Practitioner Guidance

Where the motivation is subjective, the risk disclosure has to include subjective outcomes. If a procedure is chosen for psychological reasons, psychological outcomes belong in the consent conversation. When a procedure fails to deliver them — when the patient is left with a technically acceptable result and the same distress they walked in with — that is a harm.

Ask most aesthetic practitioners whether psychological risk is part of their informed consent process and the answer will be yes. In theory, they are not wrong. The guidance is there. Practitioners can point to it. And yet patients are routinely consented for cosmetic procedures without receiving any structured information about psychological risk at all.

A form sitting in the patient file is not a safeguard — it is a document, and that document has legal consequences. Once a questionnaire becomes part of the clinical record, it becomes part of the evidence in any subsequent dispute. When that happens, the practitioner is no longer defending a claim about consent or outcome. They are defending a psychological assessment process they were never trained or qualified to run, and the questions that follow are not comfortable ones.

Cosmetic patients are warned about scarring, swelling and allergic reactions. Why are the psychological risks of cosmetic procedures still left out of consent? BDD is estimated to affect somewhere between 19% and 24% of cosmetic surgery patients. That is roughly one in five. It is associated with poor satisfaction after treatment and poor psychological outcomes. It is not a remote possibility to be noted in passing.

Lynn G v Hugo is a case with huge implications, yet it has largely gone unnoticed. Practitioners remain unaware of it, despite the fact that it dismantles some of the very assumptions they tend to rely on. "I know my patient, I would have picked up on it." People have a tendency to think "this could never happen to me"- until it does.

The medical aesthetics industry has spent years talking about the need to identify unsuitable patients. On paper, that sounds sensible. If a big part of the risk sits in patient motivation, expectations, or appearance-related distress, then screening for those issues can seem like the obvious answer. However, that logic falls apart when it meets the real conditions of cosmetic care.

What’s happening right now in the aesthetics industry around Body Dysmorphic Disorder (BDD) awareness isn’t progress. It’s performance. People are chasing titles, panels and hashtags about “psychological safety” without understanding the first thing about it. Performative “safeguarding” and spreading misinformation does more harm than doing nothing.

The PREPÆRE™ Patient Hub is a free resource aesthetic practitioners can refer patients to at any time. One of the most important parts of ethical aesthetic care is knowing when not to treat. Sometimes, a patient’s expectations may be unrealistic. Other times, they may have had too much work already. In some cases, something just feels off. But what happens after you say no ? Too often, the answer is nothing. There is no guidance, no follow-up, just a polite rejection. While t

Since July 2023, Australia has introduced some of the strictest rules in the world around psychological screening in aesthetics. The goal is well-intentioned: to safeguard patients, especially those vulnerable to mental health challenges like Body Dysmorphic Disorder (BDD). But while the policy sounds protective on paper, the reality is much more complex.

Currently, we are navigating a largely unregulated aesthetics landscape. In the NHS or private practice, the CQC reigns supreme.

A few years back, I would have been the patient of your nightmares. The one who seems normal enough—pleasant, even—

In our modern, hyperconnected world, the image we present to the world often becomes an intrinsic part of how we see ourselves.