What Your Aesthetic Expert Sees That You Don't

What a clinician actually sees

When you look in the mirror, you look for what bothers you. A line, a hollow, a shadow, a spot. You come to your appointment with that concern front of mind, sometimes with a treatment already decided. What an experienced aesthetic clinician sees is something else entirely.

The trained eye assesses proportion before detail such as volume distribution across the mid-face, the lateral face, the temporal area. The structural framework underneath: bone structure, brow position, the relationship between the orbital rim and the cheek. Movement patterns — what the face does when it’s smiling or frowning, and how that interacts with whatever that specific concern you came in about. In addition, they should also be seeing skin quality: baseline texture, tone, density, and what is changing. This is akin to an expert designer not just looking at a single window in a design, but the whole house and how all the aspects of it are working together.

The concern you came in with is usually real. But the cause is often less obvious. A patient focused on nasolabial folds don’t usually realize that it’s a result of broader mid-face volume loss, not the folds themselves. A patient who thinks her eyes look tired doesn’t realize that the treatment may need to address surrounding areas instead of the part that is presenting as tired. Treating the symptom and ignoring the cause produces results that look treated. Treating the cause produces results that look like you.

You’re looking in the mirror and I’m looking at your face. What you may see is a brown spot, a line, lips that need volume, cheeks that aren’t big enough. What I’m seeing is the overall contour and shape of your face — not only in two dimensions, but in three. Because what I want to help you with is your very best framework for the future. And your very best feature. That comes from a trained eye, and all the years of education that go into developing one.

Ava Shamban, MD, FAAD

The most common things patients misidentify

Aesthetic concerns are almost never what they appear to be at first glance. This is not because patients are wrong to notice what they notice. It’s because the face is a system, and what shows up on the surface is usually downstream of something structural.

The most instructive examples should come up in consultation regularly.

• The patient frustrated by nasolabial folds who has had them filled multiple times without satisfaction: the folds are there because the cheek above them have deflated. Treat the cheek, the folds improve without touching them directly.
• The patient who dislikes her jawline and thinks she needs Botox for masseter reduction: what may actually be happening is early jowling from descending tissue, and the treatment is structural.
• The patient convinced she needs her lips done: often the issue is perioral lines, or a lip-to-face proportion that has shifted with the overall face, not the lips in isolation.

None of these concerns may be obvious from the patient’s perspective. The mirror doesn’t show you causes. It shows you effects.

Does this one line or wrinkle bother you? You always want your facial architecture and facial shape to match your facial skin quality. Even if you have one line or wrinkle that really stands out to you, sometimes looking at the whole picture shows that that’s not really the biggest issue. Let your dermatologist take a good look at you holistically — so you can come up with a nice 360-degree plan for the long term.

Lisa Ishii, MD

How to get more out of a consultation

The clinical eye is not something you can replicate by watching videos on social or reading a guide. But you can learn to ask the right questions.

Ask your clinician to describe what they see, not just what they would treat. That distinction matters. A clinician telling you what they see is giving you their assessment. A clinician telling you what they would treat without explanation may be a sign they are not seeing the full picture.

Ask specifically about the relationship between your concern and its likely cause. If you’re bothered by X, ask: is X the thing to treat, or is there something underlying X that would produce a better result? A clinician who can answer that clearly is working from a full picture. One who can’t may be working from a menu.

There’s really no specific age that we say you’re a candidate for a facelift — everyone’s different. I do strongly suggest that you visit with an aesthetic physician who’s knowledgeable in all the different types of procedures. You’ve gotta trust your provider. He or she should direct you to the proper person and the proper procedure in order for you to get the best outcome.

Steven Dayan, MD

Why the clinical picture matters more as treatments evolve

A decade ago, the standard aesthetic consultation was narrower. A concern, a booking, a treatment. That model still exists in many places and produces results consistent with its approach: single treatments, uncoordinated, accumulating without compounding.

As the treatment toolkit has expanded, the value of starting from the full picture has grown. Once you have the picture, putting together a combination of protocols in the right order will achieve the best results. The more sophisticated the tools available, the more the initial clinical assessment determines what tools to use to actually achieve a remarkable outcome.

The clinician’s view isn’t just a diagnostic step. It’s the plan. If you aren’t getting an experienced clinician view that is focused on the complete you, you’re just not getting the best that medical aesthetics has to offer.