Findings the patient did not ask about: how they enter the plan
Quick facts
- Goal
- Decide, with sound criteria and without causing embarrassment, what to do with what you see beyond the patient's request
- Three outcomes
- Record and say nothing, mention without adding to the plan, or mention and add to the plan
- Golden rule
- The patient's concern comes first; a finding only enters the plan if they agree
- Attention
- A clinical finding that suggests disease calls for a referral, not an aesthetic procedure
Every HOF (orofacial harmonization) professional has lived this scene: the patient comes in asking about the lips, and during the analysis you see folds, a recessed chin, a contour asymmetry or under-eye hollows they never mentioned. The question that follows is one of ethics and communication: what do you do with what you saw and they did not ask about?
The answer is not "always tell" or "never tell". It is a set of criteria, applied case by case, with three possible outcomes for each finding. This page lays out those criteria. For the analysis that produces the findings, see facial analysis in HOF: step by step.
What counts as an unrequested finding?
It is anything your assessment turns up beyond the patient's concern that could, in theory, enter the plan. They fall into three families, because each calls for a different approach.
| Family | Examples | General approach |
|---|---|---|
| Aesthetic and affects the result of the concern | Recessed chin that makes the lip look larger; a fold that gives a tired look | Mention it, because it changes the result in the requested area |
| Aesthetic and independent | Mild under-eye hollow, slight contour asymmetry | Record it; mention only if the patient opens the door |
| Clinical or health-related | Skin lesion, lump, new asymmetry, signs of systemic disease | Record and refer; do not treat with an aesthetic procedure |
Why can't you ignore everything?
Staying silent about something relevant can be as problematic as overdoing it. An enlarged lip on a face with a very recessed chin can worsen the profile, and the patient will blame the procedure, not the missing warning. On the other hand, talking about everything turns the consultation into a list of flaws and hurts the self-esteem of someone who came in with a simple concern.
What criteria decide whether the finding enters the plan?
Use four questions, in order. If the answer to the first is "yes", you go straight to mentioning it; if "no", move to the next.
- Does it change the result of what the patient asked for? If so, it is relevant enough to mention.
- Is there a health risk or a sign of disease? If so, the outcome is a referral, and the aesthetics wait.
- Has the patient shown discomfort about it, even without words? Looking in the mirror, touching the area or turning the face away in the photo are signs. If so, open the conversation.
- Is it a normal variation that only a trained eye notices? If so, record it and move on. Not every difference is a problem.
How do you mention it without causing embarrassment?
Language makes all the difference. Instead of "you have a double chin", prefer "in the profile view you can see the chin contour has little support". Describe the structure, not the judgment.
Show the photo, never the mirror, because a standardized photo lets you point things out calmly. Guidance on photos is in standardized clinical photography. Ask before explaining: "had you already noticed this?". The answer shows whether the topic is new or already bothers them.
What about the professional who sells off the back of a finding?
There is the opposite risk: turning a finding into a sales pretext. Some signs you may be crossing that line: creating urgency, mentioning a discount for "adding one more area", talking about the flaw more than the benefit, or pressing after a "no". The short-term gain is lost in trust. The ethical discussion of quoting is in linking the plan and the quote in HOF.
When should you record and not mention?
Some findings deserve a record and silence. A slight eyebrow asymmetry, which everyone has, or a subtle difference in tone between the sides, does not need to become a conversation. But record it in the patient chart, because:
- if the patient later complains about a "new asymmetry", the record shows it was already there;
- comparing follow-ups needs an honest baseline;
- if the asymmetry progresses, the chart shows since when.
The idea of a baseline is in new asymmetry over the course of the plan.
What if the finding is a sign of something else?
Skin changes in color or shape, lumps that were not there before, an asymmetry that appeared suddenly, persistent swelling or systemic complaints are not aesthetic findings. The approach is to record it, tell the patient calmly, recommend a medical assessment and postpone any procedure in that area until it is clarified.
Do not diagnose in an aesthetic consultation. Describe what you saw and advise seeing the appropriate professional.
How do you add a finding to the plan if they accept?
If the patient agrees to treat what they had not asked for, treat it as a new item in the plan, with every step: explanation, alternative, volume, cost and consent. Do not "tack it on" in the same session without specific acceptance.
| Step | What to do |
|---|---|
| Explain | Show the finding in the photo and the expected effect, without promising results |
| Offer an alternative | Treat now, treat later or do not treat |
| Record the acceptance | Note it in the plan and in the informed consent, with the date |
| Requote | Update the quote and confirm it with the patient |
| Simulate | In Harmy, mark the additional area and generate a new projection, so the patient sees what changes |
Formal acceptance of the plan is covered in patient approval of the plan.
Myth or fact?
Summary
- An unrequested finding has three outcomes: record, mention or add.
- Four questions decide: does it affect the concern, is there a risk, is there a sign of discomfort, is it a normal variation.
- Talk about the structure, show the photo, ask before explaining.
- Adding to the plan only with acceptance, an explanation and a new quote.
- A sign of disease means a referral, not a procedure.
Frequently asked questions
Should I tell the patient about something they did not notice?
When it is relevant to the result or to their health, yes, in a neutral way and without pressure. Flaws that only the professional sees and the patient does not care about can simply be recorded.
Can I add an area to the plan that the patient did not ask for?
Only with their consent, after explaining the reason, the alternatives and the cost. Adding it without a conversation breaks trust and raises the risk of dissatisfaction.
How do I avoid looking like I am inventing a problem to sell more?
Present the finding as a clinical observation, show the photo, offer the option of not treating, and never tie the suggestion to a discount or a package.
What if the finding looks like a disease rather than an aesthetic issue?
Record it, advise the patient to seek a medical assessment, and postpone the procedure in that area until it is clarified. Skin changes, new asymmetries and lumps fall into this category.
Harmy images are illustrative simulations generated by AI from the patient's photo to support the conversation between practitioner and patient. They are not a promise of results. Indication, technique, product and volume are solely the decision of the licensed practitioner. This content is for information only and does not replace a clinical assessment.