What a course actually involves

3.1.1The consultation

A proper consultation happens before any product is opened and ideally not on the same day, so that you have time to think without a treatment room booked. It should cover your medical history, what you are hoping for and whether that is a realistic aim for this treatment, the product to be used, the areas proposed, the realistic range of outcomes including no visible change, the risks and what would be done about each, the absence of a reversal agent, the total cost of the whole proposed course, and what happens if you stop partway.

The chapter on deciding covers this in full, including what a good consent process looks like. The point to carry into this article is that a consultation which begins with a product and a price rather than with a history and an aim has already inverted the order.

3.1.2A session, step by step

1. Photographs. Good practice is standardised images before treatment, at consistent distance, angle and lighting. These are for the record and for your own assessment later, and you are entitled to ask for copies.
2. Cleansing and preparation. The skin is cleaned and an antiseptic applied. This is not a formality; it is the principal defence against introducing organisms into the dermis.
3. Anaesthesia. Topical anaesthetic cream is usual and needs time to work, which is why the appointment is longer than the injecting. Some practitioners use additional measures.
4. Injection. Multiple small deposits placed across the area, or a linear threading technique, depending on the practitioner and the area. The material is placed in or just beneath the dermis rather than deep.
5. Immediate aftercare. Pressure, cooling if appropriate, and a review of what to expect and what to do if something happens.
6. Instructions and contact. Written aftercare, and a named route to reach someone including out of hours. If that route does not exist, the treatment is not being provided to an adequate standard, whatever else is true about it.

3.1.3Why sessions are spaced as they are

The stated rationale is that a course delivers repeated stimulus at intervals that allow the tissue to respond between treatments, and that the effect is cumulative. That is a coherent rationale. It is also, as far as we can establish, untested: we are not aware of studies comparing different intervals or different numbers of sessions against each other in a way that would establish an optimum.

The practical consequence is that when a clinic tells you the interval is important, they are relaying a protocol rather than reporting a finding. Protocols are not worthless. Following the manufacturer's instructions for use is the correct default and a practitioner who departs from it should have a reason. But a protocol should be described as a protocol.

3.1.4The number of sessions, and the commercial pressure on it

Courses are commonly sold as a package at a discount to the per session price. This is standard commercial practice across many services and there is nothing improper about it in itself. It does create a specific pressure worth naming: you are being asked to pay in advance for treatments whose value you cannot yet assess, and the discount is the mechanism that makes committing feel rational.

Two protections are worth having. Ask what happens if you decide to stop after the first session, and get the answer before you pay. Ask whether the package price is refundable in part, and whether there is a time limit on using the sessions. Consumer protection law gives you rights in relation to services that are not carried out with reasonable care and skill, and Citizens Advice publishes accessible guidance on where those rights begin and end.

3.1.5Maintenance

After the initial course, a maintenance schedule is generally proposed. The rationale is that the effect fades and needs topping up. Whether the recommended maintenance interval reflects anything measured is the same question as before, and the answer is the same.

There is a structural point here worth stating plainly. In a category where the duration of effect has not been established, a maintenance schedule is a commercial arrangement that happens to be described in clinical language. It may well be clinically sensible. It has not been shown to be, and the interval proposed is not derived from measurement of how long anything lasts.

The reasonable patient response is not refusal but observation. Have the initial course, take standardised photographs, wait, and decide from what you actually see whether and when you want more. That puts the decision where the information is.

3.1.6Combining with other treatments

Clinics frequently propose polynucleotides alongside other injectables, energy based devices or skincare, either in the same session or in a sequence. Clinically this can be defensible. Evidentially it is a problem for you, because a combined plan makes it impossible to know what did anything, and you will be asked to pay to repeat all of it.

If you are being offered a combined plan, it is reasonable to ask what the sequencing rationale is, whether the elements could be separated in time so that you can tell them apart, and what would be lost by doing so. A practitioner who has thought about it will have an answer about tissue response and healing intervals. A practitioner who has not will have an answer about efficiency.

3.1.7What the session actually feels like

Multiple small injections into facial skin, with topical anaesthetic, are uncomfortable rather than painful for most people, and the discomfort varies enormously by area. Periorbital and perioral skin is more sensitive than cheek skin. The sensation is usually described as stinging, with a pressure feeling as the material is deposited.

You are allowed to stop. Saying that you need a moment, or that you would like to stop and think, is always available to you, and a practitioner who makes that difficult has told you something important. Consent is continuing rather than a signature at the start, and professional guidance on consent is explicit that a patient may withdraw it at any point.