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- [00:01]
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- [00:27]
Tess
Foreign hello guys. Welcome back to the Treatment Room podcast. I'm so glad you are tuned in because we have a super fun episode in store for you today. I am bringing on one of my best friends, Taylor Supiani, who is a PA for plastic surgeon Ben Ben Talay in Beverly Hills, California. We are going to make sure we get all of your questions answered about injectables in office treatments like micro needling and lasers. So it's going to be a good one. Welcome to the show, Taylor.
- [01:11]
Taylor Supiani
Oh, thank you so much, Tess. I am so excited to be here and to chat with you about all things skin care, injectables and more.
- [01:19]
Tess
Taylor is the queen of lip filler and lips. Can you tell us a little bit about what you do in practice? Because I know you're at Cupid Lips.
- [01:31]
Taylor Supiani
Now, so it's interesting. We all started out at Dr. Talley's practice in Beverly Hills and he had this brilliant idea one day to develop kind of like a lip focus center, hence Cupid Lips. And here we do all things lips, from dissolver to refilling to the Cupid Lift, which is a surgical intervention. Lip flips, we do hydrafacials on the lips, so lips are kind of the main focus, but they're not the sole purpose of the practice. We still do everything else, including micro needling lasers. We have customized skincare plans and we do full face facial balancing and injectables and everything you can imagine.
- [02:19]
Tess
Amazing. What makes you feel like lip filler is an area you want to focus on.
- [02:28]
Taylor Supiani
So it's so interesting. When I finished PA school, I was so excited to treat myself to my first lip treatment and I ended up having a botched lip lip filler job. And I kind of suspected it when I left. And when I came back in two weeks, I had a ton of spread above my lip and I was honestly pretty traumatized from the experience and I didn't have the greatest interaction with my provider. So I told myself, because I knew I wanted to eventually work in aesthetics, I told myself that one day when I become an aesthetic provider, I want to give people the results they're looking for. And I also want to bring like, the compassion and the good bedside manner too, because these are people's faces. We have to, one, respect the anatomy, and two, we have to respect when, you know, our work isn't exactly what people intended. And we have to be okay with that. We have to be okay with taking criticism when. Whether good or bad. So basically, when I entered practice, I went into it wanting to not only create aesthetically pleasing results, but to have like, that human element too, which you do so well.
- [03:50]
Tess
I mean, we. It's so funny because we met when I was your patient and we quickly became very close friends. But I feel like that is really rare to find a provider who is not only amazing with the end result and providing a desirable aesthetic, but also finding somebody you enjoy going to see that you feel comfortable getting these procedures with who you feel like will be honest and real with you, but also just make the experience feel like you are talking with a friend.
- [04:24]
Taylor Supiani
Yeah. And that's my hope for everyone. We have an abundance of providers in every positive, in every profession, and I mean, yours included. And I think what differentiates us is our ability to relate to people on a human level and connect with them and, you know, take the time when we have it to really empathize, sympathize and connect and build those relationships. And I think that's what builds long lasting, patient relationships too.
- [04:56]
Tess
Totally. And I've had the opposite experience too. And it's just. I think it's very difficult to continue a relationship when one of those pieces is missing. Either the aesthetic eye and the talent and the bedside manner. So it's challenging to have both. And I imagine it kind of takes like both sides of the brain and a very unique person to be able to do all those things. But I will say you do it very, very well. And I want to ask more about lip filler because you obviously had that experience that wasn't ideal. What do you think went wrong? Now that you have the experience you do, and you know how to provide somebody a great pair of lips and do the injectables correctly. What do you think went wrong?
- [05:49]
Taylor Supiani
You know, I think I went into it a little bit too quickly and like, what's that phrase? Like, even eager eyed, bushy tailed. I was kind of naive when I went into it. You know, I didn't really seek out providers that were known for doing lips. And I myself have very challenging lips to treat. I've had to dissolve my lips a few times. Refill. I've had numerous People inject mine with difficulty. So I think knowing what I know now and after being in practice, the. The one thing I would have done differently is research. And the nice thing is now you can do a lot of this on Instagram. So you can kind of see people's work portfolios, see if they've treated difficult lips, see if lips are even something that they're doing often and really doing your homework in that department. And, you know, I would say my biggest advice to people is you. You do want to go to someone who can explain their thought process is open to you, asking questions, and someone who also is accepting of feedback. So those are really important qualities to look for when you're looking for your injector. So it's interesting.
- [07:06]
Tess
How can somebody know, like looking at Instagram and, you know, looking at before and afters, is that. Is that the best way to gauge if you like somebody's result? Are there other qualifications, Qualifications we should be looking for? How can somebody know?
- [07:25]
Taylor Supiani
Portfolio of work is very important. It's not everything. Obviously, making sure that you're going to someone who's qualified to be doing what they're doing is very important. So making sure you're going to someone who is educated and trained and has been practicing and knows how to deal with potential complications. Asking difficult questions during your consultation, you know, you don't have to totally grill them, but if you have questions, they should be able to answer them. That being said, I do think there's a lot of value in finding providers that say no. And that goes in any kind of specialty or field of practice. I mean, no one wants to be the bad guy and turn people down or deny their requests. But at the end of the day, these are medical procedures and their medical diagnoses and prescriptions. So they have to be within reason. So I would say, you know, you have to kind of choose wisely. But good rule of thumb is go with someone that has experience, has a similar aesthetic to you. If you like their aesthetic, that's probably a pretty good indication that they're a good match. And then make sure that they're qualified.
- [08:42]
Tess
Okay, and what about when you're looking at, you know, dermatologists, nurse practitioners, PAs, would you say across the board, you know, those labels don't matter as much as somebody's portfolio?
- [09:01]
Taylor Supiani
I think when you get down to it, the work will speak for itself. I don't think that one profession does a better job than another. I think each profession has, like, a stellar set of providers that can do the work and the title is just the title. You know, how they got there is how they got there. Yeah, I wouldn't. I wouldn't say that that's of utmost importance. But for some people, they do value the title and the degree.
- [09:36]
Tess
Okay, and what about, you know, the. The various aesthetics you can have when choosing lip filler? Like, do you like when a patient brings you celebrity inspiration pictures or asks about a certain technique? I know there's, like, the Russian technique. Or do you think it's just best if you are allowed as the provider to look at the patient and decide what would be the best treatment?
- [10:11]
Taylor Supiani
I think coming into an appointment with goals is really important because for some people, they have a lot of focus on symmetry or proportion, and it's hard for me to gauge what your aesthetic is. Seeing photos is definitely helpful, like when you come in with inspiration photos, but it's also tricky because everyone's lips are different. Everyone's anatomy is different. Everyone's amount of dead space within their lips, like, the amount of volume that they can accommodate will be different. And so it definitely requires, like, a shared decision and a unique plan based on the individual. So there's only so much filler that lips can generally take, and that amount varies based on your anatomy and how much volume loss you've had or how much filler you already have in your lips. And so that really requires us to kind of examine your lips and play around with your tissue and have a conversation. Today I just had a conversation with someone because she brought in this lovely inspiration photo. But when I looked at her lips, she already had a lot of migration, and her lips were pretty firm to touch. So we had discussed potentially gently dissolving in the future so that we can hopefully eventually get her to her goal photo. Of course, they're not going to be exactly the same, but it gives me a good idea of things like proportion and what kind of shape she overall likes. I mean, there's not much we can do to modify shapes sometimes, but when. When we can, it's nice.
- [11:46]
Tess
What is the most common, like, celebrity inspiration you're seeing right now? And are there any trends you're seeing? Are people going more of a subdued look or what do you think?
- [11:59]
Taylor Supiani
You know what's so funny? I actually don't get a lot of, like, celebrity inspiration photos anymore. I feel like one that I used to get a lot of was Haley Bieber, but I actually haven't had too many celebrity inspo pics lately.
- [12:14]
Tess
For example, Haley Bieber. She's a beautiful girl, but wouldn't you say that's a pretty voluminous lip that maybe not everyone could pull off or have the space for?
- [12:27]
Taylor Supiani
Absolutely. She has really prominent upper lip pillows and she does have a little bit of either migration or maybe she has some pre existing, like kind of double lip border. So she either has like existing unique anatomy or maybe some like very slight filler complications that have happened too. So I would say her lips are a little bit more difficult to achieve from an injector standpoint, or at least to do so while still looking pretty natural. Unless someone has like very similar anatomy. And in terms of like, trends. It's funny, I feel like the Russian technique was so popular, especially coming out of COVID And that still holds true in some, for some patients of mine. But for the most part, people are actually shifting away. And I think people are realizing how migrated and overfilled lips are impacting their functionality and the way that things are looking. And they're actually kind of coming in for lip resetting, where we do the dissolving and then do gentle refilling.
- [13:37]
Tess
Can you talk about the dissolving and migration? Because I think that scares a lot of people away from getting filler who maybe want it. What kind of a risk really is. Is migration like, is that something you can fix easily? Is it something to be apprehensive about?
- [14:02]
Taylor Supiani
So with migration, for the most part, it's nothing to be super concerned about. The only time I'm really worried about filler migration is when it's altering someone's functionality of a muscle group or an area, or if, for example, in the lips, it's spread to the mucosal surface, which is the area closest to the teeth, so just beyond the pink vermilion of the lip. And the reason I worry about that is because that can actually really irritate that tissue and create scar tissue. So that can create a longer lasting problem that actually requires some surgical excision down the road if someone's really bothered by it. But I would say the longest, the, the biggest issue with filler migration is that it tends to linger. And it can linger for like decades for some people. And they've seen that in different studies like MRIs, especially for the lips and the under eyes. We've had this misconception that filler only lasts last six months to 12 months. And we're now finding that it's really volume dependent and metabolism dependent. And there are so many different factors that we can't really predict exactly how long a filler will sit there. And with that Being said, we are very expressive humans. So with that being said, you can plan place filler perfectly. And due to the nature of the fillers, behaviors of ourselves and our anatomy and our muscles, things can move and change. And so, you know, sometimes we do need a little resetting.
- [15:44]
Tess
That's wild that you could place it correctly and it could kind of move on its own. Like it has a little bit of a mind of its own.
- [15:53]
Taylor Supiani
Yeah, I mean, the problem lies in these areas. We call them sphincter muscles. And that's why the eyes and the mouth are so difficult, because they're almost like little donut muscles around the eyes and the mouth and they're opening and they're closing and they're constantly in motion. And so whenever there's constant motion, there's always a, there's always a possibility that things can shift over time.
- [16:18]
Tess
Do you want to explain some of the different categories? Like, I know a question we got was about HA Filler vs Sculptra. What are those fillers? And if there's anything else you want to explain about fillers, do you want to.
- [16:32]
Taylor Supiani
So our most commonly used fillers are the HA or hyaluronic acid fillers. And those are probably the safest fillers to use because HA is found naturally in our bodies. Of course, these are man made, but these are found naturally in our bodies. We tend to do well when we receive them. They tend not to be super problematic. And the nice, the nicest thing about them is that you can reverse them with hyaluronidase, which is an enzyme to break it down if there are complications. So from a safety standpoint, those are definitely preferable. Other fillers that we have on the market are what we call biostimulators. And those can include Radiesse and Belafil. And then we also have biostimulators like Sculptra, which is more of a particulate material, which is basically ground suture that you reconstitute and it becomes a solution. So with these bio stimulatory agents, the only downside to them? Well, there are a couple potential downsides, but the biggest downside is that you can't reverse them. So from a safety perspective, that becomes a little bit concerning, at least from an injector standpoint.
- [17:48]
Tess
So if you're going to get Sculptra, you basically need to make sure somebody is really, really skilled with it.
- [17:55]
Taylor Supiani
Exactly. Make sure you're going to someone who's a skilled provider using them in the correct locations. The downsides to using SCULPTRA would be. There are two that come to mind or at least two concerns that come to mind when I think of Sculptra. The first being the, the possibility for creating like, nodules. And the main reason that that would happen is just poor placement or not reconstituting the product correctly. So you want to make sure that whoever's injecting is doing a good job of mixing the material and dispersing it. And the second thing that you have to be cautious of with these agents is that these are technically creating some scar tissue and inflammation, and that's the way that they're working. So it's not going to be developing like the baby smooth baby skin kind of collagen we're thinking of. It's more of a response to an inflammatory reaction. So if you do decide to do these treatments, just one, making sure you're going to someone who's skilled, and two, understanding the possible implications of this.
- [19:05]
Tess
What are areas you can put Sculptra and where do you think it looks good, or where do you think it provides a nice result?
- [19:15]
Taylor Supiani
The only two areas that I really treat with Sculptra would be the temples and what we call the pre auricular space of the cheek. That's a really lovely area to treat with Sculptra because it ends up creating a little bit more fullness and making the tissue a little bit brighter in that area. Everywhere else you want to be a little more cautious. Like, I wouldn't use it as a replacement for bone by any means. It just doesn't have that structure or ability. But in terms of creating like a little bit more fullness and pop in those two spots, it's. It's relatively nice.
- [19:53]
Tess
So know how we've seen those images of twins, One who's gotten Botox and one who hasn't, and the one who has gotten Botox does look a lot more youthful when they are at an older age. Do you know what I'm talking about? Okay. If you, if you did the same thing with filler, like, know one of the twins gets filler consistently, say through her 40s. One twin never gets the filler after the filler has probably dissolved. Do you think the one who's gotten filler is going to look more youthful in any way?
- [20:36]
Taylor Supiani
That is a really tough question. I would. I. Well, I feel like this could go one of two ways. I feel like they would either look a little bit better just because there's a good chance that some of that gel, even though we think it's metabolized after a couple years. There's probably a good chance that some of it's still sitting there and still holding some important structures in place. So, for example, as we get older, we get bony absorption, we get fat pad descent, and we get overall volume loss. So my assumption would be that there's going to be some ha that sticks around and is still keeping. It's almost serving as like a replacement for some of these structures that are declining. So I would hope in that sense. But if you have the opposite effect and like someone's been overfilled and now they're noticing like tissue collapse from micro tissue expansion and like the consequences of that, or if someone's just been overfilled and they're hanging on to all that unwanted volume, it may not have the desired effect.
- [21:45]
Tess
Yeah, I think a lot of us are curious because we're probably one of, one of the first generations to be getting filler more consistently and regularly. I don't know if you would agree, but it's obviously become more commonplace for people to start to get filler. A lot of us are maybe in our 20s or 30s. What do you think we're going to look like when we're 100 years old? Do you think we're going to look weird and wonky if we've been getting filler, you know, consistently every year until we reach that older age?
- [22:23]
Taylor Supiani
I think if we treat filler as a subscription service, it's possible that we could look a little funky. And I think we're already starting to notice and see that. Especially in my practice. It was really cool working alongside Dr. Talley in Beverly Hills because I oftentimes got to see, see his potential facelift patients. And a lot of the times we were doing some dissolving before they would come in for their facelifts. And a lot of the times the motivation for the facelift was to get away from filler and to avoid pillow face or reverse pillow face. And so I think when fillers are done conservatively and at, at a reasonable pace, I think they're really, really helpful and important. But I think when you start to do them too frequently or you start to do them on like a, what you think is an as need basis, it can become a little problematic. So, yeah, I think maybe in like 10 or 20 years, we'll, we'll look back and we'll be like, oh my gosh, what, what were we doing? Or, you know, people still may look a little crazy, but I think, I think we're Learning a lot in a short amount of time about these treatments. And we're already a little more cautious and conservative, you would hope.
- [23:39]
Tess
And I'm kind of curious, what would the ideal treatment plan be for somebody, you know, who wants to care about their face and is willing to invest in what they need to do? That is a, what would that treatment plan look like? Because I think what's happening right now is it is kind of that patient decides the as need basis. Like I call my provider up when I'm like, hey, I think the filler's kind of fading. I feel like I need a little something something. And they're like, okay, tell us what you want, we'll schedule the appointment and then like, we'll give you what you're asking for. Is there a better way to do this where, you know, there's like a plan set up by the provider?
- [24:23]
Ben Talay
I think the best thing that we.
- [24:25]
Taylor Supiani
Can do, at least from an anti aging perspective, is one, to have a plan, but two to make that plan kind of based in skin care and home and, you know, stimulating treatments and not making filler so much the focus. So I think when it comes down to it, at the, at its barest bones, the home skin care is going to be super important. What you do on a daily basis. I always tell my patients it's like taking an exam but not studying. You have to do your homework, you have to do the prep. So the home skincare is super important. Doing these collagen stimulating treatments every few months, doing some microneedling every four to six weeks for a series clear and brilliant fraxel. You don't have to go crazy, but these are just some good options that you have to do for annual treatments. And then as you're preparing for these procedures or you're coming back in to take a look at your results and discuss next steps. We look at you from a volumetric standpoint and we say, okay, we've noticed a little bit of volume loss here. Next time you come in, let's plan to do a little bit of filler. So not necessarily making it as a strict schedule, but kind of more of that as need basis with emphasis on the other treatments.
- [25:43]
Tess
I see. Okay, so you're saying really focus on the treatments such as lasers and just do the, the filler where it's really needed for the volume loss. Rather than banking on that. Do you see a lot of people kind of overlooking skincare and lasers and just wanting to do injectables?
- [26:07]
Taylor Supiani
Absolutely. And I think the appeal is the Instant gratification that the injectables provide, at least from the ha injectables. And trust me, I love to inject. I love filler. I love doing filler. But I only like doing it when it's needed. I think. I think the other treatments are going to be so much more beneficial from, like, a longevity standpoint. And it's so funny, whenever someone gives me a lot of resistance in doing the home skin care or the lasers, a lot of the times they come back in after they've completed and they're like, that was so worth it. I love the way my skin looks. You just have to kind of have faith in the process. And, you know, it does require a little bit of, like, a financial and also a time investment. And you're kind of playing the waiting game for a little bit, but it is so much more worth it. And honestly, your injectable results are going to last longer because you do those things too.
- [27:03]
Tess
What are some of your favorite lasers that are on the market now? And could you talk about a few for some different skin conditions?
- [27:15]
Taylor Supiani
Absolutely. So one laser treatment that we do a lot in practice is CO2, but it's usually not a full face CO2. It's usually either what we call perioral or periorbital, which is around the eyes. And I've been loving that procedure. I've had it done on myself. My colleague Jen Hollander loves it too. It's just. It's a great procedure because it helps with a little bit of skin laxity, it helps with fine lines, it helps to. To tighten up the under eye. And for those of us that have started to experience. Experience a little bit of aging, we've noticed that the eyes are one of the first areas that we're drawn to. So it just gives us a little bit of a pep in that area. And for about one week of downtime, you really can't beat that. Another laser, or I guess another treatment that we do often in office would be microneedling radio frequency. And I'm sure you have a lot of questions about that. But when done correctly and conservatively, micro needling RF is fantastic. And I would say those two treatments are some.
- [28:25]
Tess
What are some of your favorite lasers? Can you talk about the differences between CO2 Fraxel and microneedling? Microneedling. Microneedling.
- [28:36]
Taylor Supiani
Just generally speaking speaking from, like, a patient perspective, I would say CO2 is going to be best for, like, true resurfacing. That's going to be a much deeper laser. It's Going to create a little bit more downtime, but it's going to yield stronger results in terms of giving you a tiny bit of skin tightening and also the resurfacing, like diminishing lines. Fraxel I love doing for patients that have complaints about skin texture, like pores, fine lines, earlier signs of aging, but also if they have pigmentary complaints, too, Fraxel can be good for that, especially brown spots. And then in terms of micro needling. Micro needling is great for pretty much anyone. And I love a good series of three micro needling sessions. We space them four to six weeks apart. Your increase in collagen deposition is about 400%. And as you know, in our late 20s, early 30s, we start to lose collagen and we don't produce it. So it's really important that as we get a little bit older, we start to do these procedures to start stimulating the skin. Being from like a.
- [29:44]
Tess
What would be your choice for acne scarring?
- [29:49]
Taylor Supiani
That would definitely depend. For certain acne scars, you want to do subcision just to make sure they're not tethered down. And then generally, once the. The scars are pretty mobile, you want to do some kind of resurfacing, whether that's with micro needling or micro needling. RF Some people will also do, like, a deep peel. But I've always found micro needling to be super helpful.
- [30:14]
Tess
Okay, so that's good to know. You would choose microneedling over Fraxel or CO2?
- [30:22]
Taylor Supiani
For the most part, I would.
- [30:23]
Tess
Okay. What makes you. Yeah. So. So attracted to the microneedling? Because don't lasers also produce collagen?
- [30:38]
Taylor Supiani
So lasers do produce collagen, but at least anecdotally, from my experience treating acne scars, there's something really helpful about getting in there with the controlled injury from that needle. And like I said, when you commit to doing a series for acne scarring, sometimes they'll have to do more than three. But for the most part, once they commit to doing a series, you're going to see a pretty significant improvement.
- [31:05]
Tess
Okay, beautiful. And what about pigmentation? What would be kind of your ideal treatment plan for somebody who has either melasma or post acne hyperpigmentation?
- [31:22]
Taylor Supiani
So my first kind of plan of attack for almost any pigmentation patient is going to be topicals, usually in the form of hydroquinone plus tretinoin. And I usually want them to be on this regimen for at least one, I'd say one to three months, just depending on how severe it is. Then I'll usually have someone come back in, we'll take a look and see how much improvement's been done with topicals. At the very least, their skin has now been prepped and from there we can either do some kind of laser like fraxel to help with more so like sun and age related pigmentation. Sometimes I'll refer patients out for more of like a pico laser to help break up melanin if they have a lot of sunspots or deeper pigmentation that I can't get to with a fraxel. I will say melasma is one of the trickiest things to, to treat and you probably know that in your own practice too. And everyone's melasma plan will look different, but really just emphasizing avoidance of triggers, educating patients on what potential triggers might even be, all of those are going.
- [32:32]
Ben Talay
To be super important.
- [32:33]
Taylor Supiani
Then also just stressing that there's no cure for it. So making sure these patients are on a good maintenance program once their pigmentation is pretty well under control is really important too. So getting them off these harsh topicals and also starting them on things like Bright Alive, which is one of my favorite products by Zio, and that one has tranexamic acid and papaya extract in it. So it's good at controlling and exfoliating some pigment off too.
- [33:02]
Tess
I love tranexamic for melasma. I feel like it's underutilized. It's so good, so good. Planning for a wedding, what would be Taylor's treatment plan? We can, if you want to get more specific with certain concerns, we can talk about that. But what do you think somebody should do ahead of their wedding and like when should they start this process?
- [33:27]
Taylor Supiani
I love this question because I can't tell you how many times people have come in like two months before their wedding and been like, same, I need to get my skin ready and I'm like, I'm like, well, we've missed the boat on a lot of things, but we can probably do a little Botox. Ideally, I would love for someone to come to me like 9 to 12 months before their wedding. That way we can sit down, we could talk about good skin care to do at home. We can set a plan for like any office treatments. I'll usually either recommend doing regular micro needling or micro needling rf if they also want a little skin tightening or if they have like some textural things they want to improve that require a little bit deeper of treatment or I guess more aggressive of treatment. So usually I'll Recommend some kind of series of treatments. So that already is putting you at at least like needing six months. Because typically we're spacing these treatments at least four to six weeks apart. Generally from there I'll recommend if someone hasn't already done Botox for the first time, if they're thinking about doing it, doing a trial run maybe five or six months before their wedding and then coming back maybe 2ish months before their big day. That way we can do the dose that they're happy with. And that also gives us two weeks to do a touch up too. Usually Botox and Dysport tend to look their best around like I'd say the six, four to six week mark. So you want things to soften a little bit. That way people are animating and things are looking natural in photos. So having them come back around two months before their wedding day is like the ideal time frame for Botox and Dysport. And I'd say for filler treatments, if they're looking to just do like minor tweaks and touch touch ups, maybe coming in like two or three months before their wedding, that way things can settle and integrate and look natural.
- [35:27]
Tess
Planning. Have you seen anything go wrong with somebody trying to do treatments like too close to their wedding? Have you?
- [35:34]
Taylor Supiani
Knock on wood. I haven't seen anything go wrong. But I, I would expect that. The one thing I would be really, really cautious of doing before your wedding if you've never done it before, is probably Botox or Dysport. Just because sometimes things don't go the way as you plan. You might feel heavy, you might look heavy in terms of like your brow position. And with that being said, you want to feel good on your wedding day. You want to look expressive and you don't want to feel self conscious. So I've had patients come in like two weeks before their wedding and ask to get Botox and a lot of the times I'll decline just because it's not worth chancing it.
- [36:22]
Tess
Can you talk about that experience of saying no as a provider? Because I know just as your friend, like that is sometimes you get put in difficult situations where you don't want to make somebody unhappy. But can you talk about why you're saying no and why it's important for people to listen when you are saying I don't think this is ideal for you.
- [36:48]
Taylor Supiani
Yeah. So as we kind of touched on earlier, all of these treatments, there's still medical treatments and they're based off of diagnoses and assessments or at least if you're you're going to an experienced provider. That's how I would hope it. It should be. And so when we're doing an exam, we're really trying to do no harm. We're trying to only do good. So if we're telling you no, it's probably for a good reason. So it means that you've already got some complications. We're looking to avoid potential complications. The risk outweighs the benefit. And at the end of the day, we want to make you happy. We want you to look good, we want you to feel good. And sometimes there's a delicate balance between doing just enough and doing too much. So when I look at someone and I see that they look good and there's not room for significant improvement, my advice is usually to leave it, especially when it comes to areas like the eyes. So one area that people will come to us a lot for are under eye filler. And the under eyes are so, so sensitive, so they're really prone to swelling. And like I mentioned before, filler migration, filler complications, filler show. And so if someone already has good volume in their under eyes and they've already got a little bit of filler in there, my preference is usually to do some kind of alternative. So it's not always a hard no, but it's sometimes it's more of like a pivot. And it's like, we're going to say no to filler today because it looks good. Room for improvement is very minimal. But maybe let's prep you for a CO2 laser so we can do some skin tightening and help with some fine lines. Saying no is one of the most difficult things to do as a provider because you obviously want people to leave happy and you want them to feel good and be happy, but you do also need to set boundaries and preserve the patient's aesthetic and natural features, too. So that is probably one thing that will differentiate providers from each other, is their ability to keep people looking like themselves.
- [39:00]
Tess
Do you think there is any way you recommend saying no so that it's best received and somebody doesn't go right? I mean, you can never. You can never prevent somebody from writing an angry Yelp review. But just knowing what you know now, having more experience as a pa, do you think there's a way to deliver it with less chances of somebody getting upset?
- [39:29]
Taylor Supiani
I think. I think the best thing you can do is to put it in perspective for the patient that, like, you have their best interest in mind. It's not because you don't like them. Or you don't want to make them happy, or you don't want to make them look good. I usually, I usually honestly tell people that they look great or this looks like pretty close to perfect. And whenever something is pretty close to perfect, I usually don't like to play with it. So I usually tell them from that perspective. And then, like I mentioned, you try to propose like an alternate plan or something you can do instead. So if someone's not quite ready for lip filler, you know, we've got a lip flip for some candidates. We have great lip plumpers that can actually provide a little bit of like either temporary or longer lasting volumization to get you from one treatment to the next. So it doesn't have to be a hard. No, but just doing things that are in their best interest and then proposing like another type of plan or saying, let's revisit this in like six months makes sense.
- [40:34]
Tess
And sometimes, you know, you just can't help people's response because they just may not see that perspective and they may just think, oh, I took time off to come here, I drove here, I parked here to look better and feel better. And I'm not getting that. So I'm upset. But I love what you're saying about possibly pivoting, finding an alternative so they don't feel like they're leaving empty handed. But you do have to be honest. If there's really no room for improvement or it's not something that's reasonable.
- [41:12]
Taylor Supiani
Yeah. And I mean, trust me, I still, I still have people that get upset when I say no. I've talked to you about this at length before.
- [41:20]
Tess
It's because you're ethical.
- [41:21]
Taylor Supiani
It's not, I know it's not a fun feeling. And you definitely don't want to hurt people's feelings or make them upset. And I definitely understand it from the perspective of like, I've paid a consultation fee, I've taken time off from work, I've dedicated my time to coming here. But also, you know, you can go anywhere, to almost any med spa and ask them to do a procedure, and you, you'll find someone who will do it. But I think for you to be the provider that sets boundaries and has a certain aesthetic eye and an aesthetic taste, again, that's what just differentiates you. And I think that goes for any specialty or practice. You know, being, being the expert and having the ability to have those difficult conversations is really important.
- [42:11]
Tess
Absolutely. Okay. I wanted to ask for the men who are interested in these types of treatments. What are Some popular treatments you are seeing the guys get.
- [42:25]
Taylor Supiani
So Botox is obviously something that a lot of men are interested in. And I will say a lot of the times it's the guys you would not expect, but they are definitely interested in that. And then another thing that a lot of men have recently been inquiring about are their under eyes and also their jawlines. And usually that's in terms of filler.
- [42:48]
Tess
What are some ways we can perfect the jawline? I feel like that is something I've noticed has become more of a trend and it might be because we can see some very exaggerated perfect jawlines on social media. But I'm curious, what do you think are treatments for a nice jawline for men and women?
- [43:14]
Taylor Supiani
Okay. We have so many great options for the jawline now. I would say my usually my go tos are going going to be like neuromodulators, Botox dysport. You can either do that for platysmal banding, which are those vertical necklines, or you can inject them into the horizontal necklines for a little bit of tightening combined with the filler. Another option we have is microneedling RF or the heat based treatments. So you can do in our office either Matrix, which is similar to Morpheus, or Profound, which is a more intense procedure to help target the cementum and jawline. But those heat based treatments, when done correctly and relatively conservatively can be be really impactful. Other options we have of course include fillers. But fillers usually aren't my go to for like a snatched jawline. Some people truly need a little bit of help from filler, especially if they have a little bit weaker of a chin or a jawline or just, you know, loss of structure over time. But I really find that the people that will actually benefit from jawline filler are pretty few and far between. So a lot of the times actually, and it's interesting, I actually get a lot of female patients that will ask for jawline filler for improved definition. But I find a lot of the times for the people inquiring it wouldn't be super helpful because it actually just adds width. So what I found sometimes is it looks really good at first and then as the filler settles it just kind of widens people out. So it's usually not my preference to start with that.
- [44:59]
Tess
What are I feel like for women they might be looking for less of a double chin and just more structure. So you're saying that's not necessarily filled filler because that's just adding bulk and Volume. But instead you would recommend something like the Matrix Pro or RF Micro needling.
- [45:21]
Taylor Supiani
Yeah, absolutely. So those are going to be better options for you because they're going to target skin tightening. But you can also adjust the settings a bit, at least with the Matrix to help target some mental fat. And the combination of the two is really impactful for a lot of women and men. Another option that people have would be to do like a lower face lift and neck lift. And I know that that sounds kind of crazy, but for some people, a lot of the times the neck and kind of like the sagging and fullness around the neck and the submentum can be hereditary and just in their family and their genetics. So a lot of the times we can't really fight that component. So the best thing that those people can do is actually go in, potentially do a little bit of what we call micro suction, which is micro liposuction, potentially with some repositioning of some muscles and tissues and then potentially with profound as like a finishing touch. So it's kind of a multi step thing. But that can be the best thing for some people.
- [46:31]
Tess
Did you say reposition their muscles? What does that mean?
- [46:40]
Taylor Supiani
Over time we have pretty large muscles in our neck called the platysmal bands or the platysmal muscles. Over time, those muscles, their main purpose is to pull down. And over time, as we get older, those muscles can actually sag and they almost look like redundant tissues. So sometimes they require a little bit of repositioning along with things like the glands in our neck and our submentum as well. So sometimes it's a combination of kind of muscle repositioning and also reduction of the glands in there, the salivary glands. So it actually is a really complex area to treat. And in my old practice we used to do Kybella and I never found great success with Kybella for a couple reasons. And I, I didn't realize that until I was a little bit later into my practice and actually working with Doct and that's because the neck is actually more complex than just the fat that's under the skin. We have the fat that's in front of the muscle, the fat that's behind the muscle. We've got the salivary glands, we've got the muscle, the skin, we've got everything. So it really sometimes for some people takes addressing a little bit of each of those components to make a difference.
- [47:57]
Tess
Okay, that's so interesting and you read my mind because I do see Kybella touted as like the solution for double gin. And I do see a lot of before and afters on Instagram, but, I mean, makes sense. It's just, it's one tool and there's so many, obviously.
- [48:19]
Taylor Supiani
Yeah. And I. I think with Kybella, the important thing to also realize is that if you're removing a little bit of the fat in this area, you're probably going to eventually need to do some skin tightening too, because now we've got loss of structure behind the tissue. So from a financial standpoint, you're investing in a series of usually 3 kybella plus your skin tightening. So it might be more beneficial for some people to look into, like, alternative routes or if we are really concerned with the aging neck, to just look into doing a little bit of that lift.
- [49:00]
Tess
What do you think is the most underrated treatment Tay? What?
- [49:04]
Taylor Supiani
Oh, I would definitely say good Botox, and I would say the most underrated.
- [49:10]
Ben Talay
Area to get your Botox treatment is the lower face. And I've really been into treating a.
- [49:19]
Taylor Supiani
Combination of muscles recently, including what we call the daos, the mentalis, which is by the chin, and the platysma, which are the neck. The neck bands. And when you do that, that creates.
- [49:32]
Ben Talay
A little bit of stronger jawline definition for some patients. It also acts as a preventative for the right candidate. So it acts as a preventative, so it helps with preventing enhanced jowling, marionettes.
- [49:46]
Taylor Supiani
And also just like that, generalized downward.
- [49:48]
Ben Talay
Pull and aging of the lower face.
- [49:50]
Taylor Supiani
So it's really nice from a preventative.
- [49:52]
Ben Talay
Standpoint and also from a corrective standpoint.
- [49:55]
Taylor Supiani
Because it helps a lot with shadowing and texture and definition.
- [49:59]
Tess
Is that what you did on me when you treated me the other week? Okay. How's my jaw? Beautiful.
- [50:08]
Taylor Supiani
It's so sharp.
- [50:11]
Tess
Thank you. In the best of hands, you are already perfect.
- [50:14]
Ben Talay
It's so hard because I feel like with the advent of social media and how prevalent aesthetic, aesthetic treatments are on.
- [50:22]
Taylor Supiani
Social media now, I think it's hard.
- [50:26]
Ben Talay
Because a lot of people are coming in already, like, pre diagnosing themselves and already like prescribing their own treatments and what they think is best.
- [50:37]
Taylor Supiani
But at the end of the day, a lot of people, for a lot.
- [50:40]
Ben Talay
Of people, this isn't their expertise. And they are heavily relying on their providers for guidance and advice and expertise. And so I think it is important to always make sure that we're guiding people in the right direction and doing what's best for them and not just.
- [50:57]
Taylor Supiani
Doing, like, what's trendy or what.
- [50:59]
Ben Talay
Exactly what they want. Like, oh, I want A little bit here, here, and here, you know?
- [51:04]
Tess
Yeah. I think that's what I'm nervous about, and even I'm educated, but I could see how you could easily go down that route. Like, for example, you see a Kybella before and after. That looks amazing, and you think, that's. That's what I need. But then hearing another perspective from a provider, it may not necessarily be what you need. And that's the issue. We're all kind of shopping for all these treatments and sitting at home thinking, like, how. How could I be better, look better? But I think it goes to show being in the hands of a skilled provider who can look at you as an individual and make you a custom treatment plan, I feel like that is invaluable.
- [51:53]
Taylor Supiani
Yeah.
- [51:54]
Ben Talay
And I think it also. It also depends on, like, your anatomy and your facial features and just paying respect to those. And, you know, I often will tell my patients that I'm more focused on what we call facial balancing than on symmetry. Like, symmetry is so difficult to achieve on someone. And if you've ever seen pictures of people that look asymmetric at rest and then they're kind of tweaked to be symmetrical, like, I posted this photo a while ago of, like, Ryan Gosling and Kim Kardashian, and I. I changed their symmetry patterns, and when they were perfectly symmetrical, they looked so different, and they looked funky.
- [52:35]
Taylor Supiani
So I think.
- [52:36]
Ben Talay
I think we have to kind of just own our asymmetry sometimes. And, of course, like, if you have something that drives you crazy and it's.
- [52:42]
Taylor Supiani
An easy fix, like, I have one.
- [52:44]
Ben Talay
Brow that sits significantly higher than the other. Can we tweak that?
- [52:48]
Taylor Supiani
Like, probably.
- [52:48]
Ben Talay
And yes, but the goal should be, you know, are things proportional? Do they look natural? When I look at you, do you look pleasant and, like, peaceful? Like, does something stick out at me and look. Look angry? Like, is there anything we can do to fix that? You know, just making sure that people look normal and happy.
- [53:10]
Taylor Supiani
Yeah, that's the emphasis.
- [53:12]
Tess
Yeah, that's a great point. And you touched on facial balancing a little bit. What does that exactly mean?
- [53:21]
Ben Talay
So when I think of facial balancing, I really am just making sure that, like, proportions are intact and things are harmonious and blending together, that there's no obvious striking, like, deficit either that we've created or, you know, one that we could potentially modify. So for some patients, like, they can benefit by getting a little bit more lip projection to enhance their side profile, or sometimes we can do a little bit more, like, chin definition or projection to help enhance the Side profile. Sometimes we can enhance the cheeks just to create a more tapered look from the mid face down to the lower face. Or sometimes it even includes doing a.
- [54:05]
Taylor Supiani
Little bit of, like, Botox or dysport.
- [54:07]
Ben Talay
In the masseters just to kind of atrophy the muscle a little bit. Especially if someone's been clenching and grinding just so that we can restore their normal shape, get them symptom relief, and slim down the lower face to what it used to be so that there's a nice taper from mid to lower face. It doesn't mean modifying your whole face.
- [54:25]
Taylor Supiani
Or making you more symmetrical per se.
- [54:28]
Ben Talay
It's just making small tweaks when desired to make things flow just a little bit better.
- [54:38]
Tess
I hope this question makes sense, but I'm kind of just wondering, like, if somebody thinks, like, oh, I need lip filler, do you think it's better from the provider's standpoint that they come in and say, I want to get lip filler, or would it be preferable for them to say, like, I feel like I just don't look as harmonious as I could? Like, what would you change looking at the big picture? Is that what you would prefer?
- [55:08]
Ben Talay
You know, it's funny, I. I actually prefer to hear what brings a patient in. Of course, I love doing, like, a full face assessment and creating a full face plan, but I always like to know what brings someone in, specifically because I myself have been in a position where I have had features on my face analyzed and critiqued and made aware to me, even when I was completely unaware. And then it became a point of insecurity for me, and it became something that I focused on and I wanted to modify. And I never want to inflict insecurity onto someone, so I only want to like. Again, I think most people in this profession, we only want to make you.
- [56:03]
Taylor Supiani
Feel good and make you look like.
- [56:06]
Ben Talay
The best version of yourself. And so I never want to create an insecurity or anything like that for someone. And everyone has unique features. Everyone has a different face. There is no perfect face. So who am I to tell you what you can do to look, quote, perfect?
- [56:27]
Taylor Supiani
You know, I would rather.
- [56:29]
Ben Talay
I would rather hear what someone is here for.
- [56:31]
Tess
Okay, that's really interesting and so fair. I mean, I feel like a lot of people have that experience, Taylor, myself included, of going to see a provider, and you just feel like you leave with no confidence. All these new things you're made aware of that you feel like are not even easy fixes like that might require surgery and Yeah. I think there is such a delicate way to be in practice and talk to people about these things because we all have feelings. And I think, especially if people are there, you know, at your office, like, likely they have some level of insecurity or something they want to change. So I think it's just so important that providers kind of understand that they're not too out of touch with it and have some empathy and, you know, they can be reasonable with telling somebody, you know, if they may need something or when something may benefit them. But I do think more providers need your level of empathy and understanding and compassion.
- [57:41]
Taylor Supiani
Yeah, I think.
- [57:42]
Ben Talay
I think you made a good point. Patients are oftentimes coming to us, and I'm sure you experience this a lot, too, from a very vulnerable place. It takes a lot to get to the point of making a phone call and booking the appointment and seeking the help. So I think we really have to pay attention to that and respect that and, you know, remain compassionate humans.
- [58:06]
Tess
Absolutely. Which sounds so. I mean, you would hope everyone would have that philosophy, but it's kind of surprising, even some of the people I've met at a very high level who just are totally lacking that, like, basic human empathy.
- [58:23]
Taylor Supiani
Yeah.
- [58:24]
Ben Talay
And I. I'm sure we've had this conversation before. It's like when you get that feeling from someone.
- [58:31]
Taylor Supiani
I can't.
- [58:33]
Ben Talay
I obviously can't tell you what to.
- [58:34]
Taylor Supiani
Do, but usually if I get, like.
- [58:36]
Ben Talay
That gut feeling and someone's identified things that make me feel worse and haven't proposed a plan that makes me feel better, I usually. That would be, like, my telltale sign.
- [58:49]
Taylor Supiani
Not to stick with them.
- [58:50]
Tess
Yeah.
- [58:51]
Taylor Supiani
And that's.
- [58:52]
Ben Talay
That's the beauty in this, is that.
- [58:54]
Taylor Supiani
You get to choose who you work with.
- [58:55]
Ben Talay
You're not married to anyone. You're not committed to anything.
- [58:58]
Taylor Supiani
This is your body, this is your face. This is your life.
- [59:01]
Ben Talay
Like, make sure you're going to someone that makes you feel good.
- [59:04]
Tess
Yes, absolutely. I think that's a great note to end on. Taylor, I loved having you on. Thank you so much for answering all of our questions. Is there anything else you wanted to say before we let you go?
- [59:19]
Taylor Supiani
No. Thank you so, so much for having me. This has been so much fun.
- [59:23]
Tess
Thank you, Tay. It's always so fun to have you. We've had Taylor on before, so if you love this episode, please go back and listen to her other previous ones. But I'm sure we'll have you back on in the future if we can get some more questions. But thank you so much for joining us.
- [59:40]
Taylor Supiani
Awesome. Thank you, Tess. And thank you guys for listening.
- [59:43]
Tess
Do you want to share where we can find you on social media?
- [59:47]
Ben Talay
Yeah. So my Instagram is Taylor of the face. T A Y L O R. So cute. I think we have. I'm at Cupid Lips of Beverly Hills and I believe our website is cupid-lips.com.
- [60:02]
Tess
Perfect. I'll put it in the show notes so you guys can easily find it and connect with Taylor if you're in the LA area. I could not recommend her more for lips injectables treatments. I mean, I've done so many things with you. I've done Matrix Pro, we've done micro needling, we've done PRP lip filler lip flips. I will say Taylor's treatments take the cake. Always love the end result and it's always a good experience and good time being with her too.
- [60:33]
Taylor Supiani
Oh, thank you, Tess.
- [60:36]
Tess
I love you. I love you too. We'll have you back on in the very near future. Thank you guys so much for listening. I'll talk to you in the next episode.