Aligning expectations when a patient switches providers
Seeing a patient who "didn't like what was done before" looks like an opportunity, but it is one of the most delicate consultations in HOF. The patient brings a promise you did not make, a product you may not know and expectations shaped by disappointment. The risk is inheriting all of that without noticing, and ending up answerable for a result that started in someone else's hands.
This page shows how to align expectations in that scenario. Everything is handled by the licensed professional, according to the rules of their professional council in Brazil, and the focus is on what you observe and propose, not on what your colleague did.
Why is this consultation different?
Three points set it apart from an ordinary first consultation:
- Anatomy and product may be altered. Residual material, asymmetry and fibrosis change what is possible. See patient with unknown previous filler.
- The promise comes from outside. The patient may expect you to "fix" everything or, on the contrary, distrust any suggestion.
- The relationship with the colleague is a variable. Speaking ill of them harms ethics and, often, your own credibility.
How to start?
Start with the patient's account, not the exam. Ask them to tell you what was done, when, by whom and what bothered them. Then ask for before photos, if any, and for the record of the product applied (name, lot, date), which the patient has the right to request. If there is no record, note that. Traceability matters: see injectable traceability.
Next, take a full medical history, including complications, any previous hyaluronidase use and reactions. Only then examine.
What to say when the patient criticizes the colleague?
Acknowledge the feeling, not the judgment. "I understand the result was not what you expected" validates without condemning. Avoid "this is wrong" or "it should not have been done this way".
What to explain about the limits?
Be explicit about what the correction can and cannot do. Some situations change the approach:
| Situation | Care in the conversation |
|---|---|
| Unknown product | Explain that its behavior cannot be predicted and the risk is higher |
| Material that does not degrade | Talk about the limits of correction and the possibility of referral |
| Excess hyaluronic acid volume | Explain that it may be treatable, at the professional's discretion, after assessing the case |
| Previous asymmetry | Show in the photo which part already existed, when applicable |
| Concern with no visible change | Listen carefully and assess the expectation |
When the concern is far out of proportion to what is visible, consider whether something beyond aesthetics is involved. See body dysmorphic disorder in HOF.
How not to inherit the promise?
Make it clear, in writing, that the plan is new and that the result depends on the starting point. The expectation statement should say what is possible from the current state. See aligning expectations in writing.
When to advise caution or referral?
If the product is unknown, if there are signs of a complication, nodules, pain or color change, or if the concern goes beyond what you can safely manage, the cautious decision may be to assess further before acting or to refer. That is also aligning expectations: the patient learns that your criterion is safety.
What to record?
Record the patient's account, the reported history, the product and lot (or their absence), the starting state with photos, the limits explained and the consent. See the concept of the patient record and of informed consent. For the expectation conversation at the first consultation, see aligning expectations at the first consultation.
Frequently asked questions
What should I do with a patient who comes from another provider?
Take a full medical history, ask for the records and the product used, examine without commenting on your colleague, and align expectations as if it were a new case.
Can I criticize the previous provider's work?
It is not advisable. You did not see the face before, you do not know what was agreed, and criticism can cause conflict and an ethical problem. Describe what you see and what you propose.
How do I handle a patient who wants to correct previous work?
Assess what is actually there, explain what can be corrected, what cannot and the risks, and record everything. If the product is unknown, be extra cautious.
Why record the history of a patient who switched providers?
Because the starting state of the face, the photos and the patient's account are documented, separating what came from outside from what you did afterward.
Harmy images are illustrative simulations generated by AI from the patient's photo to support the conversation between practitioner and patient. They are not a promise of results. Indication, technique, product and volume are solely the decision of the licensed practitioner. This content is for information only and does not replace a clinical assessment.