What should a treatment plan document include?

Who. The plan names the person injecting and states their license type. In California that is a physician, or a registered nurse, nurse practitioner or physician assistant under physician supervision arranged as the law requires.

If a supervising physician is not in the building, the plan should say who they are and how they are reached.

What. Product by brand name, and for filler the specific product within a brand family, since a firm cheek product and a soft lip product from the same maker behave very differently.

Lot numbers are recorded in the chart at the time of injection and should be available on request.

How much. Toxin in units per area. Filler in syringes or fractions of a syringe per area.

A plan that says "as needed" has not decided yet.

Where. A face diagram with the injection points or zones marked, or photographs with the areas drawn on. This is what a patient looks at in the mirror at two weeks to judge whether the plan was followed.

When. The expected timeline: swelling to settle, toxin to take, filler to soften, and the date at which the result is fair to judge. Most injectors put that date around two weeks for toxin and two to four weeks for filler, and say so.

What could go wrong. The risks specific to the planned areas, in plain words. For filler that includes bruising, swelling, lumps, asymmetry and the small but serious risk of a blocked vessel, with the plan stating that a dissolving enzyme is on site.

For toxin it includes a heavy brow or lid, asymmetry and under-response.

What happens next. The follow-up visit date, whether a top-up at that visit is included, and how to reach the clinic after hours if something looks wrong.

What it costs. The total and an itemized list of what sits inside it, including numbing, the follow-up and any adjustment.

The desk does not quote figures and neither should this page; the point is that nothing is added later that was not on the sheet.

What a good plan looks like on the page

Picture two documents. The first is a printed page with a face diagram, four circled zones, a number of units beside each, a product name, two dates, a paragraph of risks and a signed total.

The second is a card with a logo, a treatment name and a price. The first can be taken home, read the next morning, and checked at follow-up. The second cannot be checked against anything.

The California Academy of Sciences labels each specimen in its collection with a location, a date and a collector at its San Francisco museum, because an unlabelled specimen is just an object; an unlabelled treatment is just a purchase.

How the desk checked this answer

We assembled this list by reading the plans patients have shared with us after treatments that went well and after ones that did not. The difference was rarely the product. It was whether anyone had written down what was supposed to happen and when.

The desk cannot see the reader's face or the reader's plan, so this page describes the document, not the treatment. When the details conflict, start with what the paper says, because a plan that is only spoken cannot be checked at the two-week follow-up.

Sports charities such as the LA84 Foundation publish their grant guidelines so that a youth coach in Watts knows what was promised; a treatment plan should offer a patient the same courtesy.

Where to keep it

Keep the plan with the photographs, in one folder, and bring it to the review. The plan is the record the review is measured against, and the desk has seen too many reviews conducted from memory.