When not to show the simulation to the patient

The projection is a good support for aligning expectations, but it is not a mandatory part of every consultation. There are moments when showing the image hinders more than it helps: the patient clings to a detail, the photo doesn't allow a reliable reading, or the conversation hasn't yet reached the point where an image makes sense. Knowing when to keep the simulation to yourself is also part of using it well.

Why not always show the simulation?

Because an image speaks louder than any explanation. When it appears at the wrong time, the patient starts negotiating with the image and stops listening to what you say. A simulation is an illustration: it shows a possible direction, never the result they will get. If expectations aren't yet aligned, the image tends to become a promise in the mind of whoever looks at it. See also the difference between simulation and actual result.

In which situations does the simulation get in the way?

Which signs show it isn't time yet?

Some signs appear in the conversation, before any image:

• The patient repeats the same concern without accepting the explanation.
• They bring reference photos and want the same face. See patient brings a reference photo.
• They say "I want to see how it will look" before saying what bothers them.
• They compare themselves with a filter or a celebrity.
• You haven't finished the medical history and assessment yet.

What if the patient asks to see it?

Asking to see it is legitimate. You can postpone without refusing: explain that you first want to assess the face calmly and that the image comes later, once the conversation has a foundation. A simple sentence does the job.

If they still insist, show a restrained version and reinforce the notice. When in doubt, prefer the most discreet version of the area under discussion. Insistence on seeing "more" usually indicates the request deserves a conversation, not an image. For that case, see patient asks for more in the simulation.

How do you run the consultation without the simulation?

You can work well without a generated image. The mirror helps the patient point out what bothers them, and the area map helps you explain where the plan acts. See how to use the mirror in the consultation and how to use the area map in conversation. Talking with the patient about priorities, instead of showing a ready-made image, usually leads to a leaner plan.

Is there legal risk in showing or in not showing?

Showing the simulation does not create an obligation to deliver that image, as long as the patient was told it is an illustration. The risk appears when the image is presented without a notice, without a record or as if it were an expected result. Not showing it also causes no problem, as long as the rest of the consent is in order. What protects you is the whole: informed consent, an explanation of the risks and a record of what was said. Check your professional council's rules on record keeping and communication with the patient.

What should you record when you decide not to show it?

Note in the patient record that the simulation was not presented and the reason in objective terms: inadequate photo, pending consent, assessment in progress, patient in a moment of anxiety. No adjectives about the patient. The record protects you if, in the future, they say they "never saw it" or "saw it and it was different". For recording what was explained, see recording the risk communication.

When does the simulation make sense again?

When the clinical assessment is done, the photo is good, the patient is calm and the expectation has already been aligned in words. Then the image works as what it is: a help for talking about proportion, volume and stages. See how to present the projection in the consultation and what never to say when showing the simulation.

Keeping the simulation to yourself in certain consultations is not a flaw in method. It is judgment. The image serves the patient's decision and the safety of the plan, and when it doesn't serve that, the best choice is conversation.