Facial harmonization consultation with a trans patient

Trans patients seek facial harmonization for reasons as varied as those of any other group: some want to adjust features to recognize themselves better, others look for routine procedures, and others are still in the process and want to understand the possibilities. What tends to be common is a history of being treated with disrespect, intrusive curiosity or assumptions in healthcare settings.

A well-run consultation starts with a warm welcome and ends with a plan made to measure. This guide gathers guidance on language and conduct. It is not a professional council rule or a legal document: adapt it to your practice and listen to each person.

How do I start the consultation?

The first contact sets the tone. A few simple steps:

• Ask for the name and pronoun, naturally, and record them. "How would you like me to address you? And which pronoun should I use?"
• Use the chosen name from the start, at reception, in the patient record and in the treatment room. If it differs from the person's documents, talk about how to handle it without causing embarrassment.
• Tell the team before the patient arrives, so nobody makes a mistake at reception.
• Avoid questions about documents, genitals or surgeries that are not clinically necessary.

Respect for the chosen name is part of care and of patient autonomy.

How do I take the medical history respectfully?

The medical history is essential for safety, and some information, such as hormone use, is clinically relevant. What changes is the way you ask:

1. Explain why you are asking. "I ask about medications because some of them affect the safety of the procedure."
2. Ask only what is necessary. Personal curiosity is not a medical history.
3. Use neutral, technical language. Avoid pejorative terms and unnecessary euphemisms.
4. Ask openly. "Is there anything about your health, medications or treatments that I should know?"
5. Protect the information. Data about gender identity and treatment is sensitive and requires confidentiality, under the LGPD (Brazil's data protection law).

See also medical history. Hormone therapy can influence fat distribution and planning, and deserves careful documentation, at the professional's discretion.

How do I listen to their goals?

The most common mistake is having a ready-made plan: projecting what a trans person is "expected" to want. Instead, do what you would do with any patient: ask and listen.

• "What would you like to change or highlight?"
• "Is there something about your face you already like?"
• "How do you picture yourself a few months from now?"
• "Is there anything that bothers you when you look in the mirror?"

For the mirror script, see how to use the mirror in the consultation. And to record concerns in the patient's own words, see recording concerns in the patient's own words.

What should I avoid in my language?

Mistakes happen. The reaction matters: a brief, sincere correction is better than a long apology.

How do I handle photos and records?

Photos of trans patients carry an extra risk: improper exposure can cause serious social and emotional harm. A few precautions:

• Ask for a specific image authorization, explaining how the photos will be used and stored.
• Store photos in a secure place with restricted access.
• Do not use photos in marketing without express, specific authorization.
• Make sure the name in the system respects the chosen name, when possible, and that the team knows.
• Avoid comments about the photos outside the appointment.

See asking the patient for image authorization and consent and LGPD for photos.

How do I use the simulation in this consultation?

The simulation can help the conversation, as long as it is used as an illustration and with sensitivity. It shows specific changes in the marked areas and does not broadly "transform" the face. This must be made clear to avoid frustration.

For limits and precautions, see illustrative simulation notice for the patient.

What about the team?

Respectful care depends on the whole clinic. A reception desk that gets the name wrong or gossips about the patient undoes the care given in the treatment room. Agree on this with the team:

The text training the team in communication with the patient helps turn this into routine.

What are the specific clinical considerations?

Beyond language, some clinical considerations can go into the planning, always at the discretion of the qualified professional:

• Consider hormone use in the assessment and planning.
• Respect the person's pace, without pushing for broad changes.
• Discuss expectations with the same clarity as with any other patient.
• Explain risks and consent as in any procedure.

None of this differs from standard care: what changes is the attention paid to the person and their story.

A respectful consultation does not require special knowledge about gender identity. It requires listening, humility and willingness to correct mistakes. And, as in any appointment, it comes from listening before proposing.