Words to avoid in the HOF consultation: no talk of flaws

A badly chosen word can stay in a patient's mind for years. "Your chin is small." "This here is a flaw." "It's drooping." The professional says it without thinking, because that is how people talk in a clinic. The patient keeps it, repeats it in front of the mirror, and comes back asking to fix something they had never seen as a problem.

This page gathers the words worth avoiding, proposes neutral replacements, and shows how to describe the face without labeling it.

Why do words matter so much?

In harmonization, the professional is an aesthetic authority. What they say carries disproportionate weight. A casual comment can create a dissatisfaction the patient did not have or reinforce one they already had. This has three practical consequences:

• the patient decides out of insecurity, not desire;
• expectations become tied to "fixing" and not to "improving";
• any difference in the result becomes confirmation of the "flaw."

Judgment-free communication is also covered in nonviolent communication in the HOF consultation and in how to point out asymmetry without offending.

Replacement table

Notice that the right-hand column is not an empty euphemism: it describes what is observed and leaves the judgment to the patient. When they say "that's what bothers me," the conversation is then about their concern, not your opinion.

How to describe without labeling?

A good script is to talk about what you see, what it may mean, and the option that exists, in that order.

Note the closing: "if it doesn't bother you, we don't need to do anything." That sentence gives the power back to the patient and avoids the feeling that you are selling a fix.

What care should you take with questions?

Questions also carry judgment. "What bothers you?" presupposes a bother. More neutral questions:

• "What would you like to talk about today?"
• "Is there any area that catches your attention?"
• "If you looked at your face in the mirror right now, what would you notice?"

See the full bank in open questions for the HOF consultation and the method in active listening in the HOF consultation.

And the words used by the team?

The vocabulary applies to the whole clinic: front desk, assistants, and whoever writes the WhatsApp messages. A receptionist who says "the doctor will look at your flaws" undoes all the care taken in the exam room. Agree with the team on a list of preferred words, and practice with real situations. The idea is in training the team in communication with the patient.

And when showing the simulation?

The language during the simulation deserves extra attention. Saying "look how much better it looks" implies the face was bad before. Prefer "look at the direction we discussed" and point out what changed, without ranking. For a specific guide, see what never to say when showing the simulation.

And in written records?

The patient record is also read, sometimes by the patient themselves, and can be requested. Terms like "ugly," "horrible," or "deformed" have no place in it. Describe findings objectively: "asymmetry between the cheekbones, with less volume on the right," "accentuated nasolabial fold bilaterally." This protects the patient and protects you.

When must frankness prevail?

Neutral is not the same as vague. If there is a risk, a contraindication, or a limit, say so clearly. The patient has the right to hear that something is not indicated, that a result is unlikely, or that a procedure carries risk. The difference is that you say this about the procedure and the situation, not about the face as a flaw. See communicating risk to the patient and how to say no to the patient in HOF.

And when the patient uses the word themselves?

If the patient calls their own nose "ugly," do not correct them forcefully, and do not agree either. Acknowledge the feeling and offer a neutral description: "I understand that bothers you. What exactly would you like to be different?" This validates the concern without reinforcing the label.

What should you record?

Keep the patient's words in quotation marks in the record, with your neutral descriptors beside them. This preserves the original concern and your clinical judgment, and provides a basis for the informed consent.