Can you look natural when getting Botox & Fillers?

Can you look natural when getting Botox & Dermal Fillers?
We hear this question on a daily basis in our practice, especially being in the North East. Lets face it, Hollywood has pushed the boundaries of what is refreshed and what is shockingly obvious that someone had work done. Many people in the North East are conservative and wish to have a refresher, without appearing as though they had Botox & Fillers. This blog addresses this concern.

As a clinical trainer and injector, I understand the balance between looking natural and refreshed vs overdone. My goal is to never have someone look frozen or over filled. So, why does this happen? Often, it is simply lack of an artistic eye. Many providers can be safe injectors who understand all of the principles, but they do not have an artists vision as to what an individual face needs. It can also be that the client has taken the drivers seat and is now dictation where the provider should inject. We hear this a lot, “fill my lines, get rid of this wrinkle”. Non-surgical enhancement is not about filling lines or freezing wrinkles, it is about correcting volume loss, softening certain muscle groups and enhancing your natural beauty.

Rule of thumb 101, if the deal is too good to be true, then beware! Think Groupon deals or home parties. Many providers are inexperienced and you are not going to get a beautiful, natural look. Rule 102, if the injector or the staff look like they have had work done, you are going to look that way too. I can’t tell you the number of times I have gone into a training and am taken back by how the provider and staff look over filled or frozen. If they do not look natural, chances are you will not either. Rule 103, it if not about the amount of Botox or Fillers that makes you look overdone, but where they are placed. For example, the other day I saw a beautiful women in her late 30s with some volume loss and enhanced her with 3 syringes of filler in strategic locations like her temple, lateral cheek, and chin. Every face is unique and a cookie cutter approach is not going to give you a natural look. We can not create Angelina lips to fit your face if your other features can not carry that lip style.

With Botox it is true that too much in the wrong places will make you look unnatural, for women, that is often being over treated in the forehead, which can drop the brow and create a masculine look. However, an ultra conservative Botox approach in the areas that strong muscles pull downward, like between the brows and around the eyes can actually still make you look unnatural. Many providers do not use Botox in the lower face and this should be a red flag. If you are just getting Botox in the upper face and fillers in the lower face, you can look like you have had work done.

Come see our team and have a 360 Consultation. Our goal is to enhance your best features and make you look refreshed.


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A Rolex Doesn’t Go On Sale! A great blog by Adam Horoun shared by RN Esthetics

A Rolex Doesn’t Go On Sale: How So Many Aesthetic Providers Destroy Their Value & Tips To Avoid Being “That”​ Practice

A Blog that must be shared by Adam Haroun, Award-Winning Brand Marketing Strategist | Consultant to North America’s Most Innovative Aesthetic Practices

Did you hear about the blowout sale at the Rolex store recently?

For those of you who enjoy travel, were you able to scoop up a bargain when the Ritz-Carlton had it’s “all rooms must go!” deal?

If you’re an automotive aficionado, have you noticed that a Mercedes-Benz salesperson is always eager to slash away at a MSRP…so you will sign on the dotted line that day?

What about the “end of season” buy-one-get-one-free promotion at Louis Vuitton?

No! Of course not! The reason you’ve never heard about or seen any of the instances above is that they would simply never happen.

Many of the most prolific brands in the world recognize their value, and refuse to do anything that would ever diminish or take away from the cachet they have spent decades to build. To share two quick examples of how seriously the world’s most coveted brands will go to protect their value – Louis Vuitton literally burns unsold inventory each year, to avoid putting a lower price tag on their top-quality merchandise. Meanwhile, in the 1990s Burberry decided to abruptly stop manufacturing it’s ball caps after they gained popularity and became a cultural symbol among the street-gang youth crowd in the United Kingdom.

While these examples are extreme, the very same principles apply to your aesthetic practice. All too many surgeons and providers aim to drive business and attract new patients by doing the one thing they never should…destroying their value. Today, I’d like to share how many practices ruin the prestige and quality they work so hard to build, often without realizing it. I’d also like to share a number of action items your practice can take to avoid being one of the many that finds itself devaluing procedures.

Devaluation Culprit #1: Constant Use of Discounting/Group Buying Sites

While it’s one thing to use a promotional offer or loss leader to attract a long-term client relationship (in my experience, offering peels can be one of the best ways to leverage this strategy)…incessantly using discounts to get new patients into your practice is entirely another. Remember that from a patient’s very first interaction with your practice, you are “training” them on what to expect. A patient who comes to you through rampant discounting will expect discounts for the duration of their relationship with your practice. As for group buying sites, just say no.

Unless a client comes to BrandingMD in incredibly desperate financial circumstances, we do not permit them to use Groupon or similar sites to promote their services. There is frankly no faster way to position your practice as a commodity – the ultimate marketing “no-no”, as I explained in my previous article about why so many practices struggle. if a client comes to you over price, that is precisely why they will leave. Simply put, clients who are bargain-driven almost never have any sense of loyalty.

How To Fix The Problem: Use discounting and promotional offers sparingly, and only when paired with a campaign to further convert and engage both new and prospective patients. Ideally, any low-priced offer should be part of what we refer to as an “ascension model” – to upgrade them to progressively higher-value procedures that offer superior results. As an example, you may run a Facebook campaign for an attractively-priced peel. Once someone comes into the practice and receives the treatment, they are then entered into an e-mail nurturing and patient education campaign for laser resurfacing.

Devaluation Culprit #2: Failure to Invest In The Patient Experience

As I discussed at length in my article on patient loyalty, many practices believe that offering quality customer service is the same thing as patient loyalty. While both work hand-in-hand, they are in fact quite different. To summarize the difference, customer service is the ability of an organization to consistently meet or exceed the patient’s expectations. On the other hand, patient loyalty is the desire on behalf of the patient to continue to do business with a practice over time. Patient loyalty is rooted in an emotional connection with a practice, and driven by a consistent experience and interaction with people, products and processes. Whereas quality customer service is a requirement to do business (and further drives loyal clientele), patient loyalty is the foundation of sustained profitability and growth. The key to patient loyalty is delivering a remarkable patient experience

How To Fix The Problem: You’ll find that most patients have never received any kind of personalized communication from a doctor or aesthetic provider, ever. From a personal, unexpected phone call to your patient to having a member of your staff write hand-written thank-you card, imagine how enhanced appreciation of your patients would create word-of-mouth discussion about your practice While the sky is the limit, here are just a sampling of several simple (and very affordable) initiatives your practice can implement to create a memorable experience for your patients:

  • Handwritten letters – No list of patient appreciation suggestions would be complete without a call for handwritten letters; and for good reason – they work. Yes, they take some time, but consider doing one a day. Don’t be Hemingway, no novels – just a few lines saying thanks.
  • Train staff to learn (and use) first names – A person’s first name is the most important sound in the world. Saying it to someone shows they’re more than just a customer.
  • Share your own “amuse-bouche” – In fine dining restaurants, many chefs have an amuse-bouche, or a special bite (or small plate) specially created by their own hand, and often reserved for only the best customers. What can you give customers that is unique to your brand, or you personally?
  • Complimentary upgrades – If you add a new service or upgrade a product, consider giving it away to your best customers.
  • Post-transaction gifts – Give people something related to what they’ve purchased from you. The bigger the transaction, the more important this can be (consider the ever-present “free gift with purchase” at department store cosmetics counters!)

Devaluation Culprit #3: Driving Patient Action With Low Prices

All too many practices will do an incredible job of ‘building up’ the value and expertise of the surgeon or provider through their marketing, public relations, website, and consultation process – only to completely dismantle it at the moment that matters most. While it can be incredibly useful to use incentives to entice a patient to commit to a procedure on the day of consultation, I am of the opinion that offering substantial discounts is not the way to go about doing so. As we discussed above, discounting services from the outset “trains” your patients to expect reduced rates and negotiate with you for the duration of their relationship with the practice. What’s more, a price-based incentive to commit to a procedure at the time of consultation can create a “high-pressure”, automotive-sales type of environment which only further damages the value and quality you wish for your practice to exude.

How to Fix The Problem: The best incentives can prove to be “value adds” rather than discounts that leave a sense of desperation. From adding a non-invasive procedure at a low cost, to products that can enhance results and/or patient comfort post-procedure; there are numerous ways to drive your prospective patients to action that don’t involve “talking down” your price. An example I have seen work incredibly well for a practice that offers “mommy makeovers” is to offer a complimentary treatment with their feminine rejuvenation laser. In doing so, not only does the patient see immediate results to accompany their procedure, they often return to schedule a series of rejuvenation treatments. Not only is the patient driven to commit to their initial procedure, but the “incentive” drives another stream of revenue for the practice. If you currently use a price-discounting incentive for prospective patients, you may wish to trial a value-added incentive and compare the results – I am confident you will be pleasantly surprised.

Devaluation Culprit #4: Commodity Positioning

I saved the very best for last. As I discussed in my widely-shared article on the commoditization of aesthetic practices and procedures, while consumers may initially shop on price, what they are ultimately looking for is value. The formula to create value is simple – create an offering that is distinct in the marketplace, and serve the patient’s needs more effectively than the competition. As Theodore Levitt, the famous Harvard Business School economist, once said, “There is no such thing as a commodity. All goods and services are differentiable.” Although you may carry a generic product (as a very common example, let’s use Botox) your offered product – what you’re really selling – is the expertise, quality, skill, and distinct experience that accompanies each unit. Your execution is the differentiator here, and execution is by no means interchangeable.

How To Fix The Problem: When price becomes the primary influencing factor for purchasing a product or service, it means that the producer has failed to differentiate its services to the consumer. It means the consumer doesn’t find any more value in choosing one competitor over the other. Your practice is either perceived as a distinct brand, or as a commodity. Brands get the patient’s attention, while commodities are lost in a sea of obscurity. The more competitive your market, the more things rings true. Beginning today, I challenge you to rethink the way you approach your practice: as distinct, and never a commodity.

If you are ready to begin putting these steps into action, and maintain the value of your procedures, I’d love to share a valuable, complimentary resource that can help along the way…

For a limited time, you can download a complimentary digital edition of our popular book “Now The Patient Will See You”. With dozens of checklists, templates, and evaluation tools, this book will help you forge ahead more efficiently, confidently, and intelligently. You will be able to leverage the power of branding to enhance your existing marketing activity for maximum results. At the same time, it will accelerate your growth through a framework for market leadership that takes most practices years (if not decades) to understand and execute.

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Warning: Cookie Cutter Injecaibles Could Ruin Your Beautiful Face

The Problems with Cookie-Cutter Injectables

I have been thinking about this a lot lately. I seem to keep seeing the same faces over and over on Facebook, Instagram and in public... frozen foreheads, broad noses from too much botox, overfilled cheeks, and lips that do not fit the rest of the facial features. What is going on? I am beginning to wonder if injectors are aging people and taking beautiful faces and making them look like the same faces over and over. Here are my thoughts about why this is happening and what to look out for
As a trainer for Allergan, known as an ACE Traininer, I first began to notice this phenomenon at my own conferences that I was attended, filled with the top injectors (including Physicians, PAs, NPs, RNs).  As I was people watching, I kept seeing the same features over and over and wondered what was going on. Well, it only makes sense that if we are doing it to our own faces, the same would hold true for patients. Of course, there are so many skilled injectors out there who do not create such looks, but many do simply use injectables as though they're cookie-cutters. Here are my top 5 NO NOs:Shiny, frozen foreheads:The forehead is the only elevator in the upper face and many people complain about forehead lines with unrealistic expectations... NO movement.  So, what happens?  The frontalis is over treated with toxin creating a brow ptosis (heavy brows), diminishing the arch and masculinizing the face.


Brows should never be pulled too far apart in the center with Captain Spock peaks laterally.  This is usually a look created by a newbie who is over treating the glabellar complex (muscles in between brow) and the medial forehead area.  It also makes the bridge of the nose look wider and the eyes look smaller.  A dead give away that you have botox and an unskilled injector (Groupon anyone???).

Frozen Upper Face

Many injectors forget to use a pan facial approach to softening muscle movement with both the upper and lower face.  A little bit of neurotoxin in the chin, DAOs and perhaps lip lines can be a wonderful softening for an overall nice look.  The problem?  Once again it is the unskilled injector who often is only focused on the upper face with much too much toxin and nothing in the other half.

Over-Filled Lips.

We have all seen it and shockingly, many people want the look.  There is a fine balance, however, between giving you a full lip that looks proportioned to your face and giving you a look where you lips enter the room before you do.  Your injector should look at all of your features and create either a subtle or plump lip that fits your face.  It is also important how the filler is injected to avoid a 'joker mouth' when the corners are turned up too high and also a 'duck lip' when the lip sticks out.

Cheeks for Days

We have gone to the extreme now.  Many injectors used to fill lines and not cheeks, which did not look right.  Now we focus on cheeks and forget to assess all of the face to created softness and proportions.  This includes looking at the temples, fat pads in front of the ear area, lower face and cheeks.  Many providers over inject the cheeks, often medially, and cause the rest of the face to look off.  With such injections, often the lateral face is flattened, the temples are sunken and the eyes to look smaller.So, when you make an appointment about injectables, make sure your injector really does have an art for injecting.  They should be looking at your face, having you animate, and creating a plan that fits your individual facial features. Remember. It's about softening lines, gentle lifting and volumizing the face. Injectables should allow you to look refreshed and natural.  You want to see a provider who uses injectables all the time, has great reviews, and looks natural themselves.  If they look over filled or frozen, chances are you will come out looking the same way.

The Uplifting Anti-Aging Treatment Worth the Time and Money

We all want to look and feel great. The skin is the largest organ in the body. It protects us from the elements. But it also ages us. Sometimes, quicker than we care to admit. While investing in injectables and anti-aging skin care is great, however Ultherapy is the treatment that you really want. It will add to your arsenal of anti-aging skin care.  And this blog post will tell you why!

Where to Start

I first heard about Ultherapy 7 years ago. A  plastic surgeon clued me in, actually. And I happened to be affiliated with him. The concept made a lot of sense to me. Using ultrasound technology, you could create controlled injuries under the skin. Deep down in the dermis, you could stimulate collagen and elastin. Now, ultrasound has been around for 50+ years.  I knew that this was a great option, but the treatment was expensive. I also heard that it hurt.

Getting Re-acquainted

After trying to alternate it into our practice including Radiofrequency and Lasers, it was time to get reacquainted with Ultherapy.  After all, it has changed a lot in the past 7 years.  The amount of energy has been lowered, thus  it includes much less discomfort.  There are also more customizable treatments. These use various handpieces and advanced techniques. A LOT had changed since I first trained on this device!

FDA-Approved Anti-Aging

Now, Ultherapy is a non-invasive procedure FDA approved. It lifts skin on the neck, under the chin, the brow and the chest area. It can make your skin appear healthier. This happens thanks to the stimulation of collagen. There's really no downtime with this procedure. Many consider it a 'lunch time lift'. However, it does take more than a quick lunch. On average, you should allow 2-3 hours for a lower or full face. You only need 30 minutes for a brow though.

The Fine Print

You should know there will be some swelling post-treatment. Yellow bruising may also occur. However that can be easily covered.  Post-treatment, your face will feel sensitive to touch. It will also be a bit numb, due to cutaneous nerve swelling for a few weeks.  The procedure itself feels zingy. Almost like heat under the skin.  Many people will do the treatment with just Tylenol and Motrin pre treatment. However, we recommend some medication to take the edge off.  Our Nurse Practitioner prescribes this though.

What Else Should I Know?

The ideal age for Ultherapy is 40s-50s.  If you're older or have more laxity (loose skin), but are looking to avoid the scalpel, then it may take two treatments. These will need to occur 6 months apart for best results.  The results start to work at about 1 month. They then peak at 3 months.  This procedure is also great post-surgical procedure once healed.  Best of all, the results are natural.  We often hear people ask 'how long does it last?'.  The results are permanent. However, we keep aging. And we need to repeat the treatment every 3-5 years. This could be more frequent for older clients.

Why RN Esthetics for Anti-Aging?

Our practice is unique. Our RNs perform all of our anti-aging treatments. We have advanced certification in Ultherapy. And we've used many of the other ant-aging technologies out there. These include lasers and RF.  Ultherapy allows us to visualize the area we are treating. Then we ramp up your collagen and alastin.! We combine the treatments with our Alastin Kits for home.  We're advanced nurses, medical experts, and injectors.w We understand the anatomy. So we customize treatments to help you achieve your goals! So what are you waiting for?  Let us see you and customize a plan!
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Can your Vagina Be Depressed?

It's time for women to focus on our lady parts. After all, men have many medications and treatments to help them achieve an erection. But when will women have their turn?

Well, our team is focused on the latest technologies. So we've decided to partner with VConfidence to introduce an awesome laser. This product improves many of the symptoms that women experience post-child birth and pre/post menopause. This post below is re-shared from the vconfidence site that our team partners with.
More and more women are empowered by vConfidence’s non-invasive, no downtime vaginal rejuvenation to address laxity to reclaim their sexuality. Often, younger women who have endured induced menopause as the result of medical treatment for cancer or other issues can suffer from vaginal dryness and painful urination or dysuria. These problematic symptoms can also plague post-partum and older post-menopausal women. When sex loses its enjoyment factor and intimacy becomes painful, expectations across every dimension of one’s quality of life can diminish. vConfidence resolves major medical symptoms and invigorates your confidence with treatments that re-balance pH, reduce or eliminate urine leakage, and restore your pleasure with neo-collagenesis-based solutions that rebuild mucosa linings of the vaginal wall to tighten and revitalize tissue with a more youthful density so your pleasure receptors and romantic life are made great again.
Utilizing the latest laser technology for improved patient outcomes, vConfidence represents the ultimate in transformative fractional CO2 laser treatments that improve the health of the mucosal lining by triggering the growth of new collagen. For too long, these types of symptoms and related issues of vaginal health and well-being have been too challenging for patients to even discuss with their physicians. vConfidence represents the next generation in self-empowerment for women. Now with vConfidence, our discretion, and privacy-focused approach allows you to address your issues non-invasively. And since all of our vConfidence Approved Providers are specialized on the craft of noninvasive laser treatments, with the goal of benefiting you with better feminine health, you can know that you are in great hands.Book your consultation with our team and check out for more information.Team RN Esthetics

Medical Grade Skin Care Must Haves

Medical Grade Skin Care is Essential.

Whether you're addressing pigmentation, acne, lines, wrinkles, or other age-related changes! This isn't the same a going to the mall and purchasing a product with the MD brand name on it. Medical grade skin care products are only available at physician and medical esthetic practices. Here are some top must-haves in your skin care line up. We'll let you know why they make a difference.


This is the top anti-aging product.  Prevention is key to block both UVA & UVB rays.  UVA rays are the longer rays in length. They penetrate deeper into skin. They reach and damage structures in the dermis. This causes inflammation.  UVB rays are shorter rays. They cause damage and inflammation in the surface of the skin.  Mineral based sunscreens must contain titanium dioxide and zinc oxide. This allows them to deflect sunlight and penetrate deep into skin.  A newer Super Screen from Skin Media, called Total Defense & Repair, also prevents Infrared penetration. That can cause aging and volume loss.


These products neutralize free radicals.  Common medical grade skin care antioxidants are Vitamin C&E, Coenzyme Q10 and green tea.  Vitamin C is also shown to increase collagen production.


As we age, epidermal cells and skin turn-over diminish.  This can contribute to lines, wrinkles, pigment and other age related changes. Retinoids will help increase cell turn-over, exfoliation, increase epidermal thickness, increase production of collagen and quality of elastin. Together they will result in smoother, more even toned skin. Retinoids are your skin's BFF.

Growth Factors

These are naturally occurring tissue proteins. They initiate tissue repair, stimulate collagen and elastin synthesis, and control inflammation.  Not all growth factors are equal.  They must be stable. They must contain high concentrations of human growth factors.  Our favorite medical grade skin care growth factor is TNS Essential Serum.  This all in one product is our staff fave. It's a must-have for all skin.


These are made up of Amino Acid Chains. They increase cell production of collagen.  Peptides improve clinical appearance of aged and photo-damaged skin.

Skin-Lightening Agents

Our team is not a fan of hydroquinone products. However, we do offer very limited courses. These are combined with peels or laser in deeply pigmented skin.  Lytera is a super power serum. It contains Niacinamide, vitamine B3 to promote skin lightening, licorice root for lightening, vitamin c, retinol and more.  This is a must-have for pigmented skin. It breaks up pigment on the surface. It also prevents deep pigment from coming to the surface.Come in and see our team of experts.  Let us work within your budget to get you on a few must-haves. Better yet, sign up for our 90 day North Shore Glow & Tell for a series of peels. You'll get 90 days of must-have products for the skin.Team RN Esthetics

Dermaplaning: The Cure for the Blonde Peach Fuzz.

I'm a blonde woman. The peach fuzz facial hair is always a challenge. Lasers don't work. And who wants to deal with waxing? Then I discovered the Dermaplaning. Life was simple again! Ever heard of Dermaplaning? This blog addresses this treatment option.

What is Dermaplaning?

Dermaplaning uses a scalpel to exfoliate skin. This gets rid of the blonde peach fuzzies. This method is taught in school to Estheticians. It's a great add-on to any skin care treatment.  Dermaplaning is a safe (provided the person performing it is properly trained) and highly effective physical exfoliation procedure. It requires the use of a sterile, surgical scalpel. The scalpel gently "shaves" the skin's surface. It removes the top-most layer of dead skin along with fine, vellus hair (aka peach fuzz).Many people hear the word dermaplaning and they associate it with dermabrasion. However, this is not the same procedure. Dermabrasion is a medical procedure to deeply abrade the skin. This procedure, often done under anesthesia, can be painful. It often leaves patients with complications.  Dermaplaning is a super-simple treatment leaving the skin soft, glowing, and fuzz free.  Here is the procedure and benefits:
  • Skin is cleansed deeply.  We prefer to add this to a Hydrafacial. This procedure will leave the skin clean and hydrated.
  • Using a scalpel or similar device, and of course a delicate touch, the provider simply abrades the surface of the skin using light feathering strokes.

Who Should Consider Dermaplaning?

This is an ideal treatment for those with vellus hair (thin baby like hair). This is because it often causes a build up of dirt and oils on skin surface. It's also great for people looking for an exfoliation, but do not wish to have peels performed (ie pregnancy).  It can help products penetrate deeper and even prep skin for peels and other treatments.

What Else Should I Know?

The hair does not grow back thicker and darker... this is an old wives’ tale!  As long as the hair is superficial vellus hair, it will grow back at the same rate and texture as before the treatment. This procedure can be performed every 4 weeks as necessary.Interested?  Book with one of our master estheticians in combination with our award-winning Hydrafacial. Be fuzz-free and glowing for October.