Recording Deviations from the Plan During the Session

No facial harmonization plan survives first contact with real tissue intact. You plan 2 ml in the cheekbone and, in the session, the response or the anatomy calls for 1.5 ml. You meant to treat three areas and, midway, decide to leave one for the next stage. These adjustments are part of good practice, but they only become good practice when they are recorded. This page is about how to note a change of decision at the moment it happens.

What is a plan deviation?

It is any difference between what was agreed and what was done: an extra or missing area, a different volume, a change of order, a different technique or product than planned. A decision not to inject something that was in the plan also counts as a deviation. A deviation is neither good nor bad in itself. The problem appears when it happens without explanation, and afterward you cannot say why you decided what you decided.

Comparing planned ml and ml used depends on exactly this record. Without it, the difference becomes noise.

Why note it on the spot?

Memory of a consultation fades fast, especially on days with many patients. What seemed obvious at 10 a.m. is hazy by 6 p.m. Immediate recording also sharpens your reasoning: writing down the reason tests whether the decision holds up. And if the patient returns with a complaint, the note shows the change was thought through.

What should you note for each deviation?

Four pieces of information are enough: what changed, relative to what, why it changed and whether the patient was informed. Here is a pattern for the patient record.

The "Pending for follow-up" field is the most useful later: it turns the deviation into a future action, such as "reassess the cheekbone in 30 days and decide whether to complete the volume."

Which deviations happen most?

The "what to note" column is the one that protects you. A safety interruption, for example, should be described precisely: when it began, what you observed, what you did and what you advised. See also contingency plan in facial harmonization.

When does a deviation require a new conversation?

Some changes call for a pause and dialogue before continuing. New areas, volumes well above what was agreed and a change of goal are on that list. The patient consented to a plan, and a substantial change alters what they consented to. Stopping, explaining, showing the reason and resuming with their agreement is the safest and most respectful path.

When the deviation is small and within the plan's margin (for example, 0.5 ml less), informing the patient is usually enough, as long as the original consent provides that the final volume is decided in the session. Check the wording of your consent form and your council's rules. To structure this conversation, see adjusting the plan based on patient feedback.

How does the record feed into reassessment?

At the follow-up, open the plan, the simulation and the deviation sheet side by side. The question stops being "did the result match the image?" and becomes "what was done, relative to what was planned, and how did the tissue respond?" That reading is more honest and protects the relationship with the patient. Combine it with what to reassess at the plan follow-up and reassessment at 3, 6 and 12 months.

And where does Harmy fit in?

In the app, the plan starts on the planning screen, with ml per area and intensity. Use the projection as a baseline and, after the session, record in the patient record what was actually done. If the volume changed significantly, create a new projection with the actual values and keep both in History: that way the comparison with the actual result stays coherent.

The projection is an illustration created before the session and does not predict what the tissue will do. That is why the recorded deviation is the bridge between the image and reality. See limits of 2D simulation.

What recording culture supports all this?

Recording deviations only works when the professional feels safe writing what they really did. If a note is seen as a confession, people soften the text or leave gaps. A healthy culture treats a deviation as clinical information: "I changed because the tissue responded this way." In clinics with more than one professional, it is worth agreeing on a single sheet format, so any colleague can read the other's note. This also reduces errors when handing over patients, as in plan handover between professionals.

Another good practice is to review deviations together from time to time. If the same type of deviation keeps appearing, for example planning 2 ml in the cheekbone and always injecting 1.5 ml, the problem may be in the planning habit and not in the session. That feedback helps calibrate the next plan and ties in with the plan execution rate indicator. When the adjustment is systematic, it is worth revisiting the ranges you use as a starting point, as in ml per area: ranges in planning.

What to do when the deviation is a complication?

If the plan changed because of a complication, the note takes on a different weight: record the time, signs observed, action taken, instructions given and the follow-up agreed, without excessive interpretation. Reflection on the plan comes later. See replanning after a complication and communicating a complication to the patient.