John, 43 years of age.

He would like to look younger, and get rid of the wrinkles on his face, and soften the line between the nose and the corner of the mouth. 

John approached me via email. His main concern was wrinkles on his face as he had recently got a new younger partner who teased him. He was not using any skincare regime. He wanted a consultation via email. I asked him to send me photos of his face and fill in a form his general health, medication and allergies. When I had received the information we “discussed” via 2 or 3 emails the options for treatment, the cost and the time it would take for each treatments. 

Taking all his concerns into account I advised him about daily care for superficial wrinkles and the skincare regime using SPF creams, anti-aging products. We then discussed different methods of reducing wrinkles, using homecare kits, beauty salon treatments and medical treatments: and agreed on a course of skin peeling treatment and if this did not work, lasering of the wrinkles using the Fraxel system. I advised him as to where he could get these treatments and how much he should expect to pay. 

For the naso-labial lines I suggested some different fillers and recommended a couple of good practitioners and the cost. I warned him there  be a need for repeat treatment as the fillers last for a limited time. We also agreed that the frown line between his eyebrows could be improved with Botox treatment. 

After the consultation John felt that he was able to make an informed decision about the treatments he would like to pursue and he was happy to start with the daily care routine. We selected the centres where he was going to go for further treatment. 

John emailed me a month after this - he had started on treatment and felt confident that he had made the right decisions and was getting the very best cosmetic treatment available.

Maria, 22 years old, living in London

She would like breast implants to enlarge her A size breasts.

Maria contacted me by email saying that she has decided to have breast augmentation surgery and wanted information about the procedure and how to find a good surgeon.

She chose to have the next consultation on the phone. We agreed on a time and had a phone consultation that lasted about 45 minutes. 

During this time we discussed her reasons for deciding to have surgery. I advised her about the non-surgical “alternatives” such as padded bras, Wonder bra etc. She had tried these and found them unsatisfactory. I explained to Maria that in the UK there were two main types of implant - silicon and saline. We went through the pros and cons, and prices of each. We also discussed the positioning of the implant - over or under the chest muscle; the location of the incision - under the breast, around the nipple, through the umbilicus or armpit. I advised her how these questions should be discussed with the surgeon and how the best choice depend on the size symmetry and anatomy of the breast. 

I asked her about her general health, previous illnesses and medication so that I could estimate the risks of any surgical procedure, the types of anaesthesia etc. I advised her to stop smoking before the operation and the various resources she could use to help her give up. We also talked about the arrangements she would need to make before operation in order to help her recovery. I explained the usual amount of time needed off work and the physical restrictions required after surgery. She asked me about the amount of pain she would experience and how it could be controlled. I explained about the dressing that she would need after operation and the best bra to wear in the weeks following the operation. I warned her of the possible need for future breast surgery as time passes by, due to sagging, change in breast shape or capsular formation ( hardening around the implant). I gave Maria  a couple of website addresses that she might find useful regarding the type of implant, or find out about  other people’s experiences. 

All of these issues would need to be discussed again at the consultation with her surgeon but Maria felt she would be able to get more specific information from her surgeon having talked to me. We went through what to look for when choosing the clinic. Maria asked me if I had any surgeons to recommend and I was in the position to suggest a couple of names. Maria arranged the consultation but it was her final choice of who to go to. 

Maria found my consultation useful in that I was able to address some issues that she was not familiar with concerning breast augmentation. She felt more confident in her ability to assess the suitability of the surgeon for her needs. 

Maria emailed me a month later saying that she was very happy with her choice of the surgeon for the procedure, she had the breast augmentation and she felt more confident about herself now that she finally “ has boobs” which she could be proud of.