A signed form is not consent. It is evidence that a conversation may have happened. The conversation is the thing that protects the patient, and by extension you, and it has a shape worth learning.

The legal position in the UK shifted with Montgomery in 2015. Before it, the question was broadly what a responsible body of practitioners would have disclosed. After it, the question is what this particular patient would want to know. That is a meaningful change. It means a risk that is statistically small can still be material if it matters to the person in front of you. A visible bruise is a minor risk in general and a serious one for someone with a wedding on Saturday. You are expected to find that out.

So the conversation starts with them, not with you. What are you hoping this will do. What is the occasion, if there is one. Have you had anything before, and how did it go. People will tell you things in response to open questions that they would never volunteer against a checklist.

Then the risks, and here the temptation is to soften. Resist it. Say the word bruising. Say swelling, asymmetry, lumps, infection. For anything involving filler, say that in rare cases the product can enter a blood vessel and cause tissue damage or, very rarely, affect vision, and say what you would do about it. Practitioners worry that this frightens people off. In practice it does the opposite more often than not, because patients can tell the difference between someone who is comfortable discussing risk and someone who is skating past it.

Cover the alternatives, including doing nothing. This is the part most often skipped and it is explicitly part of a valid consent process. Sometimes the honest answer is that the thing bothering them will not be much improved by what they are asking for, and that a different treatment, or none, is the better call.

Give the money and the aftercare in the same breath. What it costs, what happens if it needs adjusting, whether a review is included, and what you charge if they want more later. Financial surprise is a common route from mild dissatisfaction to formal complaint.

Then leave a gap. For anything irreversible or expensive, a cooling off period between the consultation and the treatment is good practice, and for some procedures it is expected. A patient who has slept on it is a better patient.

When you write it up, write what was actually discussed rather than a template. Two lines in the patient's own words are worth more than a page of boilerplate. If they said they were worried about looking overdone, record that. If they mentioned the wedding, record that. Notes that sound like a real conversation read as a real conversation, and notes that sound generic read as generic.

At the end, ask what questions they have, and then stop talking. Three seconds of silence feels a lot longer than it is, and that is usually when the question they actually came in with arrives.