What a ninety-minute consultation actually covers

Ninety minutes is an unusual length for a first aesthetic appointment. It is long enough that people occasionally ask whether we are padding it. We are not, and this is what the time is actually spent on.

The first twenty minutes: history

Not a form at reception — a conversation. Current medication, because a great many drugs affect skin and hair. Previous treatments, including the ones that did not work, which is often the most informative part. Family history. Sleep, stress and travel, because all three show up in skin. Whether you are planning a pregnancy, which changes what we can offer.

The next twenty: examination and imaging

Multispectral imaging photographs eight layers of your skin, including sub-surface pigment, vascular activity and accumulated UV damage that is not yet visible. It is routinely the moment a consultation changes direction — patients who came in about dullness discover they have significant sun damage; patients who came in about pigmentation discover the primary problem is a compromised barrier.

Where hair is a concern, this is when trichoscopy and the pull test happen. Where the body is, body composition analysis.

The next thirty: the actual discussion

This is the part that cannot be compressed. What is driving the thing you dislike. What can realistically be changed and by how much. What sequence makes sense, because order matters — barrier before resurfacing, diagnosis before injection. What each step will cost and how long it will take. And, frequently, what we would advise against and why.

Roughly one consultation in six here ends with a recommendation against treatment. That conversation takes time too, and it is not one we would rush.

The last twenty: home protocol

What you do daily matters more than what we do monthly. So we go through what you are currently using — bring it with you — and rewrite it into something short enough that you will actually follow it. Usually that means removing things rather than adding them.

And then, within forty-eight hours

A written plan arrives: sequence, session count, intervals, expected timeline, downtime for each step and the total cost. Fixed for ninety days. Nothing revised mid-course, and if the plan needs fewer sessions than quoted, you pay for fewer.

You are under no obligation to book anything. A meaningful number of people take the plan away, think about it, and come back a year later. That is entirely fine.