is held as water tight as possible, especially as your client base grows. A good example of an accredited service provider is Consent Clinic.


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 will improve customer satisfaction. It’s good practice to stick to the ‘less is more’ approach – for example if a patient wants lip filler for the first time you should start with a subtle enhancement of 0.5ml and work from there. They can always add more later. This also allows time to build their confidence in both you and the treatment as well as minimise risk of swelling and bruising.

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. It is also essential that you take photos with different expressions – a lot can change with expression so this needs to be addressed in the first instance.

To summarise, consultations are more than just a brief chat before treatment. They are an essential aspect of customer care that require 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. This should overshadow what the client thinks they want, as remaining true to your practice and principles is the key to developing long-lasting customer relationships.

About the author

Dr Rupert Critchley

Dr Rupert Critchley is the lead clinician, founder and director of VIVA Skin Clinics. Since beginning his medical career at Kings College more than a decade ago, he has since developed a passion for aesthetics and established a industry-leading practice. Now dedicated to the artistry of working with dermal fillers, developing his own particular techniques and consultation methodology, Dr Rupert takes the time to train up and coming aesthetic practitioners personally.

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