The Two Questions You Must Ask Every Patient, Every Time (Or Risk a Nodule)

Hi Facecoachers,

We’ve all been there. You have a "regular" in the chair. They’ve been seeing you for three years, you know their kids' names, and you could probably map their facial anatomy in your sleep. It’s tempting to skip the "boring" paperwork and get straight to the transformation.

But here is the hard truth: skipping the intake form: even for one appointment: is how we miss the tiny clinical red flags that lead to the biggest headaches.

I’m talking about delayed onset nodules (DONs). Those stubborn, inflammatory lumps that show up months later and make both you and your patient miserable.

At Monash, we spend a lot of time in Module 6 (Clinical Frameworks and Safety) discussing how to protect your practice. One of the simplest, most effective ways to do that is by asking two specific questions every single time a patient sits in your chair.

The Science of the "Seeded" Filler

Before we get to the questions, let’s talk about why they matter. We used to think nodules were almost always about bad technique or contaminated product. We now know that's only half the story.

Biofilms are the real culprit. These are sophisticated colonies of bacteria that can "seed" themselves into the filler. This doesn't just happen at the time of injection. Bacteria can reach a filler site via hematogenous spread, basically hitching a ride through the bloodstream during a systemic infection elsewhere in the body.

A simple dental abscess or a bout of sinusitis can send bacteria into the blood, where they find your beautifully placed HA filler and decide to move in. Once a biofilm is established, it is notoriously difficult to treat: often requiring 32 to 1,000 times the normal concentration of antibiotics to clear.

This is why your intake form isn't just a legal requirement; it’s your first line of clinical defense.

This is a useful clinical reference because it shows exactly where practitioners should be checking for antibiotics and current wellness before treatment.

Under the "Support for success by facecoach" section of the form, these prompts are listed clearly in our clinical documentation:

1. "Are you currently taking antibiotics?"

2. "Have you recently had any infections anywhere in your body?"

That second question is our practical screening for whether the patient is actually well today.

This form is a core part of the clinical governance framework we teach in the Monash University course. It keeps the assessment consistent, defensible, and focused on patient safety.

Question 1: "Are you currently taking antibiotics?"

This is a non-negotiable. If a patient is on antibiotics, it means their body is currently fighting an active infection.

From a clinical safety perspective, injecting filler into a patient with an active infection: even if it's "just" for a UTI or a toothache: is like inviting trouble. You are operating in an environment where the immune system is already heightened and circulating bacteria are looking for a place to land.

Our Suggestion: If they are on antibiotics, defer the treatment.

Wait until they have finished the course and are at least two weeks clear of any symptoms. It might feel awkward to turn away a booking, but it’s much easier than managing a persistent, antibiotic-resistant nodule six months down the line.

Question 2: "Have you recently had any infections anywhere in your body?"

This is the wording we use on the form, and it’s our practical screening for "Are you well today?"

It sounds simple, but it’s actually a vital screening tool for subclinical or viral infections.

We’ve seen increasingly in clinical literature that systemic inflammatory events: like the flu, a heavy cold, or even recent vaccinations: can act as a trigger for the immune system. This "immune unmasking" can cause the body to suddenly react to a filler that has been sitting happily in the tissue for months.

When a patient says, "I'm a bit run down" or "I've had a scratchy throat," their immune system is in high gear. Injecting during this window significantly increases the risk of a delayed inflammatory reaction.

A quick extra point from the same form: the question "Are you flying anywhere in the next 2 weeks?" is circled for a reason. We screen for travel so patients are not stepping onto a long-haul flight straight after treatment when a complication could emerge and we cannot properly review or manage it.

The Protocol: Every Appointment, No Exceptions

AHPRA is very clear on this: a clinical consultation and assessment must occur every time you prescribe a Schedule 4 cosmetic injectable. This isn't a one-and-done process at the initial consult.

Things change. Patients forget to tell you they had a dental cleaning yesterday or that they started a course of antibiotics for a sinus infection.

We suggest making these two questions a bold, mandatory part of your digital or paper intake form that must be initialed at every visit:

1. Are you currently taking antibiotics?

2. Have you recently had any infections anywhere in your body?

Why This Matters for Your Governance

This is interesting because it shifts the conversation from "technique" to "suitability."

In the Monash University course, specifically in Module 8 (Clinical Assessment), we dive deep into the specific health markers that make a patient unsuitable for treatment.

Being a great injector isn't just about where you put the needle; it’s about knowing when to put the needle down. Having a rigorous, documented intake process shows that you are adhering to the highest standards of AHPRA compliance and clinical safety.

It’s about protecting the patient, but it’s also about protecting you. If a complication does occur, your clinical notes showing that you screened for infection and confirmed patient wellness will be your greatest asset.

Ready to Elevate Your Practice?

If you want to move beyond basic technique and master the clinical, ethical, and regulatory frameworks that define a true expert, consider joining us for the next intake of our 12-week intensive course.

It’s 144 hours of deep-dive content, fully online and designed for busy medical professionals. You’ll earn a prestigious Monash University certification and, more importantly, the confidence that your practice is built on a foundation of absolute safety.

Explore the Course Details Here

Stay safe and keep questioning,

Mike Clague Director, Facecoach