Pillar one · the consultation

READ the face.

Aesthetic medicine grew up around the female face, and its consultation habits went with it: the zone menu, the syringe count, a mirror used to point at flaws. A man in that chair is answering questions never designed for him. READ is how a male consultation opens inside the Band Codex: four chapters, fourteen reads, no score. Every read routes directly into the plan, a limit on it, or a gate in front of it.

The four chapters The spoken layer The observed layer The four gates The hierarchy Run a consultation

Reason

Why he is here, and why now.

2 spoken

Explore

What he loves, then what he would change.

2 spoken

Anatomy

The silent read. Where the plan is decided.

7 observed

Design

Ambition, visibility, boundaries.

3 spoken

Two layers

The patient's read and the clinician's read are different on purpose.

The spoken layer is conversational and filmable: the man answers in his own words, often looking in a mirror. It yields motivation, preference, priorities, preservation locks, ambition and gates. The observed layer is silent clinician data capture, marker pen in hand, while examining and marking the face. It yields the structural triggers, the product class, the volume ceiling and any referral. Explore is what the patient sees in the mirror; Anatomy is what the clinician observes.

Consultation rules

The spoken questions are not a script to rush through. Silence after the question is intentional.
The observed items are not a questionnaire. The patient sees them happening; he does not answer them.
A named zone is not enough to create treatment. Anatomy must support it.
A structural indication is not enough to override a preservation lock or a safety gate.
The plan carries the decisions forward; the consultation does not rely on memory.

The spoken layer · seven questions

Ask little. Read much.

Each question is written to be asked once and then left alone. Beneath each one is what the answer decides: never a treatment, always a permission, a limit or a gate.

R · Reason

“What brought you into clinic today?”

Then: “Why now? Why did this feel like the right timing?”

Decides the gate for timing and readiness. A trigger event (a wedding, a promotion, a divorce, a birthday decade) sets the tone of the plan, never its anatomy. Reset language, the wish to undo what someone else did, routes to an undone-first plan: no additive session that visit.

“What have you had done before, and what did you love or hate about it?”

Then: “Anything about how you look right now that you wish was different?”

Decides how much is already there. Existing filler reduces everything that is planned; prior thread lifts or cannula-heavy work put the jawline's exception on the table. Three signals are noted rather than scored: many clinics and never happy, nothing kind to say about his own face, a focus on features nobody else notices. Two of three means a formal screen before any planning proceeds.

E · Explore

Before the mirror is handed over, the clinician spends thirty to sixty seconds naming what already works in the face: skin quality, symmetry, a good feature. This is not flattery. It makes preservation credible before treatment is discussed, gives him permission to name a strength rather than only a defect, and stops the mirror becoming a search for flaws.

“Show me the features you’re most proud of.”

Then: “Say why. What does that feature give you?”

Decides the preservation locks. A named feature is held out of BUILD entirely, or held at its baseline with no upward permission. A lock is not a polite preference to be argued away by anatomy. “Nothing”, or an immediate deflection, is the third signal from R2 arriving.

“Now show me the features you’d love to improve.”

Then: “If we could work on only three, which three, and in what order?”

Decides where any upward permission can live. A named zone can only be treated if the anatomy read supports it; a zone ranked in his top three is the only place the plan may go above baseline, and only if tissue and visibility allow. Priority is important but not sovereign. The plain-language version, when needed: you are bringing up your weakest muscle group.

D · Design

“In six months, what’s the best-case version of you?”

Then: “Pick one: refreshed, defined, younger, or more masculine. Then say it in your own words.”

Decides the bias of the whole plan. Refreshed is a restoration bias at baseline. Defined permits structure. Younger opens a realism conversation before anything else. More masculine reinforces every anti-feminisation restraint. “Dramatically different”, said unprompted, is the honest-no branch: a surgical referral and no plan that visit, not a negotiation for a smaller version of the same promise.

“Are you worried about anyone noticing a change, or open to going all the way to the best version of the proportions?”

Then: “If a colleague said ‘you look different’ two weeks in, would that be a problem?”

Decides the ceiling, never the target. Nobody notices, some subtlety, or full harmony: three answers that set how far above baseline the plan is permitted to go. Visibility does not bypass a lock, a frame limit or a stop. Under-correction is the signature; this is the question that says so in one line.

“What would you hate at the end of this? And what about your face must not change?”

Then: “Say what you’d notice first if it went wrong.”

Decides the hard filters. A named unwanted outcome (puffy, feminised, obvious, stretched, done) withdraws permission from the zones that could produce it. A named feature is a lock. When he says “I don’t know”, the clinician offers the list and asks him to reject the ones that do not apply. The most quotable line of the consultation usually arrives here; the silence is not filled.

The close · long-term care doctrine

This is not a one-off. We review at six weeks. Then annually. We fine-tune. We evolve the plan as you age. Decades, not syringes.

The six-week review is clinical: the product has settled and is assessed. The annual review is Codex doctrine: the face is re-read against the original reading and the plan evolves rather than repeats. It is a standard of care, never a preference the patient is asked to choose.

The observed layer · seven domains

The silent read. Where the plan is decided.

Seven things the clinician reads with a marker pen while the man watches. Each is shown here as the questions it asks the face; which answer fires which point is the Masterclass. The last two are the most powerful modifiers in the whole system: frame and skin dictate the product class, how much volume is permitted, and whether the line runs at all.

Proportions

Vertical thirds, equal or imbalanced. The bizygomatic to bigonial ratio. Whether the face reads square, triangular, narrow-lower or broad-lower.

Asks: is the lower face a length question, a width question, or neither? A face already square is held. Measure it.

Profile plane

The convexity plane against a true vertical: anterior, straight or retracted. The nasofrontal and nasolabial angles. The labiomental angle, measured; normal 110 to 130 degrees.

Asks: is projection in question, and under what restraint? Is the chin-lip crease a notch or a landmark? Measure it.

Midface and the OGEE

The OGEE on three-quarter view: present, partial or absent. Anterior projection through light and shadow. The submalar hollow. The lid-cheek junction: smooth or stepped.

Asks: is the midface a lateral question or an anterior one? And is the shadow under the eye a midface problem or a true trough? One shadow can be two problems; the same shadow is never used to fire both.

Lower face

Chin length: short, average, long. Chin projection: recessed, average, projected. Jawline continuity: continuous, pre-jowl notched, gonial-soft. The angle at rest: soft, defined, already square.

Asks: which anchors are in question, and does the line run? Width is a deep move; edge is a superficial one. They are never substituted for each other.

Periorbital and upper third

Forehead: recessed, normal or over-convex. Temple: hollow or normal. Tear trough: a true bony or ligamentous shadow, as distinct from the lid-cheek step already read in A3. Eye shape and volume.

Asks: which of the quiet regions, if any, the closing step should even consider.

Frame

One of four, by the clinician's eye and no numbers: petite or thin · average · muscular or broad · large with adiposity.

Sets the product class, the volume ceiling, whether the jawline's exception fires, and whether any upward permission exists. A broad frame can permit, never demand, more; a large frame gets definition, not bulk; a petite frame limits the edge before it becomes an artificial line.

Skin and age band

Elasticity by a one-second clinician pinch at the jawline and cheek. Texture and visible laxity. The decade.

Sets the product class and the jawline's exception, adds a skin line to the plan where texture is poor, and holds the one gate that is not about the patient's wishes: over sixty with lax skin, the surgical or lifting conversation comes before additive filler.

The four gates

Four ways a consultation ends without a plan.

A later preference cannot reopen a failed gate, and a technically feasible BUILD does not make a gate disappear. Said to a room of injectors, this is the most credible page of the system.

Gate 1 · R1

Reset language

He wants to undo what someone else did. The plan is undone-first: dissolve, settle, re-read. No additive session that visit.

Gate 2 · R2 and E1

Two of three signals

A formal, validated screen for body dysmorphic concern runs off-questionnaire before planning. A failed screen ends with referral and no plan. The screen is never filmed and never narrated.

Gate 3 · A7

Over sixty with lax skin

A surgical, canthoplasty or lifting conversation comes first. If additive work proceeds at all, it proceeds on the cautious route: the default steps held at baseline, the softer product class, the line reduced or withheld.

Gate 4 · D1

Dramatically different

Asked for unprompted, this is the honest-no branch: a surgical referral is raised and no plan is issued that visit. Not a negotiation for a smaller version of the same promise.

Plan assembly

How fourteen reads become one plan.

READ produces a plan by combining four kinds of decision, in this order. Gates decide whether an additive plan can proceed today. Anatomy identifies which structural or Detail indications genuinely exist. Modifiers shape the product class, the ceiling and whether a default step is reduced. Preferences and preservation constrain the viable plan so the result remains recognisably him.

The clinician does not let a patient's named priority create an anatomy that is not present. Equally, a region indicated by anatomy still has to survive frame, skin, existing product and the Design chapter. The output explains not only what may be treated, but what will stay untouched, reduced, deferred or referred, and why.

Run a consultation through the algorithm →

When two inputs conflict, the more restrictive valid one wins

A referral, reset or honest-no gate wins.
Preservation locks and named unacceptable outcomes win over a cosmetic ambition.
Anatomy determines whether a step exists in the candidate plan.
Frame, skin, age and residual filler modulate the feasible envelope.
Visibility sets the maximum permission; it never requires its use.
During BUILD, contour restraint and the Believability Stop can still end delivery before any planned volume is reached.

What READ does not cover

READ captures aesthetic safety: contour risk, preference, preservation, tissue limits and realistic ambition. It does not replace the injecting practitioner's foundational training in vascular anatomy or complication management.

What v3.1 deliberately dropped

Fourteen items, not thirty-eight.

The first pilot was a scored questionnaire of thirty-eight items. The locked version is fourteen, with no score, because a composite obscures the reason for a decision. What went, and why.

Dropped	Why it is absent
Expression and animation checks as a chapter	Not part of the actual consultation practice. The two dynamic checks that matter live inside BUILD's midface work.
Mandatory reference images	If he brings them unprompted they are reviewed; they are never required. The mirror is not a reference-image exercise.
Priority ranking as its own item	Folded into E2's top three.
Height and weight	Replaced by the clinician's frame read.
Body dysmorphic concern as a scored item	Now an inline observation trigger; the formal screen runs off-questionnaire.
A pace or cadence question	Annual review is doctrine, not a preference to score.
A male or female switch	Not asked. The Codex is male only.
Composite scoring	Every item routes directly to a decision or a gate.