Knowing proper techniques is an important part of training to perform aesthetic procedures. However, knowledge of these techniques can be useless if one does not train their ‘aesthetic eye’ to recognize individual patient needs.
At the 2020 ODAC Dermatology, Aesthetic, and Surgical conference, held in Orlando, Florida, Susan Weinkle, MD, and Jackie Yee, MD, presented “What Does Your Aesthetic Eye See? Views from a Dermatologist and Plastic Surgeon” on January 19. During their talk, they discussed tips for performing injectables, the importance of knowing a patient’s anatomy and how to balance the face, as well as how to train the eye to see what areas need treatment and what do not.
Dr Weinkle is a board-certified dermatologist in Bradenton, Florida, and Dr Yee is a board-certified plastic surgeon in Miami, Florida. Dr Weinkle also won the “Outstanding Educator & Mentor in Dermatology Award” at this year’s meeting.
The Dermatologist: Could you tell us more about what you and Dr Yee discussed during your presentation?
Dr Weinkle: We had a very positive, supportive camaraderie and reviewed the differences between a plastic surgeon’s approach to treating a certain cosmetic concern compared with a dermatologist. We really looked at it through the eyes of a plastic surgeon and the eyes of dermatologist in how we each train our aesthetic eye to see what the patient needs because if one cannot see what the patient needs, then one cannot fix it.
We each presented about 7 cases, with before and after photographs. I would present the case then ask, “what does your eye see?” Then, I discussed how I treated the patient. It was interesting to share what we would do and how we would treat a patient because we had different views. For example, we had different points of view on the use of cannulas. Dr Yee does not use cannulas and I use them in most cases.
Also, Dr Yee would frequently point out areas where an injectable could be used treat an area, but also noted that she could get better results with a knife. For example, she said she could soften the teardrop, but that she sees the lower lid as really needing a blepharoplasty.
The Dermatologist: What areas of the face should dermatologists be familiar with for contouring?
Dr Weinkle: During our presentation, we discussed the broader construct of facial shaping, how to sculpt the face, and how to change it by, for example, softening the macular, by improving the mandibular suite, or by softening the orbital skeletonization in the temple. We also reviewed other areas of the face that can be treated with neuromodulators and fillers beyond the nasolabial fold region.
Neuromodulators, for instance, can be used to enhance the beauty of the eyebrow, which is an important feature on the face. It can affect the brow positioning by shaping a woman’s brow and helping lift the lateral limbus and relaxing the depression muscles around the eye. Obviously, the periorbital location is another very important area to address because we communicate with our eyes.
In addition, the anterior medial space is also important for contouring, and we discussed how to balance the lips. Sometimes, patients have inherent asymmetry, and so giving balance to the lips is very important. Perfect symmetry is needed for the lips, but other areas just need balance, such as the eyebrows, cheeks, and eyelids.
We also reviewed the importance of facial balance, which does not always require perfect symmetry, discussed the safety of injection, and the planes of injecting, as well as the types of products and where we placed them in the face.
The Dermatologist: What other recommendations do you have for dermatologists?
Dr Weinkle: It is important to know when to say “no” to a patient. Sometimes, you have to recognize that the patient does not need anything. You really have to have courage to look at the patient and say, “quite honestly, you don’t need any of this.”
Dr Yee showed a very interesting patient case at the end of our presentation. She asked, “what do you think this patient needs?” I looked and said, “Well, I do not think the patient needs anything.” And she said, “That’s exactly the point.” We have to be careful not to over‑treat patients and remember that less is better and less is more.
The Dermatologist: Do you have any other key takeaways you would like attendees to leave with?
Dr Weinkle: It is important that we, as dermatologist and plastic surgeons, work together. I think we are very complementary together. Also, we need to recognize when dermatologists need the expertise from a plastic surgeon.
Next year at ODAC, Dr Yee and I are hoping to expand the session and have more time to interact with attendees.
Weinkle S, Yee J. What does your aesthetic eye see? Views from a dermatologist and plastic surgeon. Presented at: 2020 ODAC Dermatology, Aesthetic, and Surgical conference; January 19; Orlando, Florida.