The Questions a Good Consultation Should Ask You
Most people prepare for a consultation by deciding what they want done. A good consultation will spend much of its time on something else: what is actually causing the thing that is bothering you. Those are different questions, and the gap between them is where nearly every disappointing result begins.
Most people get ready for a consultation by deciding what they want done. A good consultation will spend much of its time on a different question: what is actually causing the thing that bothers you. Those are two different questions, and the gap between them is where nearly every disappointing result starts.
The Questions a Good Consultation Should Ask You: the essentials
The short version
What is bothering you, in your own words, before any treatment is named
What is bothering you, in your own words, before anyone names a treatment.
What is actually causing it, which is not always what it looks like
What is really causing it, which is not always what it looks like.
Medicines, conditions, healing history, previous treatments and their results
Medicines, health conditions, how you heal, and anything you have had done before.
Skin type, tanning status, sensitivity, and any lesion that needs a diagnosis
Your skin type, whether you are tanned, how easily it reacts, and any spot that needs a proper diagnosis.
What you are picturing, and whether that is achievable by this route
What you are picturing in your head, and whether this treatment can actually get you there.
A named plan, an expected result, a timeline, and what would make them stop
A named plan, what to expect, how long it will take, and what would make them stop.
The complaint is not the diagnosis
What you complain about is not the diagnosis
Someone arrives asking for filler under the eye because they look tired. That hollow can be volume loss, but it can also be pigment, a shadow cast by a small bulge of fat, thin skin showing the vessels beneath, or fluid retention. Those five things have five different answers.
Someone comes in asking for filler under the eye because they look tired. That hollow can be lost fullness. But it can also be dark pigment, or a shadow thrown by a small bulge of fat, or thin skin letting the blue of the veins show through, or simply fluid. Those five things have five different answers.
Filler placed into a shadow that is not a hollow makes the area heavier without making it brighter. Filler placed where the problem is pigment does nothing at all. This is the most common way a technically competent treatment produces an unhappy patient: the injection was fine and the diagnosis was wrong.
Filler put into a shadow that is not really a hollow makes the area heavier without making it any brighter. Filler put where the real problem is pigment does nothing whatsoever. This is the most common way a perfectly well done treatment produces an unhappy patient: the injection was fine, and the diagnosis was wrong.
The same applies across the field. Redness can be rosacea, sun damage, an inflammatory condition or a reaction to something being applied. Brown patches can be melasma, sun damage, marks left by previous inflammation, or something that needs a diagnosis before anything cosmetic is done. A consultation that moves from complaint to treatment without passing through diagnosis has skipped the part that determines whether the treatment can work.
The same is true right across this field. Redness can be rosacea, sun damage, an inflamed skin condition, or a reaction to something you are putting on. Brown patches can be melasma, sun damage, marks left behind by old inflammation, or something that needs diagnosing before anything cosmetic is done at all. A consultation that jumps from complaint to treatment without stopping at diagnosis has skipped the step that decides whether the treatment can work.
The history that changes the plan
The history that changes the plan
Several ordinary facts about a person change what is safe and what is sensible, and a good consultation asks about all of them without being prompted.
Several ordinary facts about you change what is safe and what is sensible, and a good consultation asks about all of them without waiting for you to bring them up.
Medicines matter: isotretinoin now or recently, blood thinners, medicines that suppress the immune system and some others affect healing, bleeding or the safety of a procedure. Conditions matter: a tendency to keloids, a history of cold sores, autoimmune disease, or anything affecting wound healing. Previous treatments matter too, including what was used, when, and what the result was, because a poor previous result is information rather than something to be embarrassed about.
Medicines matter. Being on the strong acne tablet now or recently, blood thinners, medicines that damp down your immune system, and others besides, all affect healing, bleeding, or whether a procedure is safe at all. Health conditions matter: a tendency to thick raised scars, a history of cold sores, an autoimmune illness, or anything that affects how you heal. Previous treatments matter too, including what was used, when, and how it turned out. A poor result last time is useful information, not something to be embarrassed about.
Pregnancy and breastfeeding rule out a great deal, and are worth volunteering early rather than at the end. Recent sun exposure or a tan changes what is safe with light-based treatments, sometimes for weeks.
Being pregnant or breastfeeding rules out a great deal, so it is worth saying early rather than at the door. Recent sun, or a tan, changes what is safe with anything using light, sometimes for weeks.
The conversation about what you are picturing
The conversation about what you are picturing
This is the part most often skipped, and it is where the result is really decided. Two people can ask for the same treatment while imagining entirely different outcomes, and only one of them will be satisfied by what the treatment actually does.
This is the part most often skipped, and it is where the result is really decided. Two people can ask for exactly the same treatment while imagining completely different outcomes, and only one of them is going to be happy with what the treatment actually does.
A useful practitioner will ask you to describe the result in your own words, and will then say plainly whether that is what this treatment produces. Sometimes the honest answer is that it will get you part of the way, and the rest needs something else, or several things in sequence, or nothing at all.
A good practitioner will ask you to describe the result in your own words, and will then tell you plainly whether that is what this treatment does. Sometimes the honest answer is that it gets you part of the way, and the rest needs something else, or several things in order, or nothing at all.
Photographs help, and they cut both ways. A photograph of the result you want establishes the target. Photographs of your own face, taken under consistent lighting before anything starts, establish the beginning, which is what makes it possible to tell later whether anything changed. Memory is a poor witness to one’s own face.
Photos help, and they help in both directions. A photo of the result you want sets the target. Photos of your own face, taken in the same light before anything starts, set the starting point, and that is the only thing that lets you tell later whether anything actually changed. Your memory of your own face is a poor witness.
What a good answer sounds like
What a good answer sounds like
At the end of a proper consultation you should be able to repeat back four things: what the problem is, what is proposed, what to expect and when, and what the risks are.
At the end of a proper consultation you should be able to repeat back four things: what the problem is, what is being suggested, what to expect and when, and what the risks are.
If any of those is missing, ask. Specifically: what exactly is this, what are we treating it with, what will it look like at one month and at three, what are the risks and how likely are they, what happens if it does not work, and what would make you advise against doing it. That last question is the most revealing one available, and a practitioner with a good answer to it is usually a practitioner worth having.
If one of those is missing, ask. Specifically: what exactly is this, what are we treating it with, what will it look like at one month and at three months, what are the risks and how likely are they, what happens if it does not work, and what would make you advise against doing it. That last question is the most revealing one you can ask, and a practitioner with a good answer to it is usually a practitioner worth having.
A consultation that ends with no treatment is not a wasted one. Sometimes the correct answer is that the thing being complained about is not treatable by this route, or is better left, or needs a diagnosis first. Being told that is a good outcome, even though it rarely feels like one on the day.
A consultation that ends with no treatment is not a wasted one. Sometimes the right answer is that the thing bothering you cannot be fixed this way, or is better left alone, or needs a diagnosis first. Being told that is a good outcome, even though it rarely feels like one on the day.
Questions patients ask
What should I bring to a consultation?
What should I bring to a consultation?
A list of your medicines and supplements, any relevant medical history including how you heal and scar, what you have had done before and when, and if possible photographs of your skin at a time you were happier with it.
A list of your medicines and supplements. Any medical history that matters, including how you heal and whether you scar. What you have had done before, and when. And if you have them, photos of your skin from a time you were happier with it.
Should I be worried if I am told to do nothing?
Should I worry if I am told to do nothing?
No. It usually means either that the problem does not need treating, or that the available treatment would not achieve what you are asking for. Both are more useful than a treatment that cannot work.
No. It usually means either that the problem does not need treating, or that the available treatment would not give you what you are asking for. Both are more useful than a treatment that cannot work.
Is it reasonable to ask about the practitioner's experience?
Is it rude to ask how experienced the practitioner is?
Entirely. How often they perform the procedure, on what range of skin types, and what they do when there is a complication are all fair and standard questions, and a confident practitioner will answer them directly.
Not at all. How often they do this procedure, on what range of skin tones, and what they do when something goes wrong are all fair and ordinary questions. A confident practitioner will answer them straight.
Should I decide on the day?
Should I decide on the day?
For anything elective there is rarely a reason to. Time to consider is normal practice, and pressure to commit immediately, particularly tied to a price that expires, is a signal worth taking seriously.
For anything you have chosen to have, there is rarely a reason to. Taking time to think is normal. Being pushed to commit on the spot, especially with a price that expires, is a signal worth taking seriously.
What if I do not like the plan I am offered?
What if I do not like the plan I am offered?
Say so, and ask what else could be done and why it was not the first choice. A second opinion is reasonable for anything significant, and a practitioner who is untroubled by you seeking one is telling you something useful.
Say so, and ask what else could be done and why it was not the first choice. Getting a second opinion is reasonable for anything significant, and a practitioner who is untroubled by you getting one is telling you something useful.
Talk it through with a physician first.
Every plan starts with an assessment of your skin, your anatomy and what you actually want to change.
This page is general health information, not medical advice. It cannot tell you whether a treatment is right for you. Approved uses, risks and results differ from person to person, and product labelling changes. Ask us at Dermatology and Laser Centre about your own situation, or make an appointment, and seek urgent care for any serious symptom.
