Medical history in HOF: what to ask before any procedure

The medical history is the first safety barrier in orofacial harmonization (HOF). It is where the allergy that contraindicates a product shows up, along with the anticoagulant that raises the risk of bruising, the old filler the patient forgot to mention and the expectation that no procedure will meet. Almost every avoidable complication has a question that was not asked.

This guide organizes what to ask, in what order and why. It is not a closed form: adapt it to your practice, the rules of your professional board and the profile of your patients. What matters is that the essential questions are always asked, the same way, and recorded.

Why does the medical history come before the aesthetic assessment?

It is tempting to start with the mirror: the patient points to what bothers them and the conversation goes straight to areas and volumes. The problem is that, after seeing the face and building a plan in your head, it becomes harder to hear a "no" from the health history. Taking the medical history first keeps the clinical decision free of the urge to close the treatment.

The suggested order at the first consultation:

1. Concern and motivation, heard without interruption.
2. Health history, medications and allergies.
3. Previous aesthetic procedures.
4. Habits and life context.
5. Expectations and availability.
6. Only then the facial assessment, photos and planning.

How to explore the main concern?

The main concern defines what the patient wants to solve, which is not always what they ask for. "I want to fill my smile lines" can be a complaint of tiredness across the whole face, tied to the midface and not only to the nasolabial fold.

Useful questions:

• What bothers you most when you look in the mirror or at photos?
• Since when has it bothered you? Has anything changed recently (weight loss, pregnancy, stress)?
• Did someone comment on it, or was it your own perception?
• If you could change just one thing, what would it be?
• Do you have an older photo in which you recognized yourself better?

Record the concern in the patient's own words. It will serve as a reference at the follow-up, when you need to recall what motivated the treatment.

What to ask about general health?

The health history identifies conditions that call for caution, postponement or an assessment by another practitioner. The list of contraindications itself belongs in a separate guide; here the focus is on how to reach them in conversation.

Ask open questions and then confirm with direct ones. Many patients do not consider something "an illness" if it is controlled with medication.

Which medications and supplements to investigate?

Ask for the complete list, including what the patient takes "only now and then." Some groups deserve special attention:

• Anticoagulants and antiplatelet drugs: raise the risk of bleeding and bruising. Stopping them is never the HOF practitioner's decision: it is up to the doctor who prescribed them.
• Frequently used anti-inflammatories: also interfere with clotting.
• Supplements and herbal products: omega 3, vitamin E, ginkgo and others can increase bleeding.
• Isotretinoin and other skin treatments: influence healing and sensitivity.
• Immunosuppressants and corticosteroids: alter the inflammatory response and the risk of infection.
• Drugs that interact with botulinum toxin: some antibiotics and drugs that act at the neuromuscular junction, per the product's package insert.

Also ask about recent or scheduled vaccines and ongoing dental treatments.

How to investigate allergies?

Allergy to drugs, local anesthetics, latex, egg or insect stings should be recorded with the type of reaction. Hyaluronidase, for example, is of biological origin and can cause an allergic reaction, which weighs in the planning if it needs to be used. Also ask about reactions in previous procedures: exaggerated swelling, persistent redness, nodules.

What to ask about previous procedures?

This is the point where the HOF medical history differs most from an ordinary medical or dental one. The patient may have had procedures years ago, in another city, without knowing the name of the product.

• Have you had filler, toxin, threads, biostimulator or facial liposuction? Where, when and in which areas?
• Do you know the name of the product or do you have the traceability card?
• Did you have any complication: a lump, swelling that lasted, a stain, asymmetry?
• Have you had any procedure with a permanent product or one that "never went away"?
• Have you had facial plastic surgery, rhinoplasty, blepharoplasty or a facelift?
• Have you ever needed hyaluronidase to correct something?

A recent hyaluronic acid changes the volume you will find. A collagen biostimulator is not reversed by hyaluronidase. An unknown or permanent product can contraindicate a new injection in the same area. When in doubt, document and consider postponing or requesting a complementary assessment.

Which habits and context factors matter?

• Smoking: impairs healing and vascularization.
• Sun exposure and outdoor activity: influence post-procedure care.
• Intense physical activity: generally needs a short pause after the procedure.
• Bruxism and parafunctional habits: relevant to the lower third and to toxin.
• Upcoming events: wedding, trip, professional photos. Swelling and bruising need a margin.
• Profession: someone who relies heavily on facial expression or appears on video may have other priorities.

How to assess the patient's expectations?

Expectation is part of the medical history, not of the negotiation. A patient with misaligned expectations tends to ask for too much volume, to be frustrated with an adequate result and to look for another practitioner to "fix it."

Signs that call for attention:

• A request based on another person's photo or a social media filter.
• Dissatisfaction with several previous procedures, from several practitioners.
• Intense focus on minimal details that you cannot perceive.
• Urgency without a clear reason.
• An expectation that the procedure will change their life.

In these cases, talking calmly, explaining the limits and, if necessary, not recommending the procedure is part of the approach. Informed consent is only worth something if the patient understood what is possible.

Where the projection helps

Showing the likely effect of moderate volumes helps anchor the conversation in something concrete. In Harmy, the projection is an illustrative simulation over the frontal photo that changes only the marked areas, with an intensity proportional to the planned volume. This makes it easier to ask "is it something like this that you imagine?" before any needle. The projection does not assess health, anatomy or risk: it comes after the medical history, never in place of it. On how to lead that conversation, see presenting before and after in the consultation.

How to record the medical history?

Everything that was asked and answered should go into the patient record, with the date and the patient's signature when the form provides for it. Negative answers count too: "denies allergies" is a different record from a blank field.

Good practices:

• Use a standardized form and review each item aloud with the patient.
• Note what motivated each decision to postpone, contraindicate or change the plan.
• Keep the standardized photos from before and the consent form together.
• Update the medical history at every follow-up, with short questions about what has changed.

HOF medical history checklist

A well-taken medical history adds a few minutes to the first consultation and avoids hours of management later. For the next steps, see the facial assessment by thirds and the safety and complications overview.