What an actual medical consultation looks like (and why most aesthetic ones aren’t one)
Most aesthetic "consultations" in this country last five minutes.
You sit down. Someone asks what's been bothering you. You point at a wrinkle. They nod, quote you a price, book you in for the same day if there's a slot. That's not a consultation. That's a sales pitch with a clipboard.
A real medical consultation takes an hour. Sometimes more.
It's the part of the process I refuse to compress, because everything that happens after — the diagnosis, the plan, the treatments, the results, the years you'll spend with the face we make decisions about — depends on how thoroughly we do this part first.
Here's what actually happens in mine.
And why every step matters.
Before you even arrive
When you book your first consultation, you're sent a new patient form to complete in advance. Concerns and goals. Medical history. Medications. Allergies. Past treatments.
This isn't admin. This is so we don't waste the first twenty minutes of your appointment on data entry — and so I've already started thinking about your skin before you walk through the door. By the time you sit down, I've read your history. I have questions ready. The hour is yours, not the paperwork's.
Step one — your medical history
We start with what's already in your body and what's already happened to your skin. Past procedures. Skin conditions. Other medical conditions that affect how skin behaves and heals. Medications. Allergies.
I take this part slowly because the wrong treatment plan starts with the wrong information. Fifteen minutes here saves us months of trying to undo something that shouldn't have been done. There are medications that change how skin responds to lasers. Conditions that change how it heals. History that changes what's safe. None of that shows up on a price list.
Step two — what's actually bothering you
You get to talk. About what you see in the mirror, what you don't like, what you've tried, what you're afraid of, what you've been told elsewhere.
There is no pressure here. No upsell waiting at the end. Sometimes a person walks in convinced they need a specific treatment and walks out with skincare and a plan to come back in six months. Sometimes they walk in unsure and leave with clarity.
The point of this step is to understand your priorities — not redirect them toward mine.
Step three — facial analysis, static and dynamic
I look at your face at rest. Then I look at how it moves.
Structure. Proportions. Balance.
How the muscles work together when you smile, frown, raise your brows. How the skin sits when you're not asking it to do anything.
This is the step that separates medicine from menus. A menu treats the line you point at. Medicine looks at why the line is there, what's holding it, what's around it, and what'll happen to the surrounding face if we treat just that one thing without thinking about the rest. Faces are systems. They don't come apart into bays.
Where it helps the assessment, I use imaging technology to support what I'm seeing with my eyes.
Objective. Documented. Reviewable.
Step four — your skin
Skin gets its own assessment, separate from the face that wears it.
Texture. Tone. Sun damage. Inflammation. Pigmentation. Acne. Scarring. Barrier function.
The condition of the underlying canvas — because the wrong treatment on the wrong skin doesn't just fail to help. It can make things actively worse.
This is also where I rule things out.
Some of what people bring to me as an aesthetic concern is a medical concern wearing aesthetic clothing. We sort that out here, before any plan gets made.
Step five — clinical photography
If we're going to make decisions about your skin over months and years, we both need a record neither of us can rewrite later.
Standardised, high-definition photographs are taken at consistent angles, in consistent lighting. They sit in your medical file. They're for clinical comparison and progress monitoring — not marketing, not the website, not a before-and-after carousel on Instagram.
Memory is unreliable. Skin changes are gradual.
The photos are how we know what's actually happening, separate from what either of us thinks is happening.
Step six — your life
Skin doesn't exist in a vacuum, and treatments don't either.
I want to know about sun exposure, sleep, stress, the products you're currently using, the products you've used in the past, the work you do, the climate you live in, what's changed recently. Because the most expensive treatment in the world won't outwork a skincare routine that's slowly damaging your barrier — or a sunscreen habit that doesn't exist.
This is also where, if you haven't had one recently, I'll talk to you about skin cancer screening. As a Specialist GP with a Fellow of the College of General Practitioners with extended skills as a Skin Cancer GP — it’s a core part of what I do, not an upsell.
If you're sitting in front of a doctor who can do it, you should be offered it.
Step seven — expectations and budget
This is the conversation most clinics skip.
What are you actually hoping to achieve? What's realistic, given your skin, your timeline, and your budget? What are the different ways we could approach this — including the option to do nothing, or to do less than you came in expecting? What does this cost over six months, a year, five years?
I don't quote treatment-by-treatment because faces aren't treated treatment-by-treatment. I'll talk to you honestly about what a considered plan looks like financially. If the budget doesn't fit the plan, we change the plan — not the standard.
Step eight — your assessment and your plan
By this point I have the full picture. Your history. Your concerns. Your face. Your skin. Your life. Your goals. Your budget.
What you get next is a clinical assessment of what's actually going on, an explanation of the options that make sense for your skin specifically, and a personalised plan that may include skincare, in-clinic treatments, lifestyle recommendations, or sometimes — and this is the part menu clinics never tell you — nothing procedural at all.
Not every concern needs a treatment.
Sometimes the right answer is conservative care, prevention, and time. Sometimes the right answer is one thing, done well, instead of five things layered on top of each other. The plan reflects what your skin actually needs. Not what's on the price list.
Step nine — risks, alternatives, consent
If anything procedural is being considered, we don't fast-track this part.
We talk about what it could do for you. What it could do to you. What the alternatives are, including doing nothing. What recovery looks like. What follow-up looks like. What we'd do if it doesn't go the way we expect.
You leave with the information. You don't leave with a needle in your face the same day.
Consent is a process, not a signature — and it's not consent if you didn't have time to think.
Step ten — follow-up
If you proceed with treatment, you don't disappear from my list afterwards.
Follow-up appointments are scheduled to monitor progress, address concerns, and adjust the plan if your skin tells us something new. Aesthetic medicine is not a one-and-done industry, no matter how it's marketed.
The relationship between you and your doctor doesn't end when the treatment does. That's how you get results that last, problems that get caught early, and a face that ages the way you want it to — not the way the algorithm decides it should.
A final word, on outcomes
This is medicine. Medicine doesn't promise outcomes. It promises rigour, judgement, and a plan that respects your skin enough to be honest about what it can and can't do.
Every face is different. Every response is different. There are no guarantees in this room — only careful assessment, considered planning, and a doctor who'll tell you the truth even when it's not what you came to hear.
That's what you'll get from me.
Anything you've been promised elsewhere — be careful.
