Teens in HOF: When to Decline the Procedure

The request arrives by many paths: the teenager brought in by the mother, the one who researched alone, the one who shows a filter image and says "I want it like this." The professional's challenge is twofold. On one hand, not ignoring real distress about appearance. On the other, not turning the insecurity of a life stage into an injectable procedure. This guide covers the clinical and ethical reasoning for deciding, the conversation with the young person and the guardians, and the record. Rules, minimum age and legal requirements vary and must be checked against your professional council's regulations and the applicable law in Brazil, which this text does not replace.

Why is the teenager a case apart?

Three factors set this patient apart from the adult, and none of them comes down to age in years.

1. The face is still developing. Proportions, bony projection, lips and chin keep changing. A volume that looks right today may become disproportionate later, and the opposite also happens.
2. Self-image is under construction. Comparison with classmates, social media and filters weighs heavily. The concern may reflect the context more than the anatomy.
3. The ability to decide about risk is different. Teenagers tend to underestimate complications and overestimate the effect of a procedure, which calls for an informed consent done with more care and involving the guardians.

On top of this come aspects of bioethics and patient autonomy: respecting the autonomy of someone who is still forming judgment requires more listening, not less.

Warning signs in the consultation

Some patterns appear often in requests that deserve a refusal or a pause.

When these signs appear, it is worth considering the possibility of body dysmorphic disorder. See body dysmorphic disorder in HOF. The conversation with the patient is in saying no to the patient with dysmorphia and, for referral, in when to refer to psychology.

When refusal is the safest answer

The final decision is clinical and should rest on criteria you can explain. In general, refusal is the safest course when:

• the request is purely cosmetic and the face is still changing;
• the concern is not borne out by the exam (the flaw is minimal or nonexistent);
• there are signs of relevant psychological distress tied to appearance;
• the procedure carries a risk the young person cannot weigh;
• the teenager shows no will of their own;
• your professional council's rules or the law do not allow it, or there is doubt about it;
• the guardians ask for something you do not consider indicated.

There are specific clinical situations, such as asymmetry from trauma or conditions with a medical indication, that follow another logic and call for case assessment and, often, a multidisciplinary team. In those, the professional must act according to their professional council's rules and the documented need.

How to conduct the conversation

The consultation with a teenager usually works better in two parts: one conversation with the young person and another with the guardians, when appropriate and with everyone's knowledge. Some practices:

1. Start by listening. Ask what bothers them, since when and what happened for the concern to arise now.
2. Show what you observe in the exam, calmly, without belittling the concern or confirming flaws.
3. Explain facial development in simple words.
4. Present alternatives: follow-up, skin care, dental or orthodontic guidance, other professionals.
5. Talk about risk without drama, and make clear that injectables are not "without consequences."
6. Arrange another conversation, if it makes sense.

For the parents or guardians:

When the indication is different

There are contexts in which the approach changes: a documented medical indication, a disease or condition affecting the face, or a situation already followed by other professionals. The reasoning shifts from "cosmetic" to "therapeutic," but it never dispenses with documentation, guardian consent and acting according to the council's rules. In case of regulatory doubt, the prudent attitude is to consult your professional council, not to improvise.

Records and image protection

Record the concern in the patient's own words, the exam, the decision made and the reason, the instructions given and what was agreed with the guardians. Images of minors deserve extra attention: see image authorization for minors and consent and LGPD in photos. Minors' data have special protection under the LGPD (Brazil's data protection law), and use in advertising must follow what you may publish. The general record is in patient records and documentation in HOF.

Where Harmy comes in

Frequent mistakes in care

1. Accepting the first justification. "My daughter suffers a lot" is a data point, not an indication. Listen, examine and only then decide.
2. Declining without explaining. A curt "no" pushes the teenager toward someone who will agree to do it. Explain in simple language and leave the door open to talk.
3. Using the simulation as a sales argument. Showing "how it would look" to someone who is forming their self-image can reinforce the idea of a flaw.
4. Seeing the patient without the guardian when the rule requires it. Check what your council and the law ask for and do not improvise.
5. Forgetting the record. Declining is also a clinical act, and the chart should include the concern, the exam and the reason.

What you can offer instead

Declining the procedure does not end care. Depending on the case, the professional can:

• advise on basic skin care, sleep and nutrition;
• refer for dental or orthodontic assessment, when there is a functional component;
• suggest psychological support, delicately, if the distress is disproportionate;
• propose a new conversation later on, with the guardians and the teenager, without promising the procedure.

This stance is usually remembered by the family with respect and protects you from decisions the patient may later regret.