Introducing the Art Codes Framework for patient consultation

We all know the patient journey starts with the consultation. As aesthetic clinicians, we use the consultation to diagnose three key aspects: patient psychology (their motivation and how treatment might impact their life), their anatomy (the physical cause of their concern, such as fat loss or hyperactive muscles), and the aesthetics (the resulting visible problem caused by the anatomy, and how that, in turn, is causing the psychosocial problem for the patient). For example, a loss of cheek volume makes them look less happy, they smile less, feel less confident, take fewer photographs, go on fewer outings, decrease their social circle leading to increased isolation.

The Art Codes Framework by Dr Tim Pearce specifically addresses the aesthetic diagnosis, empowering clinicians to analyse and create a specific diagnosis around defining points,  defining or inverse lines, and connecting planes, to clearly explain to patients how treatment will alter appearance, improve confidence, and ultimately enhance overall well-being.  By affecting how someone looks, you will affect how they feel, which will hopefully affect how they behave, thus you can achieve a therapeutic change.

In this blog, Dr Tim Pearce will discuss integrating The Art Codes Framework into the consultation with a patient and your approach to treatment, touching on patient psychology, societal and cultural attitudes to beauty, and ethnicity.

How do you align a patient’s aesthetic goals with their psychological needs?

Your goal is to relate the treatment to your patient’s story which may involve a desire for improved confidence or self-perception. Understanding their story is fundamental to approaching the consultation and your recommended treatment.

Humans often have desires they do not fully understand; they may not consciously recognise what needs their treatment desire is meant to fulfil. For example, when a patient tells you they ‘want their lips done’, an underlying desire is driving that request. However, a lip filler procedure may not be the correct answer for their deeper need.

The key is to uncover the underlying desire; it is often unrelated to their appearance. Many practitioners assume patients want to look beautiful, but beauty is often a means to an end — enhancing their ability to survive and thrive in society. Patients equate beauty with increased opportunities for relationships, collaboration, and overall social success. However, the practitioner cannot simply impose this understanding; the patient and the clinician must be on the same page. To achieve this, you should ask questions to encourage them to articulate their current life circumstances and tell their story. You can use that information to guide them toward a better treatment solution than the one they thought they needed.

A skilled practitioner understands patient motivations and provides a more effective solution than the patient would choose independently. Most patients do not have the right answer. They may want a procedure because a friend had it done, but that friend likely has a different bone structure and facial proportions. They may admire their friend, see them as a leader in their social group, and therefore desire the same treatment to achieve the perceived outcome. However, that does not mean the procedure is the right choice for them.

Part of your role is undoing patient misconceptions in a way that feels empowering. You never dismiss a patient’s request outright; instead, you use it as a starting point to understand their underlying psychology. You then rewrite the story with your expertise. Every story involves conflict and resolution. In this case, the resolution is placed in the hands of an expert rather than an amateur. Patients may want to feel confident, start a new relationship, land a new job, or take selfies without hesitation. Their proposed solution —getting a specific cosmetic procedure — may be valid, but there may be a better approach. You are asking for permission to guide them and provide a more appropriate answer using the Art Codes Framework.

How do societal beauty norms influence patient expectations, and how can these be managed during a consultation?

What people perceive as beauty norms are often ancient ideas, not modern constructs imposed by society. Humans have an instinct to collaborate with healthy individuals because this ensures survival. Across all demographics, people tend to be drawn to others who appear youthful and healthy. This is not about hostility toward others but an innate attraction to vitality. Beauty and attraction can be powerful, even overwhelming experiences. These instincts are deeply rooted in human evolution rather than recent societal expectations.

Beyond this, symbols of status, power, and fashion fluctuate over time. Fashion serves to signal how attuned an individual is to their culture and their sense of belonging. It is incredibly nuanced. Aesthetics and fashion often overlap, but they are distinct. Fashion trends are ever-changing, whereas aesthetic principles rooted in health and vitality are more consistent. Some cultures engage in extreme body modifications, like elongated necks or piercings, which may seem unusual to outsiders but hold deep cultural significance. Similarly, in our society, unconventional aesthetic choices – like dying your hair a bright colour – may symbolise status or belonging to a ‘tribe’ or grouping. As a healthcare practitioner, you must recognise when a patient’s request is driven by a passing trend versus a genuine enhancement of their natural appearance, health and well-being.

As a doctor, my role is to create healthy-looking individuals, not to engage in body modification. If a patient requests a procedure that falls outside the boundaries of natural enhancement, I must communicate my limitations and unwillingness to agree because it’s not healthcare. For example, if a patient wants lips that exceed proportional harmony, I may acknowledge their desire but express my professional uncertainty about whether it will benefit them. Every clinical intervention is essentially a bet that the procedure will improve a patient’s well-being. If that bet becomes too uncertain, the ethical choice is to decline treatment.

Ultimately, a clinician’s responsibility is to guide patients toward choices that align with their overall health, confidence, and ability to engage meaningfully with others.

The same is true for ‘cookie-cutter-style’ package approaches to treatment that we see advertised on Instagram offering the same treatment to all patients. I liken this to Mrs Potato Head treatments – you are just switching out body parts (enhancing isolated areas with treatment) without considering the context of the patient’s whole face and their needs. They can ‘buy a new jawline’ but this is a recipe for disaster without taking the rest of their face into context and treatments should not be sold this way.

Beyond symmetry, how do the principles of harmony and proportions specifically guide your treatment planning within The Art Codes Framework?

Symmetry is essential because the face has two halves; although we do not need to be perfectly symmetrical to be beautiful, it helps, but being a little bit asymmetrical adds character. Aesthetic clinicians should strive for some symmetry but not focus on perfection. Harmony and proportion are related. The goal is to create similar proportions across the face; often this relates to the length of the lower face, which we can control because there is very little we can do with injections to alter proportion in the upper face beyond lifting an eyebrow. However, we can alter jaw lines and create relative strength in the lower face.

Western faces are relatively underdeveloped in the jaw area with crowded teeth and small jaws being common. Hence, an easy way to beautify is to increase the harmony between the facial thirds by looking at the defining points of the chin and the connecting lines that create the structure. The same is true with the cheeks and their ratio with the eyes, you can improve the harmony of large eyes and small cheeks by adding lateral width. Lips are often small in Western faces too, and by adding height and width, you can increase proportion and harmony in the lower face.

Harmony also relates to the flow of one structure into the next. With ageing, the transition between different facial structures becomes harsher than in youth because you can see the underlying anatomy. Good aesthetic treatments aim to harmonise this transition, not hide it. Creating too much definition in individual structures can destroy harmony and affect beauty. Discussing the flow of facial structures is something you can build into your consultation

How does an understanding of cultural variations of beauty inform your applications of The Art Codes Framework during consultation?

Circling back to the start of this blog, cultural variations in beauty norms and fashions will impact aesthetic preferences. Different ethnic groups have distinct beauty ideals, which influence the aesthetic treatments they request.

For example, in my experience, Chinese or South Asian patients often seek more dramatic transformations that will be noticeable to their friends and family; while Western patients typically prefer subtle enhancements that could go unnoticed because they might not want people to know they have had something ‘done’. Afro-Caribbean patients tend to age better due to greater UV resistance and have naturally strong, well-developed bone structures which results in more need for subtle restorative treatments rather than augmentative treatments.

Irrespective of a patient’s ethnicity, the universal approach remains to consider the Defining Points, Defining or Inverse Lines, and Connecting Planes of the face in front of you. That is The Art Codes Framework. Treatments should enhance their natural features rather than attempting to impose a different ethnic look or Mrs Potato Head feature that may be inappropriate and appear unnatural. Across all ethnicities, facial beauty is based on clear, well-defined features that the human brain recognises as aesthetically pleasing; therefore, the core framework remains the same for the aesthetic clinician. We want to tailor the approach and ensure natural-looking, harmonious results for all our patients.

If you have any questions or other topics for discussion, you can find Dr Tim Pearce on Instagram.

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