For licensed skincare professionals
Consultation and skin mapping
30 minutes. At the first appointment, and again at every fourth session.
The assessment that decides which protocol runs. No products are used and none are sold in this appointment. It is the half hour that makes the other twenty-one pages usable.
Who this is for
Every new client before any treatment is booked. Every returning client after three months, or after any change in routine, medication, climate or season. Every client at the start of a course and again at the mid-course review. Any client whose skin has stopped responding to something that used to work, which is almost always an assessment failure rather than a protocol failure.
Who this is not for, and where the remit stops
An aesthetician assesses how skin looks and behaves. That is the whole of the remit, and it is a real skill with real limits.
- Skin presenting acutely, meaning hot, painful, swollen, weeping or spreading, is not assessed. It is referred, that day.
- A client asking what their condition is called is asking for a diagnosis. You do not provide one, even when you are almost certainly right, and being right is exactly when the temptation is strongest.
- A client asking whether to continue a prescribed topical or oral medication is asking their prescriber, not you.
- A client asking whether to have a particular procedure is asking the professional who would perform it. The protocol is the treating professional's clinical decision.
Naming a condition changes what you are doing from assessment to diagnosis. Describing what you observe does not. "Diffuse redness across both cheeks, warm to the touch, present since March" is a professional record. A condition name is a clinical one.
Before you begin
Do not cleanse. The consultation happens on the skin as it arrives. Sebum distribution through the day, how makeup is sitting and where it has broken down, what the client actually applies at home and how much: the first cleanse destroys all of it, and it cannot be recovered later in the appointment.
Fix the conditions so that visit four is comparable with visit one. Same chair, same light, same distance, same time of day where possible. A consultation you cannot repeat is an opinion, not a record.
The assessment sequence
| Stage | What you do | What you record | What it tells you |
|---|---|---|---|
| 1. History | Ask, before looking: what changed, and when. Then current routine by product name and frequency, all oral and topical medication, prior professional treatments and dates, allergies and known INCI sensitivities, pregnancy or breastfeeding, sun and travel in the last month, hair removal, occupation and heat or air exposure, sleep and shift pattern. | Verbatim, with dates. | Most surface problems have a start date and a cause in the routine. The history finds them faster than the magnifier does. |
| 2. Unwashed observation | Look at the arrived skin from one meter, then at 30 cm. Both profiles. Then the neck. | Color distribution, shine and where it sits, visible texture, how makeup has broken down and where. | Baseline appearance and real-world behavior, available only now. |
| 3. Tactile | Clean hands, flat fingers, light contact. Roughness, temperature, resistance, and whether anything is tender. | Rough or smooth, warm or neutral, tender or not. | Tenderness is the single most useful finding in the whole assessment. It decides remit. |
| 4. Cleanse and wait | Cleanse with a neutral cleanser, blot, apply nothing, wait 10 minutes. Time it. Ask at minute 1, minute 5 and minute 10. | Time to first tightness. Where shine returns and when. | Tightness inside 2 minutes is a lipid picture. Shine returning at 10 to 20 minutes in the central panel only is a combination picture. |
| 5. Pinch test | Gently compress skin at the outer cheek and under the eye. | Whether fine accordion lines appear and how fast they release. | Lines that appear on pinch and vanish on release read as a water deficit, not aging. |
| 6. Zone mapping | Magnification, zone by zone: forehead left, center, right; glabella; nose; each cheek; perioral; chin; jawline; neck. | Texture, pore visibility, color, congestion, marks. One line per zone. | Concerns are almost never uniform. The zone map is what stops a whole-face protocol being run for a two-zone problem. |
| 7. Reactivity check | Note flushing during the appointment: after cleansing, after touch, after conversation. | Trigger, onset, duration. | Reactive-on-contact skin changes the intensity of every protocol you will run. |
| 8. Record and plan | Photograph at fixed distance and light, no flash variation, no makeup. Write the plan and the referral flags. Read the plan back. | Photos, plan, review date, client signature on the consent and disclosure. | The record is the only thing that makes session four a comparison rather than a memory. |
The one thing that determines whether a consultation is useful: you assess before you cleanse, and you write it down at the time. Everything diagnostic about how a client's skin actually behaves in their life is sitting on their face when they walk in, and the first cleanse removes it. A consultation done after cleansing describes a face you created.
The three distinctions that matter
| Looks like | Ask | Reads as | |
|---|---|---|---|
| Dry vs dehydrated | Dry: rough, dull, tight all over, worse in winter, present for years. Dehydrated: can be shiny and tight at once, fine lines that appear on pinch, dull with visible texture. | Dry: has this been true since childhood? Dehydrated: what changed in the last three months, and how many actives are in the routine? | Dry is a lipid picture and holds steady. Dehydrated is a water picture, is behavioral, and moves fast in both directions. |
| Sensitive vs sensitized | Both flush, sting and react. Indistinguishable in the chair. | When did this start, and what changed that month? | Sensitive has no answer: it is constitutional, lifelong, familial, stable. Sensitized has an answer: a new active, over-exfoliation, a device, a climate change, a professional treatment. Sensitized reverses in 4 to 8 weeks once the trigger is removed. Sensitive does not, and is managed rather than corrected. |
| Congested vs inflamed | Congested: texture you feel more than see, no color change, not tender, stable for weeks. Inflamed: redness, warmth, tenderness, papules or pustules, changing week to week. | Does this hurt when I touch it? | Congestion is cosmetic and is yours. Anything tender, warm, spreading or painful is not, whatever it is called. Touch decides it, not the magnifier. |
Frequency and review
Full mapping at the first appointment. Abbreviated re-map at every fourth session: stages 2, 3, 6 and 8, against the previous record. Full mapping again at three months, or immediately after any change of medication, climate, routine or professional treatment elsewhere.
After the consultation
The client leaves with the plan, the review date, and a two-week simplification: cleanse, tone, moisturize, sun protection, nothing else. Two weeks of a simplified routine before the first treatment does two things. It settles skin that is reacting to its own routine, and it gives you a clean baseline to treat against.
Book the first treatment at the end of the two weeks, not at the end of the consultation.
What to expect, and when
In the appointment: the client hears their own routine read back to them, usually for the first time. Expect the number of products in daily use to surprise them.
At two weeks: simplification alone resolves a proportion of presenting complaints. Record which ones. That result belongs in the file, because it changes the whole plan.
At session four: the value of stage 8 becomes visible. Comparable photographs and a zone map make a change either demonstrable or absent, and both answers are worth having.
Scope: this consultation describes appearance. Diagnosis, screening and examination belong to a physician, and a skin that looks unremarkable here has not been cleared of anything.
When a consultation becomes a referral
Stop the consultation, book nothing, and refer to a physician if:
- Anything is tender, warm, painful, swollen, weeping or spreading.
- A lesion is new, changing, bleeding, non-healing, asymmetric, or has an irregular border or more than one color. Do not photograph it and monitor it. Refer it, the same day.
- Redness is accompanied by heat, systemic symptoms, or a defined advancing edge.
- Change was sudden, with no change to routine, climate or season.
- The presentation followed a new oral medication.
- The client's stated goal is treatment of a condition, or continued management of one.
- The client is asking you whether to keep taking something they were prescribed.
Say plainly what you can and cannot do, give the referral, and offer to see them again once they have been seen. The credibility of every recommendation you make afterward rests on having drawn this line in front of them.
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