At Medify in Waterkloof, Pretoria, Dr Luhard Jansen van Vuuren leads an assessment-first approach to facial aesthetics. The aim is not to apply a standard product combination or create one recognisable look. It is to decide whether treatment is appropriate at all and, if it is, which measured plan fits the individual.
The short answer: neuromodulators, dermal fillers and skin-quality or biostimulatory approaches do different jobs. None is automatically the right starting point. Consultation does not guarantee an injection, prescription or procedure.
Start with the concern, not a product
Patients may arrive asking for a familiar product name because it is the language used online. The more useful first question is usually: What are you hoping to change, and what would you prefer to preserve?
One person may be concerned about movement-related lines. Another may notice a change in contour, support, skin texture or symmetry. Sometimes the most appropriate answer is skin care, time, treatment of an underlying condition, referral, or no treatment. Starting with a product can obscure those distinctions.
A consultation should also establish what a successful result would mean to the patient. A request to “look less tired” may relate to several different anatomical or medical factors. It should not be translated automatically into a syringe count.
What a doctor assesses before facial aesthetic treatment
Individual facial anatomy varies. A 2024 anatomical review emphasises that objective assessment of facial structure helps practitioners individualise treatment and reduce reliance on one-size-fits-all planning.
Depending on the concern and proposed treatment, an assessment may include:
- Current health conditions, medicines, allergies and previous reactions
- Pregnancy or breastfeeding where relevant to treatment suitability
- Previous facial procedures, surgery, threads, implants or permanent filler
- Facial movement at rest and during expression
- Bone structure, soft-tissue support, volume distribution and asymmetry
- Skin quality, inflammation, infection, scarring and pigment risk
- Dental treatment, planned medical procedures and recent illness
- The patient’s priorities, time frame, tolerance for downtime and budget
- Expectations, including whether the requested change is realistic and proportionate
- Reasons to postpone, avoid treatment or refer to another appropriately qualified professional
Photographs may help document baseline anatomy and support informed planning, provided consent and privacy are handled appropriately. They are a record, not a guarantee of a particular result.
Different concerns may require different approaches
The categories below are not interchangeable and are not recommendations for an individual patient.
Neuromodulator treatment
Botulinum toxin medicines temporarily reduce activity in selected muscles. This may be relevant to some movement-related lines or other clinically assessed indications. The balance between different muscles matters because facial expression depends on coordinated movement, not one isolated line.
Dermal fillers
Fillers may be considered when the clinical objective involves selected contour, support or volume changes. Different materials behave differently, and the anatomy around blood vessels is important.
Skin-quality and biostimulatory approaches
Some treatments aim primarily at skin quality or a gradual tissue response rather than immediate contour change. “Biostimulator” is a broad label, not a single standard treatment.
Sometimes no injection
Active infection, uncontrolled inflammation, uncertain diagnosis, unrealistic expectations, a relevant medical issue or unsuitable timing may make treatment inappropriate.
Neuromodulator treatment
In South Africa these are prescription medicines. The relevant SAHPRA-approved patient information must be considered, and treatment should be administered by an appropriately qualified medical practitioner with the necessary knowledge and skills. Suitability, dose, placement, expected duration and risk are individual clinical decisions.
Dermal fillers
The US Food and Drug Administration describes filler injection as a medical procedure. Common short-term effects may include swelling, bruising, tenderness or redness. Less common complications can be serious. Accidental injection into a blood vessel may cause tissue injury and, rarely, visual impairment, blindness or stroke. This is why product choice, anatomy, technique, consent and an urgent-response plan matter.
Skin-quality and biostimulatory approaches
Evidence, indications, onset, duration and complication profiles differ between products and procedures. These options should not be added automatically to a package. The practitioner should be able to explain what problem the treatment is intended to address, what evidence supports that use, what alternatives exist and how response will be reviewed.
Sometimes the right plan is no injection
A staged skin plan or referral may sometimes address the concern more sensibly than an injectable procedure.
Consent is part of treatment, not a formality
Informed consent is a conversation. Before deciding, the patient should understand:
- What is being proposed and why
- The expected range of improvement and the limits of treatment
- Common short-term effects and material risks, including rare serious risks
- Reasonable alternatives, including doing nothing
- Product-specific information where applicable
- Likely recovery, aftercare and follow-up
- What an urgent concern may look like and how to contact the practice
- The expected cost, including whether review or additional treatment may carry a cost
Patient selection, preparation, counselling, appropriate technique and follow-up are recognised components of reducing injectable complications. Even careful practice cannot make a procedure risk-free, and no practitioner can guarantee a particular aesthetic outcome.
After filler treatment, sudden or escalating pain, pale or mottled skin, a change in vision or new neurological symptoms requires urgent assessment. Severe breathing difficulty or rapidly progressive swelling is an emergency. Patients should follow the specific aftercare and emergency instructions given by their treating clinician.
Conservative planning protects expression and future options
“Natural-looking” is a preference, not a result that can be promised. A conservative plan usually means agreeing on priorities, avoiding unnecessary treatment, and reviewing the effect before adding more.
It can also mean protecting future options. Repeated or layered procedures can complicate anatomy and later decision-making. Accurate records of products, dates, treatment areas and previous reactions are therefore useful even when treatment was performed elsewhere.
At Medify, the intended direction is refinement rather than a standardised face. The plan should respect proportion, expression and the patient’s own threshold for change.
A good plan should be explainable. You should understand the concern being addressed, why the proposed option fits, what it cannot achieve, the alternatives and material risks, the total expected cost and when the result will be reviewed.
Useful questions to ask at an aesthetic consultation
- What do you think is causing the concern I see?
- Is treatment appropriate now, and what would make you advise against it?
- What qualification, training and experience do you have with this procedure?
- What product or device would be used, and is it lawfully supplied for the proposed use?
- What improvement is realistic for my anatomy?
- What are the common effects, material risks and rare urgent complications?
- What alternatives should I consider, including no treatment?
- What aftercare and review are included?
- Who should I contact if I am worried after treatment?
- What is the likely total cost of the proposed plan?
Bring a list of medicines and allergies, details of earlier procedures and products where known, and the dates of planned dental or medical treatment. Avoid hiding previous treatment because you feel embarrassed; accurate information helps the clinician make a safer decision.
How the Medify price list should be used
The Medify patient price list provides guide pricing across Face, Body, Wellness and Skin. It is useful for planning, but it is not a treatment prescription or a quote for an unseen patient.
Final treatment and pricing depend on consultation, examination, the agreed plan, clinical suitability, informed consent and product availability. A consultation does not guarantee that treatment will be recommended or performed.
Frequently asked questions
Does a facial-aesthetics consultation guarantee injections?
No. The purpose of consultation is to understand the concern, assess suitability, discuss alternatives and decide whether treatment is appropriate. The outcome may be a treatment plan, a staged approach, referral, postponement or no procedure.
Are neuromodulators, fillers and biostimulators interchangeable?
No. They act in different ways and have different indications, limitations and risks. A product category should be selected only after the concern and anatomy have been assessed.
Can a practitioner guarantee a natural result?
No. The practitioner can plan conservatively and discuss realistic goals, but biological response, healing and perception vary. No specific aesthetic result can be guaranteed.
Why does the final price sometimes differ from a guide price?
Guide prices cannot establish the treatment required for an individual. Final cost depends on the assessment, agreed treatment area and plan, the specific lawful product or procedure, and whether treatment is clinically appropriate.
The Medify approach
Dr Luhard Jansen van Vuuren is Medify’s founder and clinical lead. His role at the Waterkloof practice includes setting the standard for patient selection, consent, treatment planning and follow-up in doctor-led facial aesthetics.
Medify is the patient-care practice. DrLuhard.com is the canonical website for Dr Luhard as a medical expert and person. MedBase is a separate professional healthcare-education entity, and MedCentre Waterkloof is the separate multidisciplinary facility at the same address.
Sources and further reading
- Anatomical-based diagnosis and assessment for facial aesthetic treatment planning (PubMed PMID 37487528).
- Global Aesthetics Consensus: injectable complication avoidance and management (PubMed PMID 32201935).
- US Food and Drug Administration: Dermal fillers (soft tissue fillers).
- SAHPRA: approved patient information leaflet for botulinum toxin medicine (March 2026).
- Health Professions Council of South Africa: Scope of professions and practice.
Medical information: This article provides general patient education and does not replace consultation, examination, diagnosis, product-specific information or informed consent. It is not a recommendation for any injection, medicine, device or procedure. Treatment depends on individual anatomy, health, suitability, practitioner scope, lawful availability and a shared decision. A consultation does not guarantee treatment or prescription. Outcomes vary and no result can be guaranteed. Seek urgent medical care for severe or rapidly worsening symptoms.