Client Consultation, Skin Analysis, and Treatment Planning
The consultation arc
A defensible consultation moves through intake form, medical history, visual and tactile analysis, goal setting, plan, consent, and documentation. The intake is your first screen: pregnancy or nursing, isotretinoin use, photosensitizing medications, anticoagulants, autoimmune disease, diabetes, active infection, recent surgery or injectables, keloid tendency, herpes labialis history, and allergies. Absence of a documented answer is not the same as a negative answer.
Analysis tools
Use magnification and lighting, palpation for texture and oiliness, and a Wood lamp where appropriate. Under Wood lamp, normal skin reads blue-white, thickened keratin reads white, oily areas read yellow, dehydration reads violet, epidermal pigment reads brown, and coral-red fluorescence suggests porphyrins from acne bacteria. Fitzpatrick skin typing, I through VI, drives device and peel selection; the Glogau scale describes photoaging. You may describe what you see, but you may not diagnose. Any lesion that is asymmetric, has irregular borders, varied color, is larger than a pencil eraser, or is changing gets referred, not treated.
The plan
Write measurable goals, a service sequence, intervals, home-care instructions, and review dates. Typical intervals: superficial peels every two to four weeks, microneedling every four to six weeks, laser hair reduction every four to eight weeks by area. Patch test actives and always price and schedule realistically.
Traps: promising to cure rosacea, melasma, or acne; treating a suspicious mole; skipping consent because the client is a regular; typing skin by hair color alone. Rule of thumb: if you would not write it in the chart, do not say it in the room. Document in SOAP format - subjective, objective, assessment, plan.