Twelve reasons to decline an exosome treatment

Most guidance of this kind is written from the clinic outwards, as a list of contraindications a practitioner should screen for. This one is written from the patient inwards. It is the list of reasons you might reasonably walk out, whether or not the person in front of you has raised them. Print it, take it, and treat a single yes as sufficient.

The first six: medical reasons

1. The cause of the problem has not been diagnosed

This is the most common one and the most consequential. Hair loss is a symptom with many causes, several of which are treatable and some of which are markers of something else. Thyroid disease, iron deficiency, scarring alopecias, telogen effluvium after illness and autoimmune conditions all present as hair falling out, and none of them is treated by a cosmetic procedure. Skin concerns divide the same way. If nobody has established what you have, no treatment decision can be made, and buying a course of anything at that stage buys delay as well.

2. Pregnancy or breastfeeding

Elective cosmetic procedures are generally deferred in pregnancy and while breastfeeding. The reasoning is not that harm has been demonstrated. It is that the safety information which would allow anyone to say otherwise does not exist, and an elective procedure is by definition one that can wait.

3. Active infection or inflammation in the treatment area

Cold sores, folliculitis, inflammatory acne, eczema, psoriasis or any broken skin in the field. Microneedling through infected or inflamed skin risks spreading the problem and worsening the inflammatory response. This is usually a not yet rather than a never.

4. A history of keloid or hypertrophic scarring

Any procedure that creates controlled injury carries a different risk profile in skin that scars abnormally. A history of raised or spreading scars from minor wounds, piercings or surgery needs dermatological assessment before an elective needling procedure, not a reassurance at the front desk.

5. Bleeding, clotting, immune or oncology considerations

Anticoagulant or antiplatelet therapy, a bleeding disorder, immunosuppression, active autoimmune disease or current cancer treatment. None of these is automatically an absolute bar, and that is exactly why they belong on a refusal list: they require input from the clinician managing that condition, not a judgement made in an aesthetic clinic. If nobody has asked to speak to your prescriber, decline until they have.

6. Recent oral isotretinoin

Skin treated with oral isotretinoin heals differently, and elective procedures that wound the skin are conventionally deferred for a period after the course finishes. The length of that period is a clinical judgement, and the point here is that it should be a considered one rather than an omission.

The next three: the consultation itself

7. The product has not been named, and its classification has not been given

You are entitled to know what is going to be put into your skin, who supplies it and under what classification it is supplied. A preparation described only as exosomes is a category, not a product. An answer that avoids the question is an answer.

8. The route has not been made explicit

On intact skin, after microneedling, or injected. These are different treatments with different rules and different risks, and our page on route sets out why. If you cannot say which one is planned for you after the consultation, the consent you are being asked for is not informed.

9. No named practitioner, or no registration you can check

Ask who will carry out the treatment, by name, and what their professional registration is. A doctor's entry can be checked on the General Medical Council register, a nurse's on the Nursing and Midwifery Council register, and the Joint Council for Cosmetic Practitioners maintains a register for the non surgical sector. Being treated by someone other than the person who assessed you is common enough that it is worth asking specifically, and finding out on the day is too late.

The last three: how it is being sold

10. The price is only available today

A discount that expires at the end of the appointment is a device for preventing you from thinking about it, and it is the single clearest signal that the consultation is a sales meeting. There is no clinical reason for a course of an elective cosmetic treatment to be time limited. Our cost page gives indicative ranges so that a package price arrives as a figure you can evaluate.

11. An outcome has been promised

Guarantees, before and after images presented as typical, percentages of regrowth or a specific number of sessions to a specific result. Where the underlying evidence is early and the products are not standardised, nobody is in a position to promise an outcome. A promise tells you about the seller, not about the treatment.

12. A licensed option for the same condition has not been discussed

For androgenetic alopecia, treatments with regulatory approval and decades of clinical data exist. Choosing something unlicensed instead is a decision you are entitled to make, but it should be a decision rather than an omission. A consultation that never mentions the licensed class has left out the comparison that matters most. Our hair loss page sets the options against one another.

How to decline, in practice

You do not need a reason and you do not need to argue. Two sentences are enough: you would like to take the information away and think about it, and you will be in touch. If a deposit has been taken, ask for the cancellation terms in writing. If pressure follows, that is additional information about the clinic rather than about your decision.

Nothing on this list is a criticism of practitioners who screen for these things properly, and many do. The reason to hold the list yourself is that the person best placed to notice most of these situations is you.

Limits of this list

This is not a complete set of contraindications and it is not a substitute for assessment by a qualified practitioner who has examined you. It does not cover treatments other than exosome preparations applied to skin or scalp, it gives no advice on managing a complication, and it names no clinic, practitioner or product. If you are unwell after a treatment, seek clinical help rather than reading a website.

Common questions

Can a clinic keep my deposit if I decline after the consultation?

That depends on the terms you agreed to, which is why asking for the cancellation policy in writing before paying anything is worth the small awkwardness. A deposit is a commercial matter and it does not oblige you to proceed with a procedure.

Is it rude to ask for a practitioner's registration number?

No. Registers exist to be checked and most practitioners expect the question. If asking causes offence, you have learned something worth knowing before rather than after.

What if my hair loss has already been diagnosed?

Then the first item on the list is satisfied and the rest still apply. A diagnosis makes the conversation about treatment options meaningful, including the licensed ones.

Does an absolute contraindication ever change?

Some entries on this list are temporary, such as active infection or recent isotretinoin, and some are not, such as a scarring tendency. Which is which is a clinical judgement, and the distinction is worth asking about explicitly.

Should I report a bad reaction, and to whom?

Contact the practitioner who treated you first, and your GP or NHS 111 if you are unwell. Suspected problems with a medicine or a medical device can be reported to the Medicines and Healthcare products Regulatory Agency through the Yellow Card scheme.

Is declining the same as saying the treatment does not work?

No. Declining is a decision about you, your circumstances and the information you were given. The state of the evidence is a separate question and it is covered on the evidence page.

If you want to speak to someone

We are not a clinic and we give no medical advice. If you would like to, we can pass your details to a registered UK practitioner who will contact you directly. Nothing is booked on your behalf and there is no obligation. Read the regulation page first.

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Read next

• Twelve questions to ask at a consultationThe other half of the same conversation, printable
• Risks and the UK regulatory positionWhat unlicensed means in practice, and what follows from it
• Reading the study designsHow to place any citation a clinic shows you