What to Ask Before Your First Cosmetic Procedure

Welcome to Under the Surface,

where we explore aesthetics

and the conversations shaping modern beauty.

I'm your host, Dianna Singh, Features Director at Allure.

Today we're talking to anyone curious

about trying injectables for the first time.

The process can feel overwhelming

and there's a lot to consider

before your first appointment.

Joining us is Dr. Doris Day, board certified dermatologist,

clinical professor at NYU Langone Health,

and a leader in cosmetic dermatology.

Thank you for joining us Dr. Day.

Thanks for having me.

Let's jump right in.

[bright music]

So to kick us off Dr. Day,

could you share your personal philosophy

when it comes to cosmetic injectables?

My philosophy is that it's not the injectables

that you start with.

Mm. The most important step

is to start with a proper assessment.

And in that case, I need to get to know the patient,

why they're there,

and everybody's usually coming

to something or through something.

They're either getting over a relationship issue

or getting ready to go back in the job market,

or they have a birthday coming up, or a wedding,

or something has happened in their life

that's caused this change that they would like to address.

And when I understand their why,

what they're looking to address, that really helps.

And one of the most important things I think I do

is help them understand how what you see on the surface

is affected by everything going on behind the surface.

And I learned this from my dad a long time ago.

He was a doctor too,

but he was to me, the OG longevity doctor,

and he always said, We should all die young at an old age.

Ah, I like that. And I added,

and we should look beautiful doing it.

Yes.

So we talk about almost everything

except for injectables.

We talk about diet, and lifestyle,

and stress, and management,

and sleep, and job, and kids,

and like whatever else is on the table.

Yeah. And then we come around

to understanding what they want to accomplish.

But that conversation helps me watch

their natural animation.

Their natural facial structure.

And I feel like everybody kind of has two faces.

They have a right side and a left side,

and the right side and left side age often very differently.

Mm. And I can get a sense

of how they've aged or how they're going to age

just by watching them naturally animate.

Now, in the past, it was always about plastic surgery.

So there was surgical anatomy.

You would age, then you'd see the plastic surgeon,

they would cut, they would lift, they would tight,

they would sew, they would tack,

and then you get on with life.

But once we had non-surgical approaches,

what we started to learn

is that there's a non-surgical anatomy.

And we started looking at anatomy very differently.

We started understanding the bone structure

and the architecture of the face changes with age.

And one of the biggest problems I see

is that somebody comes in

and they go, I don't like this,

I don't like this, I don't like this.

And they start pointing at lines, and wrinkles,

or hollows, or problems that they see.

Sure. So the first thing I do

is I give my patients a mirror,

and the first thing they do is they say, Ugh.

And they wanna start pointing out their flaws.

Sure. So I back it up

and I go, wait a second,

what do we love about what you see?

[Dianna] Yeah.

What are your favorite features?

And then they start to look at themselves

a little differently. Yeah.

And I point out their best features,

the shape of their eyes,

the positioning of their brows,

their bone structure of their cheeks.

Because our instinct is to look and criticize.

[Dianna] Yeah.

And that's hardwired into our DNA.

If you went outside and there was a hurricane coming

and you only saw one little speck of blue in the sky,

and you said, oh, we're okay.

You're gonna get clobbered by the hurricane.

Yeah.

So it's a defense mechanism to look for the problem.

Sure. Rather than the good.

Yeah. And we do the same thing

in when we look at ourselves,

but we don't need to be that way when we look at ourselves.

So when I tell patients,

do we start seeing their beauty?

Yeah. And I tell everybody,

we all have beauty. Yeah.

And I wanna take you from beautiful to more beautiful.

Yeah. Not flawed to less flawed.

Yeah. And that changes

the whole conversation.

I also don't think that wrinkles make people look old.

And then the last step is,

I understand that your architecture is changing.

How many times do you look at somebody,

and then we look at pictures of them as teenagers,

and we marvel like, oh, that was you as a teenager.

You look completely different.

And yet at 60 people are still trying

to look many decades younger.

The whole architecture of your face is different.

I think beauty gets to be greater with age,

but it has to be about balance.

Yeah. And I think

that beauty with age becomes physical,

but also transcendent from that because you've survived.

Yeah.

And that is a miracle sometimes.

Yeah, yeah.

To think of all the things you've overcome

to get where you are.

Yeah. All the things

you've survived and come through all that experience

that you have.

For so many people, it is really beautiful.

And you can't create that with just an injectable,

but you have to celebrate it with the injectable.

Yeah, I mean, at Allure,

we don't use the word anti-aging

in any of our stories or communications,

because to us, to be anti-aging is to be anti-life.

Yes.

And as your father said, live long, but be young.

Exactly. Yeah.

Is it a dangerous question when someone sits in your chair

and asks you, what would you do for me?

Is that a, that opens a can of worms sometimes?

No, I think it's actually the best question.

[Dianna] Okay.

Because if I am the expert

and the person with experience,

the way that I understand it is

that if you point out a line that you don't like,

I don't necessarily think it's the line

that is so offensive.

It's what the line conveys.

So if somebody has crow's feet

or lines around the eyes,

it may convey that they're tired.

If they have marionette lines,

it may convey that they're sad.

So, they're, I tie it to an emotion.

Yeah. That is conveyed

by that line. Yeah.

And the problem for me

is when somebody asks for something

that I don't think matches their aesthetic

and I don't think will serve them well.

So that's where we see these trends

of people getting overfilled,

is because they go in and then they tell the person

what they want and the person does it.

And okay, you solve that problem.

So I say, you may have reached the goal,

you erase that line.

Yeah.

But you miss the purpose,

which was to actually look better.

Yeah, yeah.

So what happens is, if I understand the movement,

which I get from the conversation,

I get that if you have forehead lines, for example,

chances are it's because your lids are heavy

or your brows have dropped.

Mm. So the reason

that you make forehead lines is you're contracting

the forehead muscle to lift the brows,

to try to get your eyelids out of your eyes,

to look more alert when you talk.

Wow, hearing you speak just makes it so clear

that you need to go to a board certified,

highly trained professional

if you are seeking out aesthetic enhancements.

Wow.

Absolutely.

And it's so much fun to do and wow is my favorite word.

Yeah, yeah.

It's when someone looks in the mirror and they go, wow.

And that makes me happy and it's wow.

And I look just like myself.

Yeah. Those are the two words

we always want to hear,

is that somebody loves how they look

and they see themselves in the mirror.

Yeah. And that makes me so happy.

Going back to the consultation idea

and ways you can prepare,

you've mentioned, you know, as things change with age,

do you like when folks bring a photo of themselves

from always a period of time in their lives

when they were happy with their appearance?

That's always the homework. Okay.

Is to bring in a photo of yourself

from your twenties, thirties, forties,

depending on how old you are.

And it isn't so much that we want to restore you to that,

but we understand your balance.

Yeah. And where you were.

So some people never had a big chin

and they would've benefited from a little filler back then

if we had it. Sure.

And now we can help restore that.

So, it's a matter for us to understand

how their trajectory was, of how they're aging.

And actually patients love doing it.

Yeah. So I tell them,

if you have it on your phone,

Yeah. make a folder.

And then this way when you come in,

we can just open the folder.

Otherwise you're scrolling, trying to try to find pictures.

So either take pictures, put it in a folder,

and bring it as a photo or in your phone, make a folder.

Yeah.

I imagine that's a more successful gauge

than say, bringing in a photo of a celebrity

or someone who is not you.

Right, right, I mean, yes.

If somebody has different bone structure we can't match.

And we listen, celebrities are celebrities.

What other key things should someone do

before their first consultation?

Whether that's physical preparation, mental preparation.

How should the patient get ready for the consultation?

I would write down your questions.

If you have a friend who can be an advocate for you,

I think it's good to bring in a friend,

Yeah. as an advocate.

They can write down answers to your questions.

In my office, my medical assistants

are really highly trained.

They're all pre-med or pre-PA.

[Dianna] Yeah.

And they write everything down for the patient.

So we give them a printout

and a mailing of their, of all the notes of the visits.

So for me, I want to have a conversation with the patient

so I'm not on the computer.

Yeah. They don't

have to be on their phones. Yeah.

But if you have a friend or an advocate,

that's always fine. Yeah.

Write down what your goals are.

And think of your budget.

Yeah.

What I usually do is I make a calendar

for my patients and I will say,

this is what we could do today.

Yeah. And this is how

I would time it,

because I don't think it's healthy

to fully optimize necessarily in one visit.

[Dianna] Okay.

Some people only need one visit.

[Dianna] Sure.

Some people won't do anything in the first visit.

We'll just create a calendar

and we'll make a plan

and they can look forward to it.

But this way you can budget out for the year.

And I would also say to understand

that fillers are one tool that we have.

Sure.

Oftentimes the way that you're aging,

well always, the way that you're aging is multifactorial

and multidimensional and we need to address it that way.

So we have a very comprehensive conversation

about what you're using at home,

devices you might have at home or...

Sure. Or things you play with.

And then, and then how we would combine devices

plus injectables to get you the best results.

For someone who's meeting with a dermatologist

for the first time, are there any sort of red flags for you

where it's like you should run if they say X, Y, Z,

or don't say X, Y, Z.

The doctor, the person that you're speaking with

should be there to inform you.

Yeah.

And you should never feel pressure.

Yeah.

There are times where I'll have someone come in

and they'll go, I would never do Botox.

And I say, that's fine.

But then I tell them about what I think Botox is

and what it can do.

Sure.

And then at the end they're like,

could you do it for me today?

And I'm like nope.

Right now. Yep.

And I'm like, nope, you have to come back

and ask me for it,

because I don't want someone to do something on impulse.

[Dianna] Yeah.

So I would say if you didn't go in expecting

to do that, it's okay to say,

let me think about it and come back.

And the person who makes you feel

that you need to do it today or else you're gonna miss out.

We're not selling anything.

[Dianna] Right.

We're informing you and I'm there to support your ideas.

And to help you understand what can be done.

[Dianna] Yeah.

And as importantly, what can't be done.

[Dianna] Yeah.

There are sometimes there are things

that I have to understand what the limits are

of the tools that I have.

And I think that conversation is really important.

Should you do a degree of research as a patient

before you go into an appointment?

I mean, I am sure it's dangerous,

the ChatGPT of it all,

where people might come to you and say, I need X, Y, Z,

and you have to course correct them.

How much preparation should you do?

It's, I mean, I think to be informed is a good idea.

And ChatGPT may or may not be helpful.

I haven't ever really asked ChatGPT about a consult.

But I suppose it's going to be more and more common

that people do.

It never bothers me when people are informed and educated.

[Dianna] Yeah.

As long as they understand where I'm coming from.

[Dianna] Yeah.

But you know what, there are times where people

want things that I don't feel comfortable doing.

[Dianna] Yeah.

And I'm not the right doctor for every patient,

so it's okay.

Yeah. But yeah,

I think doing your homework about what fillers are.

Yeah. I'm amazed at how often

people don't know the difference between a filler

and a neuromodulator.

Sure.

Or a laser and a non laser device.

So the conversation goes very far.

Most people are on social media

and they see before and afters

and they follow different doctors.

And I think the nice thing about social media

is that for people who post a lot,

you see their authentic self.

Right. And the people who come in

to me from social media have followed me for a while

or start following me after their friend recommended me

and they get to know me.

And it kind of is a good icebreaker.

[Dianna] Yeah.

So the homework these days is more than ChatGPT,

it's following on social media.

And I think it does help you understand the aesthetic

of that doctor and make the visit a little bit easier.

Yeah. But no, I appreciate

what my patients have done their homework.

[Dianna] Yeah.

I have had a few patients who will say,

I like this product over this one

and I have all the products

and if I think it's appropriate, I'm okay with that.

If I think I have something better for them,

I have all the products.

So I always tell them I have everything.

I'm going to pick what's best for you.

Yeah. And most of the things

I have within the category are gonna be at the same price.

So I'm not picking something

even theoretically based on price.

[Dianna] Sure.

It's going to be really what's best for them.

Yeah, absolutely.

Well, it sounds like

it's an important relationship to nurture

because you're in it for the long haul

if you're doing it right.

My goodness.

I am seeing patients now.

I had someone who came in and it was 20 years later.

[Dianna] Wow.

And I realize like, wow. Yeah, that's incredible.

This has been going on a long time.

Well, that speaks so highly of you and your expertise

and we are so grateful you were here

for this conversation.

So thank you. I love it.

It's my pleasure. Thank you so much.

And thank you for watching.