The "New" Cosmetic Consultation: Patient-Centred, Suitability-First, and Why "Why?" Matters More Than the Filler

The patient who walks in has already decided online. How the Monash course teaches a patient-centred, suitable-first approach to the cosmetic consultation.

Hi Facecoachers,

The traditional cosmetic consultation is changing.

The old model was straightforward: the patient presented a concern, the doctor assessed it, made a unilateral decision and provided the treatment. The familiar sequence was:

Presenting complaint → history → examination → diagnosis → treatment.

That paternalistic model is now extinct: or, at the very least, under serious threat.

Patients no longer automatically accept unilateral physician decision-making. They arrive informed, connected and ready to participate. Often, they have already decided what they want before they sit down with us.

That does not mean the patient should direct the treatment plan. It means our role has changed.

We need to listen carefully, understand the patient’s goals and then guide them with sound clinical judgement.

From paternalism to patient-centred care

There is a useful spectrum to consider:

• Paternalistic model: the practitioner decides what is best.

• Patient autonomy model: the patient decides what they want.

• Patient-centred model: the practitioner listens, educates and guides, while the patient participates meaningfully in the decision.

  
  

The patient-centred model is the middle ground.

It respects autonomy without abandoning professional responsibility. It allows us to remain clinically directive while ensuring the patient’s priorities, expectations and circumstances are part of the consultation.

This is particularly important in aesthetic medicine, where treatment is discretionary and the patient’s perception of their appearance is closely linked to identity, confidence, relationships and social experience.

The consultation is not simply a prelude to injecting. It is where suitability is assessed.

The connected patient has already done their research

Professor Greg Goodman AM’s lecture on the “new” patient consultation highlights an important reality: the connected patient may have made up their mind before they arrive.

The teaching material notes that:

• Up to 40% of patients may have decided on their procedure online before consultation.

• Approximately 80% may feel they know what to expect because they have seen procedures on social media, television or other digital platforms.

  
  

These figures should make us pause.

The patient may arrive having watched short-form videos, followed practitioners, read online reviews or spoken with friends. They may have strong preferences about product, technique and treatment area.

But digital confidence is not the same as clinical understanding.

Patients can also arrive with:

• Misconceptions about anatomy and ageing

• Misinformation about products or complications

• Unrealistic expectations of the result

• Confusion about what treatment will actually address

• Assumptions based on another person’s face or experience

  
  

This is interesting because the patient may believe they are asking for a specific treatment, when what they really want is a broader outcome.

Our job is not to dismiss the information they have found. It is to put it into context.

Generational change matters

Gen Z and Gen Alpha are the most connected and technologically fluent generations. They are comfortable researching providers, comparing information and forming opinions online.

Gen Z patients may have “checked you out” before they walk through the door. They may know your professional history, your clinic’s social media presence and how you communicate with patients.

Gen Alpha is still the youngest generation, but already has significant influence over brands, family purchasing decisions and social media culture.

That does not mean we should target younger people with cosmetic advertising. AHPRA’s cosmetic advertising requirements place important protections around people under 18 and other vulnerable groups.

It means we need to understand the broader environment in which expectations are formed.

Know yourself, understand the patient

The lecture deck uses four familiar personality profiles:

Drivers

Drivers are direct and time-conscious.

They may say:

“Just tell me what I need. I haven’t got a lot of time.”

With a Driver, we suggest being structured and clear. Explain the priorities, the options and the next step without unnecessary detours.

Expressives

Expressives may be enthusiastic and emotionally engaged.

They may say:

“This sounds like fun. I can’t wait for the treatment.”

They may respond well to conversation and possibility, but we still need to bring the discussion back to realistic outcomes, risks and suitability.

Analyticals

Analyticals want detail and evidence.

They may ask:

“How often do complications occur? Is there anything I can read?”

Give them appropriate information and time to consider it. Avoid overwhelming them with poorly contextualised online material. Point them towards reliable sources and document the discussion carefully.

Amiables

Amiables value relationships, reassurance and trust.

They may be less direct about what they want and may look to the practitioner for a safe, supportive recommendation. Take care not to mistake agreeableness for informed consent.

The connected patient reframes each personality type. Regardless of their style, they have access to more information than previous generations and may arrive with pre-formed expectations.

The practical lesson is simple:

• Know your own communication style.

• Understand what drives the patient.

• Mirror their communication style where appropriate.

• Do not mirror misinformation.

• Keep the clinical framework consistent.

Five ways to connect during the consultation

A useful framework from Zulman et al. in JAMA outlines five practices that support physician presence and connection in the clinical encounter.

You can read the paper here.

1. Prepare with intention

Take a moment before greeting the patient.

Review the available information. Put aside the previous appointment. Focus on the person in front of you.

This small pause can improve the quality of the whole consultation.

2. Listen intently and completely

Sit down if possible. Lean forward. Avoid interrupting.

In aesthetic practice, patients do not always describe their real concern in the first sentence. “I want filler in my nasolabial folds” may be a treatment request, not the underlying goal.

Let the patient finish their story before moving into education or advice.

3. Agree on what matters most

Ask what outcome matters most to the patient.

Is it looking less tired? Maintaining a familiar appearance? Addressing a particular change? Preparing for an event? Feeling more comfortable in photographs?

Then incorporate that priority into the consultation agenda.

4. Connect with the patient’s story

Life circumstances influence cosmetic decisions.

Work, relationships, grief, ageing, pregnancy, illness, social media and major life transitions may all shape how a patient experiences their appearance.

You do not need to become the patient’s psychologist. But you should understand enough of the story to decide whether treatment is appropriate and what a reasonable outcome might be.

5. Explore emotional cues

Notice, name and validate emotions.

If a patient becomes distressed, you might say:

“I can see this has been troubling you for some time.”

Validation does not mean agreeing that the patient has a defect that must be corrected. It means acknowledging their experience while maintaining professional boundaries and clinical objectivity.

A restructured aesthetic consultation

In the lecture, Professor Greg Goodman AM proposes a practical structure for the modern aesthetic consultation.

Step 1: Credential and introduce

Start by establishing who you are and how the consultation will work.

Explain your qualifications accurately. Introduce the process. Make it clear that the consultation is about understanding the patient’s concerns, assessing suitability and deciding on a plan: not automatically providing the requested procedure.

This supports trust and aligns with the professional expectations reflected in the AHPRA cosmetic procedure advertising guidelines.

Step 2: Educate about the ageing process

Before discussing products, discuss the changes that may be occurring.

Ageing is not a single problem. It can involve changes in skin quality, volume, muscle activity, soft tissue support and facial proportions.

We suggest explaining what you observe in neutral, clinically appropriate language. Normal ageing should not be presented as a disease or a defect that must be fixed.

The aim is to help the patient understand why a particular concern has appeared and what treatment can: and cannot: do.

Step 3: Advise using a logical, structured approach

Once you understand the patient’s goals and have assessed their anatomy, provide a considered recommendation.

A gradual approach is usually more appropriate than treating everything at once. Professor Goodman’s framework suggests addressing the worst or most significant area first, then reassessing.

That may mean advising against the treatment the patient initially requested.

A patient asking for a specific product is not necessarily asking for the best clinical solution.

Step 4: Gain trust

Trust is not created by promising a result.

It is built through consistency, honesty and a willingness to say:

• “That treatment may not give you the result you want.”

• “I would prefer to assess this further before proceeding.”

• “I do not think injecting today is in your best interests.”

• “There is a more logical place to start.”

  
  

A practitioner who can decline unsuitable treatment demonstrates that patient safety is more important than immediate commercial gain.

Step 5: Plan at the patient’s pace

The plan should allow time to reassess and replan.

This may involve staged treatment, a cooling-off period, further information, referral or a decision not to proceed.

Consent is a process, not just a signature. The patient needs to understand the proposed treatment, alternatives, material risks, likely limitations, costs and aftercare.

For higher-risk non-surgical cosmetic procedures, AHPRA’s guidance should sit alongside your own clinical governance systems and professional obligations.

When the patient asks for nasolabial fold filler, ask “Why?”

This is the practical example Professor Goodman uses in the lecture.

A patient presents and says:

“I want filler in my nasolabial folds.”

A traditional consultation may move directly towards the filler.

The new consultation asks:

“Why?”

That question opens the discussion.

Why are the folds concerning the patient? What change have they noticed? What outcome are they hoping for? Is the concern actually about midface support, skin quality, facial fatigue or the general process of ageing?

Sometimes the patient’s requested treatment may require a significant amount of product while making little difference to how youthful or attractive they feel.

As Professor Goodman explains, that amount of product may be better used: or not used at all: in a plan that addresses what the patient actually wants.

The key point is not that nasolabial fold filler is never appropriate. It is that the injection should follow assessment, education and shared planning.

Suitability comes before the syringe

A thorough consultation should consider:

• The patient’s medical history and current medications

• Previous cosmetic treatments and products

• Physical and anatomical suitability

• Skin condition and relevant contraindications

• Expectations and understanding of limitations

• Body image concerns or possible BDD

• External pressure from partners, peers or social media

• Whether the patient has enough time to make a voluntary decision

• Whether the proposed treatment is proportionate to the concern

  
  

A structured intake form can support this process, but it cannot replace practitioner-led assessment and consent.

The Monash University course treats this as core patient suitability content in Module 8, alongside governance, ethics, consent, AHPRA requirements and the assessment of suitable treatments including skin therapies, lasers, Botulinum toxins and soft tissue fillers.

Six days left to enrol

There are ONLY 6 DAYS TO ENROL for the September 1 intake. Enrolments close on August 23.

The fully online Monash University course runs for 12 weeks and represents 144 notional hours of learning. It is designed for AHPRA-registered doctors and nurses who want a structured, efficient way to strengthen their approach to patient suitability, governance, compliance and ethics in non-surgical cosmetic medicine.

Use code FIRST50STUDENTS at checkout for the current offer.

This is not about adding another form to your workflow or creating a longer consultation for its own sake.

It is about making the consultation more clinically useful.

Listen before recommending. Educate before injecting. Ask why before deciding how.

That is the direction of the new cosmetic consultation; and ultimately, it is better for practitioners, better for professional responsibility and safer for patients.

( Mike Clague)