Step 1: Patient history
The first appointment begins with the patient's history. General health status, medications used, allergies, past aesthetic procedures, dental procedures, surgical operations — all are listened to question by question. The patient should not omit any medical detail by thinking "I'll keep this to myself, it's a small thing." Especially blood thinners, cortisone, immunosuppressants, hormone therapies are crucial.
At this stage, family medical history is also discussed. If there is a history of neuromuscular disease, autoimmune disease, or bleeding disorder in the family, the physician needs to know. The patient often acts with the logic of "if he asks, I'll tell him"; this is wrong. A topic the physician forgets to ask about is a topic the patient should bring up spontaneously.
Step 2: Photo analysis
When the patient sits in the chair, they go directly to the illuminated photo area, not in front of a mirror. Standard photos are taken from the front, left and right semi-profiles, and usually from the lower jaw angle. Photos are a reference; they are used for comparison after the procedure and in subsequent sessions. No serious clinical procedure proceeds without taking photos.
After the photos, a "mimic-rest" test is performed in front of the mirror. Eyebrow lifting, frowning, blinking, smiling — each mimic is evaluated separately. Which muscle works too much, which mimic ages the face the most, whether the expression the patient is bothered by is really caused by the muscle they complain about — all of these are determined at this stage.
What the patient should ask the physician
- Which product do you work with? Can I see the packaging?
- How many units do you plan for my face?
- What should I expect at this dose, and what should I not expect?
- When should I call you if there are side effects?
- Is a control appointment given after 2 weeks?
- Will you perform this procedure, or an assistant?
- Are emergency interventions (hyaluronidase, epinephrine) available in the clinic?
Step 3: Planning and expectation management
After the examination, the physician explains the recommended plan to the patient: which areas, with how many units, in what order. The plan should be an offer, not a prescription; the patient should be able to ask questions and hear alternatives. The suggestion "let's do it all at once" is often commercial, while the suggestion "let's do the glabella first and see the result" is a clinical approach.
Expectation management is the heart of this stage. Which line will be completely erased, which line will soften but remain, which area requires supportive treatment for static lines — all of these are discussed. Sentences like "This procedure will make you 10 years younger" are an indication of distrust in the clinic. Realistic sentences are short: "This will soften the vertical line between your eyebrows, it won't be noticeable when you're resting. It will reappear with mimicry, but lighter."
Clinical note:When I hear a patient say "yesterday the doctor decided in 10 minutes, did it right away," I get uneasy. Good decisions take time; not performing the procedure at the first appointment is not a deficiency but a quality.
Step 4: Consent form and version notes
The consent form is not bureaucracy. The name of the drug to be administered, lot number, dose, application areas, expected effect, possible side effects are written down one by one. The patient should read the form, ask questions, and sign it. A copy of the form is given to the patient.
After the application, a card is issued: which date, which dose, which area. This card serves as a reference for subsequent appointments and allows the patient to follow their schedule independently. A mobile application or WhatsApp reminder system belonging to the clinic is also useful but does not replace the routine of taking notes.
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