All processes and aspects of consultations between the patient and the doctor must be documented and stored in the patient’s records. A detailed record of the patient’s treatments must contain their medical history and examination results which could include the area, material and substance mixture and injection technique.
All examination results from the first consultation should be recorded visually and in written form detailing the measurements and facial images for future verification of the treatment. All signed consent forms and treatment cost agreements along with any investigative biopsies (which are rare in aesthetics) should be carefully filed in the patient’s records for at least a period of ten years.
Advice: Always hand over the ‘before’ picture to the patient so they have a reference point of how the treatment is progressing and is a good example to judge the changes in hair and skin.