Someone came to see me recently about the dark circles under their eyes. They expected a conversation about treatment options. They left with a pathology form instead.
I know that isn't what most people picture when they book an aesthetic consultation. But before I reach for anything, I ask four questions. How are you sleeping? How is your nutrition? What is your stress doing? And how is your cycle?
Those four questions aren't a formality
In this case, the answers pointed straight at diet and at the menstrual cycle. Neither of those is visible from across a treatment room, and neither comes up if the conversation starts and ends with what you want done to your face.
So we ran bloods first. Your ferritin, which is a measure of your iron stores, came back significantly lower than it should be. We treated that. A few weeks later the tiredness had lifted and the under eye area had genuinely improved, without a single injectable being placed.
Low iron is easy to miss
Here's the part that catches people out. You can have low iron stores without being technically anaemic, and a standard blood count won't always pick it up. You need ferritin to find it. A 2025 review of iron deficiency in adults found that a large proportion of women of reproductive age have iron deficiency without anaemia, and that ferritin is what catches it. Closer to home, a systematic review of South African data found iron deficiency in women of reproductive age is common here too.
Low iron shows up as exactly the things you might book an aesthetic appointment for. Tiredness. Dark circles. Hair that isn't quite what it was. If nobody looks, it never gets found.
Making something look better and fixing the cause are two different jobs
A lot of aesthetic consultations are a menu. You name a concern, someone names the treatments that address it, and you choose between them. It's efficient, and honestly it usually works, because the treatment will improve how the concern looks.
But when the real driver is your iron, your sleep or your hormones, a treatment placed on top does exactly what it's designed to do and no more. You get a result, and you keep the fatigue. Six months later you're often back for the same conversation.
This isn't me talking you out of treatment
I want to be clear, because this argument flattens easily. Injectables are a core part of what I do. Fillers, botulinum toxin, skin boosters and biostimulators all do real work, and I use them regularly.
When you have a structural concern, filler is the right answer. When it's skin quality, a skin booster is. This isn't about one treatment being more virtuous than another. It's about sequence. A health conversation first doesn't stop you having a treatment. In most cases you still have it. What changes is that it happens with the full picture in view, and occasionally it turns out you didn't need it.
What a health first consultation actually looks like
It's not complicated. It takes a little longer, and it means I'm willing to end an appointment without booking a treatment. Four questions cover most of it: sleep, nutrition, stress and cycle. If any of those feel unstable, that's worth understanding before anything gets placed. And if you're tired alongside an aesthetic concern, bloods are worth running.
Aesthetic medicine is still medicine, and the consultation should look like one. Sometimes the most useful thing I can hand you isn't a treatment plan. It's a pathology form.
If you'd like the whole picture looked at properly rather than one concern treated in isolation, book a consultation and we'll start there.