How I Decide What to Recommend – And What I Leave Out
A good treatment plan isn't just about what to recommend - it's about what to leave out. Dr Chia Min Shan on the clinical reasoning behind every recommendation, why less is usually the better starting point, and what a clear brief makes possible.
She sat down and said -
"I want to look better. But I want to look my age. I don't want to look like I've had anything done."
Honestly one of the most refreshing things a patient has ever said to me.
No chasing youth. No dramatic transformation. Just - healthy, rested, appropriate for who I am right now.
That brief is so much easier to deliver than "make me look ten years younger." And the result is always more natural. Because the goal is clear, the constraint is clear, and everything that doesn't serve both gets left out.
Most consultations aren't that clean. But her clarity is a useful frame for how I think about every recommendation I make - and perhaps more importantly, everything I choose not to recommend.
What I'm Actually Assessing
When a patient sits down, I'm looking at several things simultaneously before I say anything.
Skin quality first. How does the surface look - texture, tone, hydration, any pigmentation or redness. How does the skin behave when it moves. Is the dullness coming from surface accumulation, dermal dehydration, or deeper structural changes. This tells me whether skin quality treatments need to come before anything structural.
Then structure. Where has volume been lost and where has it descended. Is the jawline softer because of volume loss, skin laxity, or both. Are the nasolabial folds deeper because the mid-face has flattened, or because the skin has lost elasticity. These distinctions determine whether filler, a collagen stimulator, an energy device, or a combination is the right answer.
Then proportion. Before recommending anything, I want to understand whether what the patient is noticing is actually disproportionate, or whether it's a natural feature of their face that treatment would disrupt rather than improve. Not everything that bothers a patient needs to be addressed. Some things are simply part of how they look - and the right answer is to say so.
What Gets Left Out
This is the part of the consultation that rarely gets discussed - but I think it's as important as what gets recommended.
I leave out treatments that address concerns the patient hasn't mentioned and doesn't seem bothered by. Pointing out things a patient hasn't noticed and then offering to fix them is not good medicine. It's a sales technique dressed as assessment.
I leave out treatments that would require significant ongoing commitment without clear benefit relative to simpler alternatives. If a patient's concern can be adequately addressed with one well-placed treatment, recommending a multi-step protocol doesn't serve them.
I leave out treatments where the timing is wrong - where a previous treatment is still developing, where the skin quality foundation isn't ready to support a structural result, or where the patient is still deciding what they want.
And I leave out anything that would produce a result inconsistent with how the patient actually looks - treatments that would make them appear to have had something done when they've specifically said they don't want that.
Why Less Is Usually the Better Starting Point
Aesthetic medicine is reversible to a point - hyaluronic acid fillers can be dissolved, botulinum toxin wears off - but some changes are harder to undo than others. And more importantly, a patient who leaves with a result that's slightly more subtle than they expected can always return for more. A patient who leaves with a result that's more than they wanted has a more complicated path back.
Starting conservatively, reviewing the result, and building from there is a more reliable route to a patient who's happy long-term than doing everything at once and hoping the calibration was right.
The 50-year-old who wanted to look her age taught me something I already knew but she said better than I had. The brief shapes everything. When you know what you're trying to achieve - and what you're deliberately not trying to achieve - every decision in the treatment plan becomes simpler.
At mt clinic at Journey Aesthetics, the consultation is where that brief gets established. Everything else follows from it.
Dr Chia Min Shan is the Medical Director of Journey Aesthetics Medical Clinic in Katong, Singapore. She specialises in skin quality, facial aesthetics, and natural-looking results using treatments including botulinum toxin, dermal fillers, skinboosters, polynucleotides, Ultherapy Prime, Volnewmer, Fotona 4D, and Corage 2.0. Every treatment plan she creates is built around a thorough consultation - because understanding what a patient actually wants is where good aesthetic medicine begins.