Injectables: Real Talk With A Cosmetic Dermatologist, Dr. Marnie Nussbaum

This month, Dr. Marnie Nussbaum delves into the details of her vision and philosophy for doing cosmetic injectables at her medical practice and offers advice on how to be sure you are getting the best possible treatment with a legitimate and board-certified provider!

What is your vision/philosophy when it comes to offering injectable treatments at your practice (both neuromodulators and fillers)?

Dr. Marnie Nussbaum: I view each cosmetic patient individually which is why a cosmetic consultation is so important. It is essential to discuss specific concerns, expectations as well as short and long-term goals. Each patient is treated with a tailored approach encompassing neuromodulators such as Botox, fillers (volumizers), lasers and skin care. I tend to go for a more natural appearance, as we can always do more but it is hard to ‘undo’ what has been overdone. My view is that we are on an aesthetic journey together to attain desired results. However, I truly believe minor, frequent tweaks are the best way to attain a natural yet rejuvenated appearance. Many of my patients love that they look refreshed, yet no one can tell they had “work” done. 

How does someone know when they are ‘ready’ for injectables?

Dr. Marnie Nussbaum: My philosophy has always been you don’t NEED anything. However, if something bothers you – fix it :). Yes, it may be a slippery slope, however an ethical board-certified dermatologist should treat the desired correction. For instance, I love my husband’s crow’s feet (fine lines around the eyes), however, some patients want them gone to open up the eye area. 

What are your thoughts around the new ‘dry bar for injectable’ locations we are seeing pop up across the country?

Dr. Marnie Nussbaum: I cannot stress enough how important it is to be treated by a board-certified physician with aesthetic experience. The new injectable pop-up locations are appealing to the “dry-bar” phenomenon of convenience at an affordable price. However, treating your face is not like getting your hair or nails done! There are significant consequences to injectable adverse events such as skin necrosis/death and blindness. These pop-up shops cannot compare to the years of experience that a board-certified physician has in both clinical and academic education. It is essential to understand facial anatomy, vasculature and how these structures interact together AND vary individually. There is no paint by numbers map for injectables. You want a physician that tailors their approach to your specific anatomy, concerns and medical history. While I realize convenience is key in our current lifestyle, we need to keep in mind safety and expertise which is why I am now offering a new concierge service that gives patients the convenience of being at home without compromising on safety or medical expertise. 

Related, any advice for patients looking for a provider/what to look out for when they are doing their research?

Dr. Marnie Nussbaum: When researching a provider, look at their past education, clinical experience and board certification. Most of all, ask your friends and family members – word of mouth is the best when coming from a trusted source (especially your primary physician!).

What is the best advice you have for someone who is considering injectables but afraid of where to start?

Dr. Marnie Nussbaum: Make an appointment for a cosmetic consultation and discuss areas of concern or simply ask questions you may have about the procedure, product or after care.

Are there any new injectable ‘trends’ that you are seeing/requests you receive?

Dr. Marnie Nussbaum: The current trend is treating the face in a 4-dimensional way (the fourth dimension meaning during movement). When fillers first came onto the market, people viewed the face 2-dimensionally, meaning they simply filled in the lines. We then moved toward a 3-dimensional approach which included added volume in deflated areas to lift the face and erase lower lines. We finally have arrived at treating the face 4-dimensionally and therefore volumizing as well as lifting but keeping in mind movement and facial expression. The key is to understand how to utilize the expansive armamentarium of neuromodulators and fillers synergistically to maintain a rejuvenated and refreshed appearance. I also vehemently believe that well-placed droplets of filler and botox can dramatically alter the effects of aging as opposed to filling the face with multiple syringes. We want natural yet refreshed, not dramatically altered. We want you to walk into the room feeling your best but still looking like you, not like a different person.

Any skincare you recommend to help complement injectables?

Dr. Marnie Nussbaum: Skincare is essential to maintaining results of injectables and the integrity of the skin. For example, everyone should be moisturizing to protect the epidermal barrier, which, when dehydrated, can create fine lines and appear dull. I put almost every patient on a vitamin C serum in the morning to protect against UV damage which causes free radical damage leading to wrinkles and skin cancer. This is in addition to recommending a daily sunscreen at a minimum of SPF 30. I also recommend a retinoid nightly (except if pregnant or breastfeeding) in order to increase skin cell turnover and keep the skin looking healthy.

Anything else you would like to share or highlight?

Dr. Marnie Nussbaum: The most important thing is to love yourself from within and realize that that is where the real beauty lies! That being said, healthy skin is happy skin! Your provider should be your partner in sharing concerns, questions and goals. You should always feel comfortable with every decision being made and understand the reasoning behind each and every approach! Good luck!