The word consultation does an enormous amount of work in cosmetic advertising. It is used for everything from a proper clinical assessment by the person who will treat you, through to a fifteen minute appointment with a non clinical adviser whose job title is consultant and whose actual role is sales. The two are not related. Knowing which one you have been booked into is one of the more consequential things you can work out in advance.
Who should be doing it
The person who assesses you should be the person who will perform the procedure. This sounds obvious. It is routinely not what happens. In a model that has become common, a patient is assessed and sold to by one person, and treated on the day by another, sometimes meeting the treating practitioner for the first time minutes before the needle.
Professional guidance is clear on the principle. The GMC's guidance for doctors carrying out cosmetic interventions places responsibility for the consent discussion on the doctor performing the intervention, and says it must not be delegated. Similar expectations run through the standards of the other healthcare regulators. Where the person injecting you is not a registered healthcare professional at all, no regulator's guidance binds them, and you are relying entirely on their own standards.
Why you want it, and whether it is appropriate
A real consultation starts with you rather than the treatment menu. It asks what is prompting this, what you expect to change, whether the concern you are describing is actually addressed by the procedure being discussed, and whether there is anything in your medical history, your medication, your expectations or your circumstances that makes it a poor idea now.
Regulatory guidance in this area asks clinicians to consider psychological vulnerability, including whether a patient may have body dysmorphic disorder, and to be prepared to decline to treat. A consultation that is incapable of ending in the word no is not a consultation. If every path through the appointment leads to a booking, the appointment was never an assessment.
What must be covered
Whatever the setting, the following has to be on the table before you can meaningfully agree to anything.
- What the procedure actually is, in plain language, including the product or drug class used and what it does in the body.
- What result is realistic for you, as distinct from what is achievable for someone else.
- The risks and complications, including the rare but serious ones, and what would be done about each.
- The alternatives, including less invasive options and the option of doing nothing at all.
- How long it lasts, whether it is reversible, and what happens as it wears off.
- Recovery, downtime, and what is normal in the days afterwards as opposed to what is not.
- Who to contact out of hours, and how fast they respond.
- What a correction or a complication costs, and who pays for it.
- The total price, including any follow up, and what is not included.
The last two are where a great many consultations quietly fail. The cost of the treatment is discussed enthusiastically. The cost of putting it right is not discussed at all.
What you are entitled to at this stage
- To be assessed by the person who will perform the procedure, and to have the consent discussion with them.
- To be told the risks that would matter to you, not a generic list, and to have your own circumstances taken into account.
- To be offered the alternatives, including the alternative of doing nothing.
- To be given the price of correcting a poor result before you agree to the procedure.
- To take the information away and decide later, without penalty or pressure.
Consent is a process. A signature at the end of it records the process. It cannot replace it.
Risk has to be personalised, not recited
The legal standard for what must be disclosed shifted decisively with the Supreme Court's decision in Montgomery v Lanarkshire Health Board in 2015. The test is no longer what a responsible body of clinicians would have disclosed. It is whether a reasonable person in the patient's position would attach significance to the risk, or whether the clinician should reasonably be aware that this particular patient would.
Applied to cosmetic work, that has a practical consequence. If your job, your hobby, your event next month or your particular anxiety makes a specific outcome significant to you, the discussion has to engage with that, not with a laminated list. A consultation that recites generic risks and never asks what matters to you is not meeting the standard.
A consultation that ends with a signature on a consent form you were given for the first time that minute, in the treatment room, with the product already drawn up, has inverted the process. The form is meant to record a discussion that already happened.
Time between the discussion and the needle
There is no single statutory cooling off period for cosmetic procedures across the UK, and anyone who tells you otherwise is oversimplifying. What exists is professional guidance that expects patients to be given time to reflect, and consumer law that in some circumstances gives cancellation rights for contracts made at a distance or away from business premises. We set out how those interact in our guide to cooling off.
The practical point stands regardless of the law. If you were assessed and treated in the same appointment, you did not have time to reflect, and no form saying you did changes that.
What you should leave with
You should leave a consultation with written information about the procedure, a note of what was discussed including the risks, a clear price, and the name and registration of the person who will treat you. If a prescription only medicine is involved, you should know who is prescribing it and whether they have assessed you in person. That is covered in our guide to remote prescribing.
You should not leave with a deposit paid on a treatment you have not had time to think about, a finance agreement signed in the room, or a discount that expires before you could reasonably reflect. Those are sales devices, and their presence in a clinical appointment tells you what the appointment was for.
What a good consultation feels like
It is slower than you expect. It spends more time on your history than on the product. It names at least one thing that could go wrong in enough detail to be uncomfortable. It offers doing nothing as a real option rather than a rhetorical one. It gives you a price that includes the unglamorous parts. And it ends without a booking, because the practitioner assumes you will want to think.
If that description sounds unlike the appointment you have been offered, that is worth knowing before you go, not afterwards.