The history that should change the plan
A history form that is collected and filed has done nothing. This article sets out what should be asked, and what a practitioner should do with each answer.
A consultation should ask about: current medication including anticoagulants and immunosuppressants; allergies, particularly to fish, and any history of anaphylaxis; autoimmune and inflammatory conditions; diabetes and how well controlled it is; a tendency to keloid or hypertrophic scarring; a history of cold sores if the perioral area is involved; previous injectable treatments in the area and what was used; pregnancy and breastfeeding; recent or planned dental and surgical work; and any history of granulomatous or unusual reaction to an injected material.
Each of those has a consequence. A form that collects them without changing anything is a document rather than a safeguard, and the test of a consultation is whether the answers visibly affected the plan.
4.6.1Medication
Anticoagulants and antiplatelet medication
Increases bruising and bleeding. Should be disclosed and discussed. Should never be stopped or altered for a cosmetic procedure without the advice of the doctor who prescribed it. A practitioner suggesting you stop prescribed anticoagulation for an elective cosmetic treatment is giving advice outside their competence.
Immunosuppressive medication
Changes infection risk and may change tissue response. Warrants a conversation with the clinician managing the condition rather than a decision made in an aesthetic consultation.
Isotretinoin and recent systemic acne treatment
Affects skin healing and is conventionally a reason to defer procedures that injure the skin. The interval used varies between practitioners and is convention rather than settled evidence.
Anything else
The full list matters because interactions and relevance are not always obvious to a patient. Bring your repeat prescription list rather than trying to remember.
4.6.2Allergies
Fish allergy, because the product is fish derived. Any history of anaphylaxis to anything, because it changes the risk calculation for every elective injectable and determines what emergency provision should be in place. Allergy to local anaesthetics, if any anaesthetic is to be used. Latex, if relevant to the equipment used.
Be specific rather than categorical. Allergic to fish is more useful than allergic to seafood, and diagnosed by testing is more useful than I think I might be.
4.6.3Conditions
Autoimmune and inflammatory conditions
Both the condition and its activity matter. An injected foreign material in someone whose immune regulation is atypical is a reasonable thing to think about carefully, and practitioners differ in their approach. The right route involves the clinician who manages the condition.
Diabetes
Control matters more than the diagnosis. Poorly controlled diabetes affects healing and infection risk. Well controlled diabetes is a different situation.
Skin conditions in the treatment area
Active eczema, acne, psoriasis or dermatitis changes the barrier and the tissue response. Usually a reason to wait rather than to decline.
Cold sores
Relevant if the perioral area is being treated, because injection can provoke a recurrence in someone prone to them. This should be raised in advance so that it can be planned for rather than managed afterwards.
A tendency to keloid or hypertrophic scarring
Multiple punctures in someone prone to abnormal scarring warrants a specific discussion about the area concerned.
| What you disclose | Why it matters | What should follow |
|---|---|---|
| Anticoagulant or antiplatelet medication | Bruising and bleeding | Discussion, planning, and never a suggestion to stop prescribed medication |
| Immunosuppressive medication | Infection risk and tissue response | Conversation involving the clinician managing your condition |
| Fish allergy | The product is fish derived | Reference to the manufacturer's documentation, and a recorded discussion |
| Any history of anaphylaxis | Changes risk for every elective injectable | Assessment of emergency provision and who is trained to use it |
| Autoimmune condition | Immune regulation and tissue response | Individual decision with input from the clinician managing it |
| Diabetes | Healing and infection risk | Discussion of control, not just of diagnosis |
| Cold sores, if perioral | Injection can provoke recurrence | Planned for in advance |
| Keloid tendency | Multiple punctures in scar prone skin | Specific discussion about the area |
| Previous fillers in the area | Material may still be present and can be involved later | Establish what, when and how much, from records if possible |
| Previous reaction to an injected material | Predicts further reactions | Careful reconsideration of whether to proceed |
A framework written by this publication to organise a decision. It is not a measurement, it is not drawn from any study, and no figure in it should be quoted as a finding.
4.6.4Previous treatments in the area
This is the item most often collected inadequately, and it matters a good deal. What was injected, when, by whom, how much, and whether anything unusual happened. Previous permanent or semi permanent fillers are particularly important, because material that is still present changes the tissue and can be involved in later reactions, sometimes years afterwards.
Many people do not know what they have had. If you do not, say so rather than guessing, and if you can obtain your records from the previous provider, do. This is a strong argument for keeping your own record from now on.
4.6.5Previous reactions to injected materials
Any history of a delayed swelling, a nodule, a granulomatous reaction or an unexplained inflammatory episode after a previous injectable is significant and should change the conversation. So should a history of reaction after a vaccination or another injected substance, since delayed inflammatory reactions to injected materials are recognised across the field.
4.6.6What a practitioner should do with the answers
Not file them. The visible signs that a history has been used are simple. The practitioner refers back to something you said. The plan changes: a different area, a smaller volume, a deferral, a request that you speak to another clinician first, or a decision not to treat. Something is recorded about the discussion rather than only the answer. And you are told what the answer means for you specifically.
Professional guidance on consent describes a process in which the patient's individual circumstances shape what is discussed and what is offered. A history taken as an administrative preliminary and never mentioned again does not meet that description.
4.6.7Your side of it
Disclose fully, including things you would rather not. Practitioners are not shocked and are not making judgements about your life. Under disclosure is common, particularly around alcohol, supplements, previous treatments elsewhere and body image concerns, and it removes the practitioner's ability to help you.
Bring your repeat prescription list. Bring what you know about previous treatments. Say if you are unsure rather than guessing. And if you remember something afterwards, tell them, because a history is not fixed at the moment the form is signed.
Questions
What should I bring to a consultation?
Your repeat prescription list, what you know about previous injectable treatments in the area including when and what was used, and details of any allergies including how they were diagnosed. If you do not know what you have had before, say so rather than guessing.
Does it matter that I had filler years ago?
Yes. Delayed inflammatory reactions involving previously placed materials are recognised in aesthetic medicine and can occur long afterwards. What you have had, when, and how much is relevant even if it caused no trouble at the time.
Should I stop my medication before treatment?
Not unless the doctor who prescribed it tells you to. Never stop or alter prescribed anticoagulant, antiplatelet or any other medication for an elective cosmetic procedure on the advice of an aesthetic practitioner.
How do I know my history was actually used?
The practitioner refers back to what you said, the plan changes in some visible way, something is recorded about the discussion rather than only the answer, and you are told what your particular circumstances mean for you. A form that alters nothing has done nothing.
What if I forget to mention something?
Tell them when you remember, including after treatment. A medical history is not fixed at the moment a form is signed, and a practitioner would far rather hear late than not at all.
- GMC, Decision making and consent
- GMC, Guidance for doctors who offer cosmetic interventions
- NHS, Allergies
- British Association of Dermatologists
- NHS, Cosmetic procedures
- British National Formulary
Links to regulators, professional bodies, legislation and research indexes. They are cited because they are public and checkable, not as endorsement of this publication. No source listed here has any commercial relationship with us.
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