Why Do Patients Often Ask for the Wrong Treatment?

For almost a quarter century, I've spent my days talking to people about facial balance. What's the right thing? What's the wrong thing? People come in here all the time wanting nasolabial fold fillers. 80% of the time I'm like, no, you don't need it. Don't do it.

A lot of people come in here looking for lip injections and they want to look natural. I'm like, you already look unnatural because the lips are too full for you. The lip is jutting out. It doesn't look natural. So I have to re-educate them on that.

But then when you try to teach them about the importance of having mid-face volume, proper chin balance, proper pre-jowl balance, proper jawline balance, they're hesitant because they've seen so many bad filler jobs. Listen, bad things scare people out of things. Michael Jackson's rhinoplasty scared a lot of people out of getting a nose job. But if things are done properly, it goes unnoticed. It goes naturally with your face. You don't notice it. It's only the weird stuff, the bad stuff, the botched stuff. Those are the things you notice.

And with the aesthetic industry booming, and med spas and all sorts of doctors, family doctors, internists, pediatricians, neurologists, nephrologists, everybody getting into the aesthetic business, there are people walking around with unnatural looks about them, and it's going to scare their sister or cousin or neighbor from getting a procedure, because they know, hey, Julie went for fillers and now she looks terrible. Doesn't mean fillers are bad. It's just that Julie chose the wrong injector.

I'm not even talking about just fillers. We could do fat injections to certain areas. We could do deep plane facelifts to basically reorient things in a more natural direction. If somebody comes in with significant submental fullness, I'm not going to talk them into Kybella. That's not going to work. That's a waste of your time and your money. If they're young, they can do an isolated deep neck sculpture. If they're not young, then they'll need to combine it with a deep plane face and neck lift. Those are things that have to be done.

The misconception about the Botox brow lift: if you want the brows to come up significantly, you have to tolerate lines on the forehead. If you smooth out the frontalis, the lines on the forehead get smoother, but then the muscle that's actually doing the lifting goes to sleep, so you're not going to get a brow lift. Therefore, you have to choose between smooth or lifted. If not, then we have to think about an actual brow lift, brow resetting, brow repositioning.

So I've spent all day long for over two decades talking to people about what's right, what's wrong. The problem is people come in here having seen bad stuff from friends, family, neighbors, Instagram. People come in here getting the wrong information from social media.