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February 22, 2020

Consultation Tips from 6 of the Top Cosmetic Injectors

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Welcome to the Industry Interview Series


In an industry that sees annual double-digit growth, it’s important to stay needle-sharp. So, who better to learn from than some of the best aesthetic professionals in the business? That’s why Job Snob’s new Industry Interview series will focus on getting answers you need from aesthetic professionals who are at the top of their game. 


This week we sat down with some of the best cosmetic injectors and asked how they approach consultations with new patients. These injectors have honed their skills through years of experience, and they were kind enough to share how they keep their consultations on point. 


Our Panelists: 

JS: How do you approach a full facial assessment with a new patient? 


Dr. Jason Emer: It’s important to do a full assessment of the patient’s skin and overall concerns at the first consultation.  We address the face in a very strategic fashion: 1. Skin texture, 2. Color and tone 3. Skin laxity (or looseness), 4. Movement & lines, and 5. Volume loss.  Each area has a specific treatment that can give a comprehensive result.  For example, skin texture, color, and tone can be treated with peels, lasers, microneedling/PRP, skincare and facials. Volume loss is treated with Sculptra and/or fillers or fat grafting.  It’s important to emphasize a proactive long-term maintenance plan about aging rather than retroactive one. Most treatments we have to improve the skin will NOT reverse age but will slow down the process and improve previous damage (like sun damage or scarring).


Kim Welch: I always start with the mirror in the patient’s hands. I use the guideline “listen before you speak”. Asking questions about what they see can tell me 90% of what they need, past experiences, and patient expectations. I will then ask, “What is your favorite facial feature about yourself?” That will guide us into accentuating their best quality, which sometimes means working on other areas that might be distracting us from that area. For instance, if their best feature is their eyes but they have distracting 11’s (glabellar lines), then I will explain how softening the lines in between their brows will bring more attention to their eyes. 


Misty Shedd: I love having new consults and getting to know the patient and what brought them in that day. 


This time gives me the opportunity to play detective – I watch their movements, the way they scrunch their face when they talk, ask how they sleep, and understand why we see what we see on their face.


Rand Rusher: I explain a patient’s face to them before I touch them, and I show how the face is asymmetric. The left side of all of our faces is flatter and wider while the right side of our faces is higher and a little fuller. I point this out to the patient and it usually freaks them out, but it also says, “I know faces”. I try to convey to my patients that it’s the differences that make us look beautiful. I’m not trying to make their appearance “perfect”. If you do what’s right for the patient, they’ll come back to you for the rest of your career. 


Neekan Rivera: I like to look at the patient’s “before” photos objectively before I walk in, which has been really helpful. This gives me time to look at their anatomy and create a plan before I see the patient in the treatment room. I have found that if I’m prepared going into the room, I’m more effective at developing a plan for the best result.  I also often ask for patients to bring a photo of themselves from a few years prior so I can assess how they have aged and try to achieve a natural outcome that is true to their anatomy.


Pinky Elliott: I always try to educate patients on anatomical changes over time and how that affects our appearance, rather than focusing on “aging”, which may (unfortunately) have a negative perception. For example, when a patient first comes to me in her 30’s, I can speak about gradually treating volume loss before it becomes more pronounced. If someone is in her 20’s I might discuss where we are able to predict future volume loss, even if we aren’t treating that issue yet. If she’s in her 40’s, I may address the best way to build back some of the volume that has been lost, without creating an unnatural result. It’s also not uncommon for my recommendation to be no treatment at all if someone truly doesn’t need it. Finally, my consultations focus on balance and symmetry versus treating areas in isolation.


JS: When putting together a new patient treatment plan, what should every injector keep in mind?


PE: I make sure to do a thorough review of medical history and make sure they are a good candidate for everything I might recommend. I always create a plan around what is going to provide the best outcome for the patient, regardless of the financial implications. If the patient’s budget is a limitation, we can plan to treat them over a longer period of time, and still get a great end result. I make recommendations around skin quality and texture that compliment what we are doing on the injectable side. Finally, if the patient isn’t a good candidate or has underlying issues that I can’t address, I will refer to a surgeon, Naturopath, or other specialist better aligned with their needs. 


JE:  It’s important to customize a treatment plan based on all the areas of aging including texture, sagging, and volume loss. We also individualize the plan based on skin type and aging. In those with darker skin types, certain lasers cannot be used because of the risk of hyperpigmentation. In some patients with significant loose skin, you have to be honest about having surgery or surgical options, like a face or neck lift, before non-surgical ones that may give very minimal or no results. 


KW: Remember, you are the professional. The patient came for your expertise. Educate them on what you know. As aesthetic injectors, we have an amazing gift of understanding facial aging. Share it with them. I never pressure my patients to get treatments done; I just offer information. After I have given a treatment plan I ask, “Is this in your budget?” If not, I absolutely understand, let’s prioritize. What is the most important? Where is a good starting place? Typically, they will go home and remember what you taught them and be ready for a full correction next time. 


RR: I’ve been a nurse for 35 years and have been injecting for 25 years (since 1997), and I have learned this the hard way: you can only make the smaller side bigger. I once made a patient look like a blueberry. I made her big. She was symmetric, but I realized, she wasn’t as pretty. So that smaller side a lot of the time balances the larger side. 


Also, we’re taught 5 syringes is only a teaspoon – but if it’s placed properly, one syringe can do magic. 


JS: Have you seen any consistent patterns during consultations that you would share as a “watch out”?


RR: I’ve become a Face Fixer because there are so many people who are overshooting.  I’ve had to fix more tear troughs than I’ve actually done.


This idea that everyone needs everything- there’s that old saying, “Everything looks like a nail if all you have is a hammer.” And there are too many people in this business, where that’s all we do. It means that everybody needs everything. And that’s really not true.


This idea where everyone is “preventing” isn’t accurate. You might prevent a wrinkle on the forehead, but the frontalis muscle weakens as you age. If you start weakening a girl’s brow at age 19, she better sign-up for her first brow lift at age 40. 


JE: Time and time again, patients will come in with a filtered selfie photo of themselves from IG or Snapchat hoping to achieve that same aesthetic in real life. They don’t realize how overdone that would truly make them look or how unrealistic that type of filtered look is. 


They also bring in photos of celebrities wanting to look like them, although those celebrities have had major surgery, fillers, Botox, lasers/peels/skin- care to get those types of outcomes.  I tell patients we do not want to make them look disproportionate or altered; we want subtle micro-optimal changes to get enhancement without anyone knowing.  


Less is always MORE when you are using injectables to enhance a patient’s naturally gorgeous features. A truly respected injector is conservative and precise — no one wants the “blowfish” look or “pillow face” which is what happens when injectors aren’t experienced enough – it’s less about line FILLING and more about sculpting, defining and accentuating signature features.


NR: The biggest red flag is when a patient has seen multiple providers, and no one has been able to please them. If several of my talented colleagues have treated a patient and they still aren’t happy with the outcome, there’s a good chance I won’t be able to make them happy either.


KW:  Patient expectation! When patients come in and say, “I want these lines gone”, my response is always, “I cannot make them gone, I can soften them”. If they have had previous treatments and are never happy, I doubt I will make them happy either!


It is a policy in our office that we never speak badly about other injectors. We don’t know the whole story. We offer the best we can do and give the patients realistic expectations about a treatment and leave it up to them if that is going to meet their expectations.


PE: When patients come in and say no one else has been able to give them the results they want.


JS: How do you bridge the gap if you and the patient have different priorities for treatment?


RR: If the patient is asking for something that I don’t believe is right for them, I tell them. I’m a big believer in being honest. How am I going to help you if I’m not telling you the truth? 


NR: I try to address what’s most important to the patient in a way that is safe and complimentary to their features. Then I educate them on why I recommend treating different areas with different procedures and techniques. The goal is that the patient will understand why we are taking a certain approach for the best ultimate outcome.


PE: I have found that if I provide a really solid consultation, patients are likely to listen. For example, I see a ton of women who come in just for lip augmentation. I end up educating them on why treating other areas of their face would be more impactful. Usually, that provides a better outcome for the patient and everyone is happy.

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