I grew up in the days of Merle Norman pancake full-coverage base makeup. It wasn’t called foundation at that time, and I doubt anything other than full-coverage base makeup existed. The trend in the ’80s was to wear your “base” darker than your skin tone so people knew you were wearing makeup, and lines of demarcation along the jawline were flaunted with pride. YEAH, GIRL! While war paint makeup was all the rage, having a good skincare routine certainly was not. I may or may not have been born with good skin — who knows — but all the sun damage and abhorrent skincare behavior well into my late 20s (I slept in my makeup and never wore SPF) left me with super textured skin complete with enlarged pores, acne scars, sun spots, broken capillaries, and rosacea.
When I finally began taking care of my skin, I started with a consistent skincare routine. Over the years, my needs graduated to a medical-grade skincare system to reverse sun damage and remove brown spots. For the last ten-plus years, I have focused on laser and microneedling modalities to address skin texture and laxity. I have a love of lasers much like I have a love of Botox and tretinoin, and my skin has greatly improved with these treatments and procedures.
Having previously worked with plastic surgeons, cosmetic dermatologists, PAs, ARNPs, and aestheticians in medical aesthetics for years provided me with a unique perspective on how to approach cosmetic treatments and procedures — I know how to research and determine what treatments and procedures to pursue. I’ve spoken with friends many times that weren’t satisfied with their outcome, and deep-dive questions reveal they didn’t receive the best treatment for their skin concern. Many times, patients express to their practitioner during an existing treatment (like injectibles or facials) about a secondary skin concern, and no surprise, they are offered a solution that is also provided by the practitioner. Therein lies my concern for many of you. If you are passionate about skin health but uncertain which treatments are best for your specific need, let me guide you.
Aesthetic medicine is big business.
Aesthetic procedures are elective, most do not have an insurance component, and procedures are paid in full at the time of treatment, sometimes prior to. Understanding that this yields greater profit margins than most medical practices is important because the aesthetics industry is extremely competitive. Providers in this field are expertly trained in cosmetic procedures and also highly skilled in the art of cross-selling and converting patients to additional treatments. There is zero cost in converting an existing patient to additional treatments. While an aesthetic practice may offer a treatment that addresses your skin question, it may not be the best-targeted option for your concern. There can be multiple modalities that provide similarly successful outcomes, however, some “will sell you what they have.” It’s okay if you don’t receive all your cosmetic treatments in the same practice — you may get chemical peels at one practice, injectibles at a different practice, and laser treatments at a third practice. Each area of treatment requires a different skill set and just because a provider is excellent at machine based treatments (like lasers) doesn’t mean they are equally skilled at facial sculpting with fillers and thread lifts.
Know how to credential your provider.
Credentialing a provider doesn’t have to be difficult. Many cosmetic patients are eager to share their experiences and give a recommendation. While nothing beats word-of-mouth referrals, always do your own research. A well-designed, updated website with Before and After galleries is a great start, in addition to checking MDs’ board certifications in their specialty (ASPS, AAD). Research patient reviews on Google, WebMD, Healthgrades, Vitals, RealSelf, and other forums. For PAs, ARNPs, and aestheticians, online reviews and Before and After galleries are harder to find, but many reputable providers maintain portfolios of their patients at their office. They also utilize social media for enhanced credentialing. MDs, PAs, ARNPs, and aestheticians share their expertise and skills by posting patient results on these platforms. Social media has been embraced by the aesthetic community and is an excellent tool for converting existing patients to additional treatments and recruiting new ones altogether.
Consult with Drs. Google, YouTube, Instagram, even TikTok.
Providers strongly discourage patients from doing this, and I understand why when it comes to non-cosmetic medical concerns. However, when it comes to cosmetic procedures, I disagree. Once you know how to research on these platforms, you’ll be better prepared for treatment consultations to maximize your outcome and patient satisfaction. Simple Google searches for “What is the best treatment for A?” or “What is the newest treatment for A?” are outstanding complementary research to your friend’s referral. Once you’ve narrowed down top treatment options, search “treatment A vs. treatment B.” I obsessively read beauty forums and blogs, clinical trials in medical journals, watch videos on YouTube, do hashtag searches on Instagram and TikTok, and absorb information from all platforms to learn about new developments. My favorite skincare goddess, Dr. Shereene Idriss, a board-certified cosmetic dermatologist in Manhattan, properly schooled me on the overhype of hyaluronic acid and why it can’t be a better skin hydrator than old-school glycerin (hint: size matters)! I was led to her YouTube channel by way of Instagram, which is where I discovered her. Astute aesthetic providers are heavily utilizing these media outlets to educate patients because cosmetic patients are well informed.
New tech isn’t always better than old tech.
In the aesthetic world, new technologies and treatments tend to be adopted quickly. However, just because there is a new version of an existing product or technology, it doesn’t make it better. For example, if your concern is redness caused by rosacea and broken capillaries, the gold standard in treating this condition has been pulsed dye lasers (PDL), like Vbeam. However, the NKOTB is BroadBand Light Photorejuvenation, commonly known as BBL, and is a corrective treatment for brown AND red pigmentation. While BBL is an outstanding therapy and does treat redness in addition to brown spots, PDL remains the gold standard for redness. But few practices in our area still carry this “old tech laser.” Most practices now have the BBL because of it addresses a multitude of concerns — new tech. Years ago, my own experience with BBL treating my broken capillaries and rosacea, with disappointing long-term results, led me to question if there was a better option targeting my skin concern. I learned about Vbeam, a PDL laser, and experienced a better result with Vbeam compared to BBL.
The best provider in the practice for your concern may not be the doctor.
Let’s use Botox as an example: As a Botox user for 16 years and a previous aesthetic industry insider, my experience has been that the best injector in a large group practice, many times, is not the MD. The doctors in a group practice, that also have PAs and ARNPs providing injectable procedures, typically focus more on complex cases while the PAs and ARNPs support more cosmetic patients. Since the PAs and ARNPs tend to be injecting more patients more frequently, they gain consistent experience allowing them to refine their injectible skills. They also acquire more advanced training with injectibles than some MDs. This is not to say MDs aren’t also excellent injectors, because they are — many are outstanding. It’s simply a consideration when you’re investigating practices that employ various provider levels, all who perform the same procedure.
Additionally, a treatment result can directly be correlated to the “technician.” I’ve recommended the Hydrafacial to almost everyone because my aesthetician is simply the best. Yet, a few were disappointed in their Hydrafacial with different aestheticians. Know the experience level of the aesthetician in your sought after treatment.
Manage your expectations.
Skin health is a long game, results can take time, and multiple sessions may be necessary to achieve desired results. A good provider will help you set appropriate expectations and educate you on how to maintain results. We must protect what we correct!
Lastly, make sure you share the same aesthetic perspective because what your provider thinks is beautiful may not be what you consider beautiful. Trust your provider but follow your gut.
What experiences and advice on your skin health journey can you share with us?