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“There are many factors at play, but many times, patients are coming because of specific triggers. It could be getting them ready for a wedding or something significant has happened in their life—maybe a breakup or a job change. So, I think it’s important to delve into the core of why they’re seeking our services. Then, we move on to identifying their top priorities. Sometimes, patients might not be able to clearly articulate what they see, but they can express what they feel. They might say, “I feel like I look really tired” or “I feel like I look exhausted.” This kind of input allows us to piece things together.

Occasionally, it’s more helpful for them to express the main thing they feel about themselves rather than asking them to look in the mirror and describe what they see. Sometimes, there’s something they can’t quite put their finger on visually, but they have a strong sense of how they feel. This feeling becomes a significant guide for me. Additionally, understanding their motivation is crucial—what they want to change and why they want those changes. This insight helps me provide them with guidance on which treatment options we should consider.”

“You know, it’s an interesting question. Um, because I’ve been working with patients in the transgender community since like eight. Because of course, we opened the first laser hair removal clinic in San Francisco, and some of my first patients coming through were trans women. Um, so I would say, at least to me, androgyny isn’t necessarily a new concept, but I do think that the awareness of it now is a lot more. People are a lot more aware of the ability to, you know, have a more androgynous appearance.

And you’ll see that my trans patients and my cisgender patients, my non-binary patients, um, maybe they, you know, my cis women really like their strong jawline but they want a softer cheek or, you know, something like that. And so, um, I think people have more of an awareness of it now. People are more able to kind of verbalize, you know, what they’re looking for because they want to kind of float between, like, their maybe more female-presenting side or their more male-presenting side. So, that’s why I think the communication is easier with it now. Um, because people have a broader understanding that androgyny is an option for them as far as their appearance.”

“Every time I meet a new patient, and even with those I’ve been treating for over 20 years, it’s crucial for us to come together and reassess. Skin changes, goals shift, and sometimes our strategies need adjustments. When a patient sees me for the first time, we conduct a comprehensive facial analysis, considering everything from their skin to their overall health and lifestyle. Each person is unique in various ways, making this process quite intricate. This approach provides them with a roadmap, highlighting primary, secondary, and tertiary concerns. We then work through these step by step.

Imagine this like a candy store: if we try to do everything at once, resources could become limited. Hence, during the treatment plan, we focus on addressing the patient’s most significant goals initially. For instance, we might begin with BOTOX or Dysport, followed by fillers a month later. Meanwhile, we’ll be prepping their skin for more advanced procedures like resurfacing or microneedling, even photofacials. About six months down the line, a minor procedure like Kybella for the chin might be on the horizon. This plan not only guides our actions but also helps patients prepare better. They can allocate resources and schedule downtime, recognizing that not all procedures are quick “lunchtime” appointments.

The roadmap serves as a reminder for the patient and aids in keeping track of their progress. Are they keeping up with Retin-A? How’s their experience with the CE serum? Do they need more eye cream? This check-in is essential because skincare plays a significant role in our approach. While injections are essential, skincare is akin to your personal dental hygiene routine—just like flossing and brushing complement your dentist’s work. This balance can extend the time between appointments, as healthy skin requires continuous upkeep. This individualized treatment plan encompasses all these aspects to ensure the best results in the long run.”

“The timing can differ significantly for each patient. I encounter individuals with hands that appear stunningly youthful at 60, while others in their 30s may not share the same youthful appearance. A crucial factor is your body’s natural tendencies. Some are blessed with inherently smooth, full, and beautiful hand skin, whereas others may not be as fortunate. Hence, pinpointing a specific age isn’t feasible. The determination hinges on various factors: body composition, volume loss, sun damage, pigmentation issues, and texture concerns.

Volumizing the hands yields impressive results and works remarkably well. However, as we restore volume to the hands, people begin noticing other aspects too. Consequently, I’ve employed an array of procedures. Laser resurfacing and photofacials have proven effective. I’ve integrated Retin-A usage into treatment plans, along with micro-needling for hand rejuvenation. This comprehensive approach is vital because while we might have an overall appealing appearance, our hands can easily reveal our age, becoming a noticeable giveaway.

In essence, there isn’t a universal age when hand rejuvenation is necessary; it’s an individualized assessment. Our hands can age differently due to various factors, making a personalized approach critical to achieving the desired outcome.”

“That’s an interesting question because there weren’t a lot of Master injectors when I started. Um, and again, when you start doing injectables, even if it’s just like botox or, when I was starting, was collagen, um, when I started there really weren’t any training programs for this sort of thing. She just kind of learned; in my case, I was mostly trained by the dermatologist I was working for at the time. Um, and it’s terrifying the first time, you know, the first few times you see patients on your own and you just got to make a decision, and you’re, you know, it’s very intimidating, uh, when you’re first beginning.

And being a master injector basically means is, I can globally treat the entire face with whatever it is, fillers, injectables, Botox, that sort of thing. Um, and then, we’ve, no one would recognize if something’s not happening like because all these things have complications. And so, I think the most important thing is, you know, as a master injector, you know what they are, you know your facial Anatomy by heart, you’re able to avoid a lot of things and early intervention if you do see something happening. And it’s also you just lose, I would say, when I’m starting to work with new patients there’s always, you know, we create like a whole roadmap as far as we’re going, what we’re doing. Um, and so, I no longer have like anxiety of any sport when I start injecting a patient, just because you know what you know, and you know, it’s hard to explain that in a way, but there’s just something about it. It’s more than ten thousand hours everybody thinks, so ten thousand hours you become an expert. I’m like, oh no, I still learn something new every day. Um, and I think that’s the other thing, is like being a master injector, we’re constantly learning and constantly training, you’re constantly on top of new treatments, procedures, techniques, you know, that sort of thing.”

“Well, that’s an interesting question because there’s a lot of um debate around injectables. Uh, there’s a lot of fear, there’s a lot of overuse, and that sort of thing. So I think we’re very fortunate to have, you know, fillers and injectables like Botox, Dysport, and all, you know, all the things that we have now. Because when I began in this industry, there wasn’t a lot of options. Um, but I think everything needs to be used consciously and used in a very considerate way. Because, you know, in looking at a patient’s entire global appearance, um, and, you know, you can always add more but you can’t always subtract things. So I think it’s important to really hone in on what the patient’s goals are, what your aesthetic goals are for them, and what you together decided you want to achieve with the patient’s cosmetic outcomes and take it from there.”

“Yes, I mean, definitely. This can give them a peek in the window, you know, for certain things, especially with fillers. But also, injecting the masseter muscles with either Botox or Dysport can kind of slim the jawline a little bit. Doing a little bit of Botox or Dysport in the brow to elevate the brows a little bit. And of course, skin treatments. Everybody needs a skin treatment, everybody needs some kind of Retin-A, maybe some photofacials. Everybody can have better-looking skin, so that’s kind of gender-neutral in my opinion.

But there are a lot of things that we can do, especially if someone wants a stronger jawline. We now have a new filler out that’s specifically for jawline contouring, so that’s pretty cool. There’s definitely a lot of options, and it’s, again, not going to get the patient 100% there, but for some patients, it’s enough to take a little bit of the edge off of their anxiety with their appearance.”

“Certainly, the variety of offerings we have now is far, far, far more reaching. When I first started in this industry, Botox was not FDA approved for cosmetic use. We were using it, we were injecting it, it was off-label. But that’s the reason there weren’t training programs and you know, and that’s the thing. Also, at the time I began, collagen was the only dermal filler that we had, and you had to test patch patients and wait 30 days to treat them to make sure they weren’t actually allergic to the product. Lasers were in a very early phase, photofacial was just being developed by the dermatologist I was working with. You know, so many things have changed. We now have so many offerings. We didn’t have skin tightening, we didn’t have microneedling, we didn’t have a lot of things, and now we’ve got a filler for every nook and cranny. You can fill areas of the face, hands, earlobes, you know. So many options. And when I started doing fillers, we were only filling the nasolabial fold area and the lip, and now we’re doing cheeks, temples, tear troughs, and jawline contouring.

So, it’s really turned into a very exciting industry, and there are still a lot of changes coming. I think patients are much more open to learning about non-surgical options. I think the media has helped somewhat with that in terms of making it very approachable. You’ll see companies like Allergan and Galderma direct marketing to potential customers out there in television ads. So, it’s become a source of social media. Social media has completely blown the cosmetic industry onto the page.”

“That’s an interesting question. There are a lot of great skincare products out there. I tend to lead more toward medical-grade skincare that has a lot of science behind it. One of the brands that I find works well, especially when integrating it into treatments in my practice, is the SkinCeuticals line. It’s very well studied, but it’s not the only line out there. So, I will draw from several different lines. You do want to stay within a medical-grade, and that’s why it’s important, if you’re going to get core products like any antioxidants and actual anti-aging products, you want to be getting them from a plastic surgeon’s or dermatologist’s office because we have access to medical-grade skincare.

The problem with over-the-counter products is they can only contain four percent of any active ingredient, so everything else in there is fillers, petroleum, water, and a bunch of other stuff. And some of that stuff can be actually very irritating. So, if you know what’s in your products and you understand the science behind something like vitamin C and how it penetrates and does what it does, you’re going to get a lot more bang for your buck. And the products don’t have to be hundreds and hundreds of dollars. Certain products may be, but at the same time, there are very high-quality products that are in the medical-grade skincare line that I feel are very reasonable. And you use so much smaller quantities of them because they tend to be more concentrated.”