Who is a poor candidate
The most useful thing a practitioner can say is no. This article sets out the circumstances in which that is the right answer, so that you can recognise a consultation that reaches it and one that does not.
Treatment should be delayed or declined where there is active infection at or near the site, active inflammatory skin disease in the area, an unexplained new skin lesion, uncontrolled systemic illness, or a recent or planned dental or surgical procedure that would place the tissue under strain. Pregnancy and breastfeeding are conventional reasons to defer, on the basis that safety in those circumstances has not been established rather than that harm has been shown.
Beyond the clinical list there is a second category that matters as much: people whose expectations cannot be met by this treatment, people under pressure from someone else, people with a body image concern that treatment will not resolve, and people who cannot make an unhurried decision. A practitioner who only screens for the first list is doing half the job.
4.1.1Clinical reasons to delay or decline
Active infection
Any active infection at or near the treatment site is a reason to wait. Injecting through or near infected tissue risks spreading it into the dermis and deeper. Cold sores in the perioral area deserve specific mention, because injection can provoke a recurrence in someone prone to them, and this should be discussed at consultation rather than discovered afterwards.
Active inflammatory skin disease in the area
Eczema, active acne, psoriasis or dermatitis in the treatment field changes both the barrier and the tissue response. Waiting for the skin to settle is the ordinary answer.
An unexplained skin lesion
A new, changing or unexplained lesion in the area should be assessed on its own terms before anyone injects anything nearby. The NHS and the British Association of Dermatologists both publish guidance on what warrants assessment. A cosmetic consultation is an opportunity to catch this, and a practitioner who notices and refers has done something more valuable than any treatment.
Uncontrolled systemic illness
Elective cosmetic procedures are for people who are well. Uncontrolled diabetes, an active flare of an autoimmune condition, or any acute illness is a reason to postpone.
Bleeding disorders and anticoagulation
Not an absolute barrier, but a conversation. Anticoagulant and antiplatelet medication increases bruising, and prescribed medication must never be stopped or altered for a cosmetic procedure without the advice of the prescriber.
A history of keloid or hypertrophic scarring
Multiple punctures in someone prone to abnormal scarring warrants a discussion about risk in the specific area.
Recent or planned procedures in the area
Dental work, surgery, or other injectable treatment nearby changes the local tissue environment and the timing needs thought.
4.1.2Pregnancy and breastfeeding
The standard position across aesthetic medicine is to defer elective injectable treatment during pregnancy and breastfeeding. It is worth being precise about the reason, because patients are often given a vague answer that sounds like a warning about harm.
The reason is that safety in pregnancy and breastfeeding has not been established for these products, because studies in pregnancy are not conducted for elective cosmetic interventions and would not be ethical to conduct. That is an absence of evidence rather than evidence of risk. It is nonetheless the right basis on which to defer, because there is no clinical need being served and no reason to accept an unquantified risk for a cosmetic aim.
4.1.3Autoimmune conditions and immunosuppression
This is an area where practitioners differ and where the truthful answer is that it depends on the condition, its activity, the medication and the individual. An injected foreign material provoking a tissue response, in someone whose immune regulation is already atypical, is a reasonable thing to think carefully about. Someone taking immunosuppressive medication has a different infection risk profile from someone who is not.
The correct route is a conversation involving the clinician who manages the condition, not a decision made in an aesthetic consultation on the basis of a form. A practitioner who asks about autoimmune conditions and then proceeds without engaging with the answer has treated the form as the safeguard.
| Circumstance | Usual position | What should happen |
|---|---|---|
| Active infection at or near the site | Defer | Treat the infection, reschedule |
| Active eczema, acne or psoriasis in the area | Defer | Let the skin settle first |
| New or changing skin lesion | Assess first | Referral for assessment before anything cosmetic |
| Pregnancy or breastfeeding | Defer | Explained as absence of data, not demonstrated harm |
| Prescribed anticoagulation | Proceed with discussion | Never alter prescribed medication for a cosmetic procedure |
| Autoimmune condition or immunosuppression | Individual decision | Conversation involving the clinician managing the condition |
| History of keloid scarring | Individual decision | Specific discussion about the area |
| Expectations this treatment cannot meet | Decline | Say so plainly and explain what would address the aim |
| Pressure from another person | Decline | Consent is not free in these circumstances |
| Under eighteen | Decline | See the regulation chapter |
A framework written by this publication to organise a decision. It is not a measurement, it is not drawn from any study, and no figure in it should be quoted as a finding.
4.1.4The second list
These reasons to decline are not medical and they are at least as important.
Expectations the treatment cannot meet
Someone seeking volume, contour change, removal of a structural shadow, or the elimination of established deep lines is asking this treatment to do something it is not aimed at. The right response is to say so, not to treat and hope.
Pressure from another person
A patient attending because a partner, a parent or an employer wants them to is not giving free consent in any meaningful sense. This is not rare, and a practitioner should be alert to it.
Body image concerns that treatment will not resolve
Where a person's distress about their appearance is disproportionate to what is observable, or where previous treatments have repeatedly failed to satisfy, treating again is unlikely to help and may compound. Professional guidance on cosmetic practice specifically requires practitioners to consider psychological factors and to be prepared to decline. The NHS publishes information on body dysmorphic disorder, and recognising the pattern is a clinical skill rather than a judgement about a person.
An inability to decide unhurried
Same day treatment after a first consultation, discount pressure, and a limited time offer all work against considered consent. A person who cannot take time away from the clinic to think should not be treated that day.
Under eighteen
Legally straightforward for the relevant categories in England, and covered in the regulation chapter. Ethically straightforward regardless of the legal detail.
4.1.5What a good screening conversation looks like
It asks about medical history in specifics rather than as a tick list, and follows up on answers. It asks what you want and why, and asks what would count as this having worked. It asks whether anyone else is involved in the decision. It states plainly which of your aims this treatment can and cannot address. It offers you time. And it is capable of concluding that the treatment is not right for you.
The clearest signal of a practice worth trusting is that it turns people away. If you ask a practitioner when they last declined to treat someone and they cannot think of an occasion, that is an answer.
4.1.6If you are unsure whether you are a candidate
Ask directly. Given what I have told you, is there any reason I should not have this, or should wait? The question invites a specific answer and it is difficult to answer well without engaging with your history. Follow it with: what would make you decline to treat someone? The two together are one of the most efficient assessments of a consultation available to a patient.
Questions
Can I have this while pregnant or breastfeeding?
The standard position is to defer, and it is the right one. The reason is that safety in pregnancy has not been established for these products, because such studies are not conducted for elective cosmetic treatment. That is an absence of evidence rather than a demonstrated risk, and there is no clinical need being served in the meantime.
I have an autoimmune condition. Am I excluded?
Not automatically, and not automatically included either. It depends on the condition, how active it is, what medication you take and your own circumstances. The right route is a conversation involving the clinician who manages your condition, rather than a decision made from a tick box on a consultation form.
I take blood thinners. Does that rule me out?
Usually not, but it increases bruising and it must be disclosed. Never stop or alter prescribed anticoagulant or antiplatelet medication for a cosmetic procedure without the advice of the doctor who prescribed it.
How do I know if my expectations are realistic?
Ask what would count as this having worked, and ask which of your specific concerns this treatment will not address. A practitioner who can name things it will not do is giving you a usable answer. One who says it will help with everything you have mentioned is not.
What if I feel pushed into deciding today?
Leave and think. Same day treatment after a first consultation, time limited discounts and pressure to commit all work against considered consent, and professional guidance on cosmetic practice contemplates time to consider as part of the process rather than as a courtesy.
- GMC, Guidance for doctors who offer cosmetic interventions
- GMC, Decision making and consent
- NHS, Cosmetic procedures
- British Association of Dermatologists
- Joint Council for Cosmetic Practitioners
- NHS, Body dysmorphic disorder
Links to regulators, professional bodies, legislation and research indexes. They are cited because they are public and checkable, not as endorsement of this publication. No source listed here has any commercial relationship with us.
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