Dermal filler is often discussed in terms of products and technique. The consultation gets less attention, yet it is where most risk is identified and managed. Treating it with the same structure as any other procedural consult protects the patient and the clinician.
The outline below is a practical framework rather than a protocol. Local regulatory requirements always take precedence.
Presenting concern and goals
Start with the patient’s own words. What prompted the visit now, and what do they hope will be different? Open questions reveal more than a list of areas. A patient asking for “more volume” may be describing asymmetry, a change after weight loss, or a photograph of someone else.
Record the concern as stated. It anchors the plan and later conversations about whether expectations were met.
Medical history
A focused history before filler typically includes:
- Current medications, including anticoagulants, antiplatelets and supplements that may increase bruising
- Allergies, including to local anaesthetics
- Autoimmune or inflammatory conditions
- History of herpes labialis, relevant to perioral treatment
- Pregnancy or breastfeeding
- Recent or planned dental work, vaccinations or illness
- Previous aesthetic treatments, including products, dates and any permanent or semi-permanent fillers
- Any previous complications and how they were managed
If a patient cannot name a previous product, note that. Unknown prior material changes the risk picture.
Psychological screening
Aesthetic consultations carry a known risk of seeing patients with body dysmorphic concerns or expectations no treatment can meet. Brief validated screening questionnaires exist and are worth considering. At minimum, ask how much the concern affects daily life and what the patient expects afterward. A plan to decline or refer should be ready before it is needed.
Examination
Assess the whole face before the requested area: proportions, symmetry, skin quality, and the face at rest and in animation. Note existing asymmetries and scars, and document them so they are not later attributed to treatment.
Standardized photography, taken with consent, under consistent lighting and positioning, supports both planning and follow-up. Store images under the same privacy standards as the rest of the clinical record.
Shared decision-making
The options discussed should include doing nothing, waiting, a staged or smaller approach, and alternatives that are not filler. Patients often arrive with a fixed plan; a structured discussion can change it. When filler is a reasonable option, explain the proposed product by name, the approximate quantity, the technique, and the cost.
Informed consent
Consent for filler should cover:
- Common effects: swelling, tenderness, bruising
- Less common problems: nodules, asymmetry, infection, delayed inflammatory reactions
- Rare serious risks: vascular occlusion, skin necrosis and visual complications
- What happens if treatment needs correcting, including options for hyaluronic acid products
- The patient’s right to pause or stop at any point
Give the patient time to read and ask questions. Same-day consent under time pressure is weaker consent, both ethically and legally.
Documentation
A complete treatment record usually includes the product name, lot number and expiry, volume per site, injection depth and technique, needle or cannula used, any immediate reactions, and the aftercare given. Lot numbers matter if a product recall or a delayed reaction ever needs tracing.
Complication readiness
Before the first injection of the day, the clinic should have a written vascular occlusion protocol, the materials to carry it out, staff who know their roles, and a clear pathway for urgent referral, including ophthalmology. Patients should leave with after-hours contact details and a list of warning signs.
Follow-up
A review visit allows the clinician to assess the result, check for early problems and adjust the plan. It is also when expectations are revisited honestly. Many complications that are managed well are those caught early.
In practice
Clinics differ in how they structure this visit, but the elements above are widely shared. As one example of a consultation-first approach described for patients, see how one Vancouver clinic outlines its filler assessment.
Written by the team at FaceCrime Skin Labs, a medical aesthetics and naturopathic clinic in Vancouver, Canada. This article is general clinical education and does not replace regulatory guidance or formal training.
