It is paramount that a pre-treatment asymmetry is considered before advising or following any diagnosis. Your pre-treatment photos will be a vital tool in doing this. Consider whether the patient’s reaction to it is disproportionate or not. This must be done first, before anything else, otherwise you risk making matters worse should you offer further treatment.

Patient diagnosis of new asymmetry from the procedure is very common, irrespective of it being there pre procedure. This is likely attributed to a patient anticipating the results of the treatment daily, giving close inspection to their face in a way they likely have not done before.

Using the five factors above, you can methodically establish which is responsible for the patients complaint of asymmetry.

PRECEDING CLINICAL PROCESS, IN PLACE BEFORE TWO WEEK REVIEW

• Begins at consultation stage. Thoroughly assess all of the facial anatomy looking for existing asymmetry, scan for differences in lines and wrinkles from one side to the other and be inclusive of all anatomy: fat pads, bone, teeth, muscle, skin.
• Point these out to the patient at consultation before you have treated them, it is common for patients to notice all kinds of anomalies on the face that have been there for years but will only notice after treatment and think are because of it.
• Photographs: muscles at rest and under traction and movement, ensure good lighting so the skins surface can be seen also. Use as a base line, repeat photos on patients return and compare if they have complaints
• Take photos of injection points to note how treatment may have affected result