Robyn Siperstein, MD, FAAD: Initiating a Patient-First Dialogue in Cosmetic Dermatology

Robyn Siperstein, MD, FAAD, is a board-certified dermatologist practicing at Siperstein Dermatology Group in Boynton Beach and Boca Raton, Florida.

Siperstein sat down with Dermatology Times at the 2023 Society of Dermatology Physician Assistants (SDPA) Annual Fall Dermatology Conference in Nashville, TN, to discuss key highlights and takeaways from her sessions, "How to Choose a Cosmetic Plan for a Patient," and "Contrary to Popular Belief: Thought Changing Research in Cosmetic Dermatology."

"People often remember how they feel but not exactly what is said," Siperstein said. "And so I often ask people to discuss their favorite feature, not just what they want to fix."

Transcript

Robyn Siperstein, MD, FAAD: I am Dr. Robyn Siperstein. I'm a board-certified cosmetic dermatologist from Florida, and today I'm going to be talking about how to choose a cosmetic plan for your patient. I think it's really important not to just go from the top of the face to the bottom, but also to go from the inside out. The analogy that I use is a 5-layer cake. So the bottom of our cake is the plate which is like our bone, and then a 2-layer of yellow fluffy cake. The bottom yellow flap is the deep fat, he top is a superficial fat, and in between, we have some red icing, which is an analogy for the muscle. Icing on top, as well, is our skin. I talked how we need different modalities for each. So for instance, on the top of the skin, we would use things like IPL, laser resurfacing, ablative procedures to help smooth out. For our superficial fat layer, that creates our contours, so a soft, non structural filler is great there, whereas deeper down on the plate or the bone or the deep fat, we need very strong structural fillers. Kind of think of it as the base building blocks of a house.

So depending on where you are, we'll guide you in what you're going to recommend from a step-by-step perspective from inside out. I also give some tips on how to make the patient feel their best during the consult and creating the plan. People often remember how they feel but not exactly what is said, and so I often ask people to discuss their favorite feature, not just what they want to fix. When I am discussing things that might be negative, such as asymmetries or lines that they have at rest, to warn them what will or will not go away and proper expectations, I have famous people pictures of, for instance, Taylor Swift with 1 eyebrow higher than the other, chins different lengths, so that they know even the most beautiful people do have asymmetries and that it's okay.

My second talk is Contrary to Popular Belief, and that is one of my favorite talks to give. Unfortunately, in all aspects of life, we're often taught things, and we don't think to question them. So the whole idea behind this is to question things that were taught from generation to generation and really analyze where we get our knowledge from and make sure that it's evidence-based. I review different studies and how to analyze a study and then go through some specific examples. The 3 examples I give, one is around neuromodulators, such as Botox, not bending our heads or resting for 4 hours, and where this myth actually came from, and what is much more likely given some of my research and literature review.

I also discuss filler longevity. We thought for a long time on-label indications anywhere from 6 months to up to 2 years. But we're now getting MRI studies showing that it can last up to 15 years in certain areas, and so this is important to use this knowledge in our consults and consents.

Lastly, was my most recent research project which is on cannulas, and it is showing that even 27 and 30- gauge cannulas can be safe and often better for certain really delicate areas like the undereye area. I go into my research and actually some videos using cadavers showing why cannulas are so much safer because their coefficient of friction helps to glide over and under the vessel, and also that they have less arterial penetration force than a needle.

[Transcript has been edited for clarity.]

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