How to say no to a patient who is a minor

The teenager arrives with a reference photo, sometimes with a guardian, sometimes alone. Many requests start from a comparison on social media or a remark that hurt. The professional is caught between the young person's wish, the guardian's authority and their own assessment of the indication, and the no has to be said without closing any of those doors.

This page offers a structure for the conversation with the teenager and the guardian. It does not replace your professional council's rules or the law on minors in Brazil, which should be consulted by anyone who treats this group. See also teenager and guardian in the consultation, patient too young and the search question can a teenager get botox?.

Why is declining usually the most careful course?

A teenager's face is still developing, and what looks like a flaw may be part of the stage. Besides, the wish to change at this age is often tied to social pressure, comparison and self-esteem still being built. Elective procedures require a clear indication, valid consent and follow-up, and a minor has particular limits on giving consent. So the prudent stance is to assess very cautiously and, when in doubt, not to treat.

Who is in the room, and why does it matter?

The dynamic changes depending on who came.

How do I talk to the teenager?

Talk to them, looking at them, not about them. Ask what bothers them and since when. Often the complaint relates to a specific remark, and hearing that changes the conversation. Validate the feeling without validating the solution: "it makes sense that you feel this way" is different from "so let's change it".

Avoid compliments that sound like pressure ("you're beautiful, you don't need it") and comparisons with other young people. If the complaint seems tied to intense distress about their image, consider the path in when to refer to psychology.

How do I talk to the guardian?

The guardian wants to protect and sometimes wants a quick fix. Explain that the reason for declining is safety and timing, not unwillingness to help. Show that you heard their concern, describe what can be monitored and propose another conversation in the future.

Which phrases help keep the relationship?

• "What I see is a face that is still developing. I would not do it now."
• "You are not being turned away, the procedure is just not indicated at this stage."
• "If it keeps bothering you later on, we will reassess together."
• "I can suggest some simple care and talk about what bothers you."

Avoid promises like "in a few years I'll do it", which sound like a postponed yes. Prefer reassessment with no commitment to a result.

And the simulation?

Showing a projection to a teenager can reinforce the wish to change. Think carefully before using it, and if you do, be clear that it is an illustration and that the procedure is not being proposed. In general, for a minor with no indication, the simulation does not help. See when not to show the simulation.

How do I document it?

Write down who was present, the request from the young person and from the guardian, the clinical assessment, the reason for declining, the guidance given to each and what was agreed (monitoring, referral, follow-up). Avoid adjectives. If the teenager shared something sensitive, handle it confidentially and according to the rules. The patient record and the medical history reflect the conversation, and informed consent is no longer relevant when there is no procedure.

A well-delivered no to a teenager may be, for them, the first time an adult takes their concern seriously without trying to fix it with a needle.