Ethics of result simulation in facial harmonization

Simulation is one of the most persuasive tools the HOF practice has gained in recent years. That is exactly why it needs its own rules. A convincing image on a phone screen weighs more in the patient's decision than ten minutes of explanation, and that weight can be used to inform or to push. The difference between the two uses is ethical, and it is the responsibility of whoever holds the device.

This page gathers the limits that apply to any simulation, whether made in Harmy or by any other means: what it can and cannot represent, how to present it, how to protect the patient's data and when it should stay put away. It does not replace the rules of your professional council, which you should consult directly.

What is the legitimate role of simulation?

Simulation has two legitimate roles: helping the patient understand what is being proposed and helping the professional align expectations before any injection. In both, it is a conversation aid. It is not a diagnosis, not a contract, not a sample of what will happen.

Anything beyond this enters an ethical risk zone. The most common deviations are four:

1. Showing more than you would do. An exaggerated image seduces, and the patient starts expecting a result you never intended to deliver.
2. Using it as a sales argument. The simulation appears at the moment the patient hesitates, as a form of pressure.
3. Treating it as a promise. The phrase "it will look like this" turns an illustration into a commitment.
4. Advertising it as a result. The image leaves the office and becomes misleading advertising.

Which principles guide its use?

The principles below come from bioethics in general and apply well to simulation. They do not depend on the tool.

Patient autonomy is the core. Deciding without pressure means seeing the image with the right information: it is an illustrative simulation, the real result varies, and the patient can say no after seeing it. The general reasoning is in the bioethics entry.

How do you present it without steering?

How you speak changes the effect of the image. The same screen can sound like information or like a promise, depending on the sentence that comes with it. Two rules help:

• Describe, do not promise. "This image shows an approximation of what the planned volume can do" is a description. "You will look like this" is a promise.
• Show the limit along with the gain. Before turning the phone around, say what the image does not represent: texture, swelling time, movement, individual response.

The exact wording a clinic can use is in disclaimer text for illustrative simulation and the conversation with the patient in how to explain that the simulation is not a guarantee.

What about the patient's privacy?

A photo of the face is personal data, and facial analysis can generate facial biometric data. Under the LGPD (Brazil's data protection law), this type of data requires a clear legal basis and extra care. In practice, for simulation, this means:

• asking for specific consent for the photo and the simulation, in writing, before photographing;
• stating that the photo is processed by a third-party service when that is the case, and for what purpose;
• not sending the patient's image to anyone unless they ask;
• storing it in the patient record, not on a personal phone;
• deleting it when the patient requests it and the law allows.

The page consent and LGPD in photos covers the subject in detail, and simulation and informed consent shows how simulation fits into the document.

When should the simulation not be shown?

There are situations where showing the image does more harm than good. Think twice, and often keep the phone away, when:

• the patient is clearly distressed about their own appearance and asks for broad changes, which may indicate dysmorphia or body dysmorphic disorder;
• the expectation is already unrealistic and the image will reinforce it;
• the planned procedure does not show well in a still image (for example, changes in texture or skin quality);
• there is pressure from others or from a deadline, such as an upcoming event;
• the patient has not given clear consent for the photo.

The assessment of the case is yours. The page when simulation gets in the way of the plan lists signs, and when not to show the simulation covers the conversation.

What can leave the office?

The safest rule: the simulation does not leave as advertising. It is consultation material. To advertise a result, what counts is the real photo, with specific authorization for image use and within the rules of your professional council and CONAR, which change and should be read at the source. The page what you can advertise: CFO and CONAR covers the topic.

Even when the patient asks for the image for themselves, it is advisable to:

1. send the version with the simulation disclaimer visible;
2. state in writing that it is an illustration and does not promise results;
3. record that the image was delivered.

If they want to post it, talk about what that means: a simulation published by a third party, without context, circulates as if it were a result, and that can come back to you. The case appears in patient wants a screenshot of the simulation.

How do you record it?

The record is proof that the simulation was used honestly. In the patient record, note:

• that the simulation was shown and in what context;
• the disclaimer given to the patient;
• the areas and volumes it represented;
• the patient's reaction and decision;
• whether the image was delivered and in what format.

The step by step is in recording the simulation in the patient record.

Quiz: what would you do?

Summary

• Simulation serves to inform and align expectations, never to promise or pressure.
• The image must represent what you would actually do, with the limit said out loud.
• Photo and simulation need specific consent and data protection.
• A simulation is not a result and is not advertising.
• In dysmorphia or unrealistic expectations, showing may make things worse: assess first.
• Record in the patient record what was shown and said.