Adolescent and Guardian in the Consultation: How to Handle It

Seeing an adolescent changes the structure of the consultation. There are two people in the room with different roles: the one who lives with the face and the one who is legally responsible for the decision. If you talk to only one of them, you lose the other, and the consultation becomes fragile from a clinical, relational and legal standpoint.

This page organizes how to run it: whom to listen to, who consents, what to say to each and what to document. It does not replace the law or your professional board's norms on aesthetic procedures in minors (in Brazil, CFM, CFO and others), which vary and change. If in doubt, consult your board and a legal professional before scheduling.

Who decides and who signs?

In general terms, the adolescent is heard and the legal guardian consents. Listening is part of good practice: the young person has an opinion, lives with the result and needs to understand what is happening. The formal signature, however, belongs to whoever is legally responsible for them.

How should you structure the consultation?

A sequence that works well in clinics is to split it into three short moments.

1. Opening with both. Introduce yourself to the adolescent first, then to the guardian. Explain that the consultation will listen to both and that nothing will be decided in a rush.
2. Listening to the adolescent, in a moment alone, if the guardian agrees. Tell the guardian beforehand, and explain it as a privacy routine. Ask what bothers them, since when, and whose idea the procedure was.
3. Feedback with both. Present the assessment, risks, alternatives and timelines, and ask both to say what they understood.

The goal of the one-on-one listening is to find out whether the wish is the adolescent's own. Peer pressure, comparison with influencers and social media filters are frequent reasons, and they deserve a careful conversation. The glossary covers consent under informed consent.

What should you ask the adolescent?

Open questions work better than direct questions about the procedure:

• What do you notice most when you look in the mirror?
• Since when has it bothered you?
• Has anyone talked to you about it?
• What do you think would change in your life if this changed?
• Have you researched this? Where did you see it?

The answers help separate a real concern from social pressure or an unrealistic expectation. If signs appear of intense distress about appearance, constant comparison or isolation, the prudent course is not to proceed with the procedure and to suggest an assessment by a mental health professional. See also how to say no to a patient in facial harmonization.

What should you tell the guardian?

The guardian needs to understand three things: what is being proposed, why, and what the risks are. Avoid jargon and avoid promises. Also explain what will not be done and what alternatives exist (including doing nothing for now).

A delicate point is when the guardian wants the procedure and the adolescent does not. The correct answer is the same: the professional should not perform the procedure against the young person's expressed wishes, even with the guardian's signature, and should document the conversation. The reverse also holds: if the adolescent wants it and the guardian does not authorize it, it is not done.

What about the simulation and images?

If you use a visual projection in the consultation, present it as an illustrative simulation, not as a promise. With adolescents the care is greater: the simulated image can become a rigid reference, and the young person may compare their real face with it for a long time. Show it sparingly and reinforce that the result depends on anatomy and on how things evolve.

As for images, a clinical photo in the patient record requires the legal guardian's authorization and care with the LGPD (Brazil's data protection law), which treats the data of children and adolescents with specific attention (article 14 of the law, available in the official text on the Planalto site). For the image use form, see image authorization for minors.

What should go in the patient record?

• Identification of the adolescent and the guardian, and the relationship.
• Concern in the adolescent's own words.
• Whether part of the consultation was one on one, and that the guardian was told.
• Assessment, indication or refusal, with the reason.
• Risks and alternatives explained, to whom and when.
• Consent form signed by the legal guardian, according to the applicable norms.
• Image authorization, when there is one, with the purpose described.

The patient record is where the conversation becomes a document. Write down what was said in neutral language.

When should you postpone or decline?

Postpone when the adolescent is in active growth, when the concern seems tied to social comparison or filters, or when the guardian and the young person do not agree. Decline when there is no clinical indication, when the applicable norm does not allow it, or when there are signs of distress that deserve a mental health assessment. In every case, document it and offer a new conversation later.

For managing expectations, see aligning expectations at the first consultation and aligning expectations in writing.