The Art of Natural Aesthetics with Dr. Alisha Armstrong

Ready for a refreshingly honest chat about all things aesthetics? On this episode of "The DERM Expert," our host Emily Brewer, DCNP, sits down with her good friend and fellow expert, Dr. Alisha Armstrong, owner of Premier Med Spa.

Alisha opens up about her inspiring journey, from working in a busy pediatric ER to becoming a successful business owner and medical injector. She shares a deeply personal story about her first Botox experience and how it sparked her passion for helping others feel confident and like themselves again.

We're diving into what it's like to walk into a consultation, why "looking weird" is everyone's biggest fear (and how to avoid it), and the dangerous trends you should definitely steer clear of. Plus, we'll chat about exciting new treatments like biostimulators that give you that gorgeous, gradual glow and how more men are stepping into the world of aesthetics.

This episode is all about finding a trusted expert who puts your comfort and safety first. You'll hear why the goal isn't to look "perfect," but simply to look and feel your best.

For more information, visit www.thedermcentertn.com or schedule an appointment here

Transcript

Alisha Armstrong: 0:00

What are your two favorite things about your face? Ooh, I love that. Yeah, that's been a new development. Yeah, I love that. Because I want to bring out those things. I think very few people truly want that frozen look. You know what I mean? I think for the most part, people still want to have some sort of an expression. You want people to say, you look great. What have you done? Exactly. Not go to their friends and say, oh my gosh. Look what she did. Have you seen Alicia? Have you seen those cheeks or those lips? And that's when those features start to stand out. So it's perfect if no one can tell you've had anything done, but you just look great. That's where we want to be. It's such a vulnerable moment going into someone and saying, holding a mirror and pointing out all the things about yourself that you're there to correct or enhance or erase. And that's a very exposing moment to be looking at those things in the mirror and talking to someone else about it. Music Welcome back to the DermExpert podcast. Today's episode, we're going to dive straight into the world of aesthetic medicine. Joining me today is Alicia Armstrong, Dr. Alicia Armstrong. So welcome. Thank you. Thanks for having me. Absolutely. Alicia is the medical injector and the owner, founder of Premier Med Spa in Chattanooga. Three locations now, right? Yep. Three locations as of beginning of this year. That's a big deal. Yeah. I love the growth. It's great. It's good. Scary. It is very scary. If you'd asked me about a year ago if I wanted to third, I would have said absolutely not. But here we are. It just happens sometimes. Sometimes it just unfolds. It does. It does. It's undeniable. I love it. Well, thank you for being here. Thanks for having me. It's exciting. Yeah. Why don't we start? Tell us a little bit about your backstory with with aesthetics. How did you get into this area and subsequently end up with your own business? Yeah. So I have kind of a strange journey to get to where I am. I started in the a number of years while I was doing my nurse practitioner and did some NICU and then I worked with pediatric trauma and surgery for a few years came back to Chattanooga when we were starting a family and worked children's ER and then having a six-month-old and a two-year-old I was feeling really run down and ragged and honestly what I tell people is I just would look in the mirror and not recognize myself I just kind of felt like I had you hear the phrase a lot let myself go and just felt really discouraged that I was kind of losing myself in a way because you obviously have to when you've got little ones like that and so I wanted to do Botox because I had pretty significant forehead lines that were staying and so went got that done I remember a lot about that first experience sitting in the car and being really nervous that I was making a mistake you know like what if this looks crazy and I look terrible and I've done this out of quote vanity and then I'm regretting my decision and then when I went in the experience was really uncomfortable for me I felt really like like I didn't belong there everyone was dressed to the nines and had full face of makeup and hair and you know dresses and heels and here I was probably had spit up on my shirt and my hair in a messy bun and new mom look new mom look a hundred percent and I just felt I was like, I don't know that I am like these women, you know, I just don't have it together like they do. But I got the Botox done. And I absolutely loved the result. And the refresh is the best word I could use where I still looked like me. In fact, my husband didn't even notice for a couple months. And he was really unsure about me getting it done. Because like many, just people that don't know about it, women and men, they see the overdone and the crazy looking results so he was terrified that I was going to look wild and so I didn't look any different to him he didn't notice so that was all great and then I started to just fall in love with what it gave me from a confidence standpoint and thought, you know, one day when I get out of the emergency room, I would love to have my own business of this and I would love to make people feel better every day. And so I said, when that time comes, I will make sure that people don't feel like I felt when they come in the door and that they don't feel like they don't belong or like they, for some reason don't, don't have a right to these procedures. There's a certain type of woman that can get this stuff done. And so I started working part-time at a spa and got trained and began to develop my education in the field and then was able to start breaking away I started in one room it was about a 700 square foot room and it was just me and started seeing patients and I was also teaching at the University of Tennessee Chattanooga in the nursing program so I was kind of slowly growing my clientele in the aesthetics world while I was working there and then there came a point where I was busy enough where I could break away and do this full-time and so then I started looking at an actual brick and mortar kind of build out which was crazy and so after about I think it was about 17 years I was in pediatrics and did the high intensity the high adrenaline stuff and it's exhausting it was exhausting it was mentally I definitely was experiencing some compassion fatigue and just I had little kids of my own and working in pediatrics and especially the ER there was just it started to hit home in a different way having my own and so it felt like the right time I thought, you know, I'm really going to become a hardened person if I continue in this. And there was a very specific night that I remember where I was working in the ER. And I won't go into details because it could be triggering for people. But, you know, a newborn that had gone home and didn't make it. And we just, as you know, working in the hospital, you have to kind of leave that. We walk away from the family. And then you go back to your other assignments. I had other patients to see. The level of detachment. that has to happen with that type of job is next level. It is next level. So everybody just has to return to like kind of status quo and you don't, take a moment to feel anything you can't. And I had this kind of moment sitting at my desk where I was like, I don't want this to not hurt. I don't want to not feel this. I felt like I felt like I was getting numb and I didn't like becoming that way. And so that was my last night. I was like, I can't do this anymore. I want to experience the field of nursing where people are happy to see me. It's not just the worst day of their life that they're coming in and seeing me. So it was a very, the transition happened very naturally and I knew it was time. And so that made that transition, did the build out. And then we've just kind of grown from there, but I've stayed really passionate about the staff and how people are approached hopefully everyone feels comfortable coming in and we don't do a lot of hair and makeup and you know i want people to feel very comfortable coming in for some reason women complain all the time when they come in for how they look you know i've just been working out i'm sorry i look like this or i've been sweating that feeling of judgment it is judge ourselves yeah we do that feeling of i hope nobody is judging how i look right now yeah you know and i always say don't apologize Yeah. you don't have to dress up to come see me. They're coming in. They're being vulnerable with me anyways to tell me what they don't like about their face. They're putting their trust in me. The face is what everyone is going to see. So I'd never take for granted what a huge amount of trust that is to have someone do anything to your face. And then to have to apologize on top of that because you're sweaty or you didn't have time to fix your hair. I'm like, come in here in your pajamas and your flip flops or your house shoes. We do not care. We do not judge because everyone is welcome and everyone should have the right and the opportunity to access these procedures and to feel like themselves again and to feel refreshed and there isn't a specific type of person that should only be allowed to have that so those are kind of that's how I got here and then that's definitely what I would say is my biggest philosophy for the office that will remain throughout no matter how big we get I always want it to feel very comfortable yeah less medical and stuffy and more Inviting. More inviting and more just like a comfortable experience where they don't have to think twice when they leave the house about what they have on. They're like, oh, Alicia doesn't care or, you know, any of the other injectors. I actually started coming to you as a patient in 2020 during COVID, seeing myself on the screen and pictures and stuff. And I thought, oh my gosh, my forehead wrinkles. It's got to change. So I actually came to you as a patient. And the first time we met, you told me that exact story. And in that moment, I was like, We click. Yeah. I love that whole concept because, I mean, you're right. It's such a vulnerable moment going into someone and saying, holding a mirror and pointing out all the things about yourself that You're there to correct or, you know, enhance or erase. And that's a very exposing moment to be looking at those things in the mirror and talking to someone else about it and to be creating an environment that you're creating in your business to where people can come in and they can feel comfortable talking to you and not have that added sense of, am I being judged for what I look like and what I'm wearing? The fact that I have just come from the gym or whatever. wearing my child's spit up, like what you said. Right. You know, there is that feeling of I can come in and be comfortable still. And I think that is wonderful what you're creating. So I love that. Thank you. Yes. So fun fact about Alicia. So former Miss Chattanooga. Former Miss Hamilton County. In a different life. In a different life. Yeah. So being in that, you know, beauty pageant industry at a young age, and now here you are in the beauty industry. This has been, beauty has been sort of a big part of your life, right? What is your philosophy on beauty itself? Yeah, I love that question because I have an interesting history with beauty and I have some very positive experiences from being in the pageant world, but I also feel like I learned a lot of the negative side of beauty. I definitely think it feeds into a lot of us Again, comparing ourselves to others. I mean, you can imagine in the pageant world. It's a straight up comparison. Straight up. You're standing literally on a stage and letting people compare you to each other. And backstage, you could imagine all these women getting ready and you're looking at her and saying, oh, gosh, she's got that. I don't have this. And she's I love. it's just my nose, but you know, you start thinking all these things. And so I kind of developed a relationship with beauty that was a little bit negative where I was just kind of got burnout on the comparison to where I'm just like, it was nice though. I got to the point for some reason, I guess you could go one extreme to the other. And I went the opposite extreme to where I didn't care about any of that anymore. Like I didn't, It's freeing. that's fine. It's none of anyone else's business. And so I did start to be like, you know, other people's opinion of me is none of my business. And so we hear that all the time, but it's really hard to embrace that. And then you fast forward, I'm in the beauty industry and helping people, but I do feel like it's helped me coach my patients through like I have a 30-second rule that I'll tell them a lot because I'm like, if you're not putting on your makeup, you have 30 seconds to look in the mirror at yourself because anything longer than that, you're going to pick yourself apart. It becomes so unhealthy. It does become unhealthy. And we all know the more we look, the more you're going to find. The longer you look, the more you're going to find. And so I'll get people come in all the time where they're like, what do you think I need? And I'm like, I have to back up and say- You hate that question. I do hate that question. Because for one, it doesn't matter- what I think yeah you know I and then it's setting us up for everybody doesn't need to look the same you know my taste doesn't have to be their taste it creates a complex it does if you say well I think you need to do this or do that and then they're like oh I didn't even realize exactly now I'm self-conscious yeah I don't want to point out things that they haven't even noticed and that's the last thing we need to do because we're good at finding plenty of Right. changed that up even further to be like okay before we get into that what are your two favorite things about your face I love that yeah that's been a new development yeah I'm like I love that because I want to bring out those things you know like let's focus on what other things to your face we can do to bring out your favorites and then we can minimize the things you don't love but those favorite things get lost a lot of the time because we focus so heavily on what we want to change and so it's like let's rewire that conversation and first of all it's not what I think you need it's what bothers you but what you love is very important too in that because I don't want to minimize those features either and so aesthetics is done well when it's all in balance you don't want any of the features to stand out from the others and so you do have to factor in the shape of their eyes the shape of their nose the shape of their lips so if they want lips we don't want those to overpower all the other features and so it's an art form it is an art it is a tremendous art form I mean you're a sculptor you're sculpting someone's face you are and you have to know how the face ages you know i think that's a really cool thing is like if we're doing a good job we're restoring to some degree obviously we're not turning back the clock 20 years but we're restoring how they looked a few years back or maybe in best case, 10 years back.

Emily Brewer: 14:50

Yeah.

Alisha Armstrong: 14:51

But I don't want them to ever look different than they did to begin with. And that's when people start looking strange and this field starts to get a bad rap because it's like, she doesn't even look like herself or. And I think that's one of the first things too, that patients, when they are thinking about going down the road of injectables, one of the first things I think that comes out of their mouth, at least in my experience with patients is, well, I just don't want to look weird. I You know what I mean? So finding that artistic balance, that marriage of that clinical knowledge with that artistic element as an injector, I think really sets... injectors apart between being good injectors and great injectors is when they can actually find that balance between the artistry and the clinical knowledge that goes with it sure I think that's yeah that's the perfect way to say it you know there's a lot that goes into it people come in and say oh my friend got this done I want to have that done and it's like well you've got a different face and then let's talk about your medical history you know do you have any autoimmune conditions because that may change what type of filler so it's not just as cut and dry as like cookie cutter let's put this filler here and And make you look like everyone else. Let's make you look like, you know, the influencers or Love Island. That's the new one. Everybody's watching Love Island. So I'm getting, you know, a lot of that. It's probably partially geography in this context. town specifically we do have a lot more people that just want to look refreshed and very natural and I'm sure if we were in a bigger city or in LA or Miami we'd get a lot more of kind of like a more dramatic look or a dramatic change but I don't really get many people at all that want more than just refreshed and rested and those are the two words I hear the most and so I think I think very few people truly want that frozen look You know what I mean? I think for the most part, people still want to have some sort of an expression. And I think just socially, it's important to be able to still make a facial expression. You know what I mean? It's funny, you know, when my daughter was little and I would be getting onto her and she would say, why do you point your eyebrows at me? And I would be getting onto her. And it was so funny because when she said that as a toddler, you know, that has stuck with me over the years. And I thought, okay, even with her being little, like she was noticing my facial expression and I want to maintain that because I want to still be able to point my eyebrows at her when I'm important. It is an important message. And, you know, I think not being frozen is definitely kind of falls into that art form of how can you inject in a way that gives those refreshed, you know, more youthful looks without creating that image of distortion. And I think it's important. I say like the best injectors, it should be a thankless job where people are out and they don't know that you've had anything done, but you look great. Yeah, he didn't pick up on it, right? That was the perfect... the perfect injection done, in my opinion. Because those are the goals, I think, when it comes to the aesthetic industry is how to do it in a natural way. You want people to say, you look great. What have you done? Exactly. Not go to their friends and say, oh my gosh. Look what she did. Have you seen Alicia? Have you seen those cheeks or those lips? And that's when those features start to stand out. So it's perfect if no one can tell you've had anything done, but you just look great. That's where we want to be. How do you approach telling patients no? I think that's an interesting... You know, it can be, usually we've got a good relationship with the patients because we've seen them at least a few times, but usually they're asking our opinion. Like, do you think I need more in my cheeks or my lips?

Emily Brewer: 18:33

And I think

Alisha Armstrong: 18:33

when you look at yourself every day, you stop seeing maybe the reality and you start looking at it thinking, oh, well, you know, I need to go back and have more. I need to have more. And I think that there is a level of blindness sometimes just with looking in the And that creates that distorted look. It does. So I think as an injector, being able to tell them, no, let's pump the brakes. Yes. So is that a conversation that goes well when you have that with your patient? Usually they appreciate our honesty. Hopefully they're coming to us because they have that trust in us and they feel like, oh, she's going to tell me if I'm overdoing it. And they appreciate that approach just as much as they appreciate us saying what we think would look great. They're like, rein me in, you know, if I need to. And so I don't really have a lot of people that get upset when we say, no, I don't think you need any more. I mean, maybe they just go to somewhere else where they can where they'll add more which I think people end up with their injector that fits their aesthetic because it is such an art form you know it's just like those painting classes where you have all these people who are all painting the same picture but nobody's looks different the same to each other and that's well said yeah that's exactly what it's like of injection is you know you find the person that has the aesthetic that you like a lot of times you like the way they look to be honest you know if they look crazy then you're like oh this might not be the person you know i don't love that look and that's okay we don't all have to look the same there are certainly people that probably like a more dramatic look when it i say like unnatural but that's probably not a fair word to use but you know it's just i could say like a more dramatic change you know they're they're wanting um a more a bigger change from their baseline than what i usually like to do and so they end up with an injector that likes to do that i mean in our office it's set up a little bit different too i'm also kind of will die on the hill of not paying my injectors on commission um which is very different in the aesthetics industry you do that um i do that because i want them to be able to say no um I don't want them to have a financial skin in the game. And I feel like just naturally, no matter how good of a person you are, if your bottom line is affected by how much they spend, then you're going to hesitate to say no. And that's why I get a lot of patients that have been other places for consultations and they're in tears because they were told they need six syringes in their face. And they're like, I didn't realize my face looked so bad. I can't tell you how many people that are in tears in a consultation because they're like, well, now I... see all these things that I never noticed. And they told me I need six syringes to achieve this. And, you know, and I'm like, six syringes where, you know, that would change your whole entire face. And so that's important to me. I always am up front when I hire new injectors because most of the industry pays on commission. But just for my practice, I may be the only injector one day because of me living on that Yeah. That is not the end game here. I want people to feel great. I want it to be accessible for people that don't have just tons of money to throw into it. It stays true to your philosophy of your business model of creating that environment that is truly focused around your client and getting them in a scenario that they feel comfortable where they can trust you, there's such a level of trust that has to go with an injector. And knowing that your business model is such that your injectors are not incentivized to try to push more product, that is huge. It's important. That creates a level of trust with a patient that you can't put a price on that. That is amazing because a patient knows that they can come to you and truly get honest feedback and honest opinion about what is required to achieve the results that they're after. That's true. I love that. One thing I learned, I was listening to a podcast the other day that was talking about just like the history of beauty. It's funny we're having this conversation because I was just listening to a really cool podcast. They were talking about even back to like the gladiators. They were developing cold creams to heal their injuries. And then they started using them for beauty and then using coal for eyeliner and different things. And it was like kind of a sign of wealth. But the main takeaway that I thought was so interesting was they were saying like the standard of beauty by definition is unattainable and it's like wow like we need to remember that right you know it's a capitalist society so that unattainable beauty really drives revenue for a lot of places and it's like that's not what I'm trying to do here I've been in that rat race of beauty pageants where it's we're all trying to reach the unattainable yeah and it's exhausting so it's like it's unrealistic it is and i think having no flaws whatsoever or being like quote perfect that i don't think that should be the the end game i never use that word in my office oh yeah ever even when we're talking about acne treatment or we're talking about rosacea or whatever, whatever kind of skin condition we're talking about, make an effort to never use the word perfect because there is no such thing. No. Imperfections are a way of life. Right. Why would we want that? It makes us interesting. It does. It totally does. And I'll tell you, I don't know if you notice this, but when people come in and you ask them what bothers them about their face, I would probably say 85 to 90% of the time is something I would not have even noticed when I'm looking at them. I mean, yours is probably different because it's the skin, you know, maybe a rash or like acne or different things, but a feature of their face that really bothers them. I'm like, really? That bothers you? Like, I didn't even see that, you know? That speaks volumes to how hard we criticize ourselves, does it not? It really does. Wow. So it's a really interesting thing. psychological environment that it is has been created and like you said since covid we have still a ton of people that are doing zoom calls and they're doing stuff on their cameras at home and i'm getting people in higher numbers more than ever especially necks because yes they're looking at their neck yeah in their camera when it turns around the wrong way and you're like nobody's looking at you from this angle even when we look in the mirror we kind of like do this yeah look at ourself and then they'll be like oh i'm seeing my neck i'm like well you're tucking your chin down you're It has to have skin there. It has to move. Yeah, you have to be able to stretch around. Yeah. But, you know, I do think that has changed. beauty or at least what we're trying to attain significantly because we're on cameras all the time. I was that. Yeah. That's what brought me in. And then you're looking when you're in those meetings, you know, back in the day where we sat at a table and talked with everyone, you couldn't look at yourself the whole time. And now we're doing these online video conferencing and most people are just looking at their own camera the whole time to make sure they don't look crazy. This was last night. I actually had a video meeting that I had to do. And, you know, I caught myself a few times thinking, is my Botox wearing out? Do I need to get a touch up? You know, and I was like, I got to focus on what we're talking about. Right. That's how it is. And so people coming in, they're like, I can't look at myself in this camera anymore. You got to fix this shadow and that shadow that's happening. And I'm like, Oh my gosh, turn the camera off. Have you seen Matthew McConaughey when he was on that zoom during COVID zoomed in with like, and he like, if he looked kind of rough on those zoom cameras that we, we don't have a chance, you know, literally. Yes. It's just, and again, like what we're seeing with employees, And like this social media has just taken it to a whole nother level of unattainable. Yes. And seeing. Reality versus Instagram type situation. Filters. Filters are terrible. I love this picture of me. And I'm like, it's not you, first of all. You're using a crazy filter. That's robot you. Or at least their own lips. And they want me to give those to them. And I'm like, same. I would love those as well. But that's not my anatomy. Literally. So it gives us access to... people that we just compare ourselves to. So for sure. Let's talk trends. So 2025, what were some or what are some of the trends that you're seeing people coming in interested in? A lot more people this year are interested in biostimulators. I feel like that's going to be a really huge change in industry. Sculptra, Radiesse, even like the platelet-rich plasma, we're drawing their own blood and spinning it down. We do that from, we do platelet-rich plasma, platelet-rich fibrin and then we have easy gel which thickens it even more and makes it more like a filler consistency so it'll volumize what's the difference between a biostimulator and a filler good question so biostimulator is sculpture specifically is a little bit different because it is purely a biostimulator so it kind of what my explanations it like fertilizes the area so it's like you go in you're adding this sort of fertilizer if you will and later months down the road is going to stimulate collagen. And so the way I like to to explain it is the way it was FDA approved was they went through a medical FDA and they got it approved for patients with HIV that were very gaunt. And so it takes a lot longer to go through the cosmetic FDA. And so they're like, let's go through the medical FDA. And these patients that looked incredibly gaunt with sunken cheeks, if you look at the before and after they've had Sculptra and it just fills out their face and makes them look more healthy and less emaciated. And so that's kind of what Sculptra does. First step in to the market. Right. So I think it's fascinating, but it really explains what it does because it just kind of plumps the face and not in a way that it makes them look like chubby. It's so natural. It is. It actually looks really good. It is. It's nice. It just stimulates collagen, kind of gives us back a little bit of vibrancy in those areas where we've lost volume. Radiesse is kind of a combination of a filler and a biostimulator. It's calcium hydroxyapatite, and then it mimics bone. And so So it goes like on jawline, cheeks, anywhere where you're mimicking bone. You get the immediate result of the filler, but then it also has a biostimulator component. So you are going to get some of that collagen production. Kind of best of both. It is. It's a little combination of the both. The downside to it is you can't use it in those kind of hyper mobile areas that aren't bony. You can hyper dilute it, but it's usually not what I pull for if I'm looking for an area. kind of outside. We've did a little bit in necks and whatnot and hyper dilute it for that collagen stimulation component. But typically I'm using it on bony. And then when you start getting into like your platelet rich plasma and stuff, that's just your own blood spun down in different viscosity to stimulate collagen. And I think that's a really cool way for people that aren't comfortable with filler. Very natural. It doesn't get more natural. We don't add anything to your body. It is. Yep. And so that is a great gateway for people that just are really uncomfortable with the idea of putting anything in their body. And it's just their plasma kind of dependent on the health of their plasma. And then we have ways to thicken it so that it is like the easy gel is really cool because it's thick enough that it will mimic filler in the short term. So you're still getting that bio-stimulator component, but for weeks or months, they get some, say, cheek projection or tear trough projection. And then it gives you that little bit of instant gratification that you often miss with some of like the PRF or the PRP. So it just adds that little... change in the viscosity yeah so but that seems to be people are just looking for more natural approaches like more of a functional medicine type approach um because i think we are seeing a lot i don't know if you're seeing a lot more autoimmune stuff but we're oh my gosh yes yeah so i think people are more comfortable with just trying to stay natural in their approach at least as long as they can because we are seeing so many different autoimmune issues popping up and so these are safe for these patients they are that's great yep so it gives them another option that They can feel comfortable. They're not going to have an allergic reaction or something like that. Yeah. And the results, are they ongoing? They're permanent? Do they break back down? They don't break back down. That collagen that you've stimulated isn't going to go anywhere other than the normal process of aging that your body just, you know, you're going to break down collagen over time. But it's not like a filler where your body's actively breaking it down and metabolizing it because your body is like, oh, this belongs to us. This is part of our body. It doesn't recognize it as foreign. So you don't get that kind of immune attack like you do on other things I mean that's the nice thing about our body is that over time it's going to break down things that it doesn't recognize so it just bypasses that whole route so you get a longer I love the temple injection with Sculptra. instagram or you know tiktoks or something where they've seen it done there but it's just a really cool spot that gets overlooked a lot very impactful it is not a spot like you know people come in i'm sure they want their lips done or their cheeks or whatever and that's one of those spots that i think would be an area where you know they don't necessarily come and ask for it and it's one of those conversations maybe to have where it's like well maybe let's try this in that area and just see if maybe it helps to correct some of these other things that maybe are bothering you that maybe won't bother you as much when we put a little bit into that area But I think, you know, with the biostimulators, knowing that they're not instant, like a filler. That's the part I think for patients to know is that if they go that route, it's a process of it taking time. They've got to be in for the commitment in the long haul. It's the marathon. And they've got to understand that it's not a quick fix. So, yeah, I think educating them on what this is and what it isn't. plays a huge role most of the time they're really happy with the results when we have explained it to them and they understand um they come back in six months they see the before and after pictures and they're like oh wow yeah you know but it's it's kind of undetectable so a lot of times they'll come in like you said they'll see the before and after and they're like oh i didn't even realize that is a big difference but it's been so gradual and that's another key to people not noticing is like definitely your people at work see you every day so they're like She hasn't done it. She didn't look weird any day. She didn't come back over the weekend. We can look in any different gradually. She's starting to look different. And so that's when it's been done nicely as well. And sculptors really good about that because it is just kind of a gradual build and you just, you know, in a few months look glowing and. Nobody can really tell what's different. Yeah. So it's cool. What about crazier trends? Last night I was on Instagram, saw a post on the Today Show. They were talking about in a talks. Have you heard about this? I have heard in a talk. This was new for me. Had never heard of this. I read about it and I thought, what? And I had to research it. So it's a. korean botox basically or a korean neuromodulator you can go online here in america you can buy it they send it directly to your door 50 units syringes needles all the things for you to self-inject it talk about why that is not good oh my goodness there's so much self-injecting and it pops up on my tiktok from time to time and it just sends chills down my spine doesn't it oh gosh it's just so dangerous it is so dangerous and people think yay this is fun this is beauty it's cheaper it's cheaper why don't I just do it myself I can be taught or my friend can be taught and it's like this is not this is not makeup you know you're not putting a full set of nails on yourself correct that's not what we're doing yeah this is a i mean it's a neurotoxin and that word itself should kind of alarm people that like maybe i don't need to be messing with this but it is in another way just practicing medicine without a license you know yes dosing yourself and knowing how much to put and where and where you don't always inject into the wrinkle you know never really yeah and so just we spend years you know i've been doing this for 10 years and i still learn things every time I go to a class or do a webinar and it's constantly changing and I do different treatments from one patient to the next. No patient gets the same treatment as another because our anatomy is not the same. You know, we might have the same muscles, but we all use them very differently. Even just between my two children, they have the same parents, obviously the same muscles at work, but the way they use them is so different. Their facial structure is totally different from one to the next. You can't get a diagram from china or korea of where to put it and that fit your face package insert yeah instructions or instructions that's what i can imagine it is it's just like maybe a diagram of where to put it it's like you can probably not even like very clearly explained what i would think not if it's anything like any furniture i've ever put together it's probably not very clear right but it's like i mean you're going to drop brows i even see people that have gone to professional injectors, if you will, that do it for a living that have their side of their face dropped or like crazy things can happen even with somewhat trained people. Like it's not an easy science. You know, I see fillers being injected at home and there's a whole Facebook groups of women's teaching each other to inject filler that they're getting. I assume these women are not trained, not trained, no medical background. And then you jump into a whole different world of vascular occlusion and tissue death that can happen that we worry about, you know, 10 years in with skilled hands, skilled hands, I'm always on high alert, because it can happen to the best of us. I've had injected, I've had vascular occlusions, and I know what I'm doing. But fortunately, I'm also trained to know how to handle them. And I have all the tools at my fingertips. But you think even just the endotox where you're not worried about vascular occlusion, you still have to worry about like anaphyl access what if yes you don't know what's in that you know do you have an actually buying how do you know what you're actually getting

Speaker 01: 38:06

yeah

Alisha Armstrong: 38:06

you have no idea there's no regulation to it whatsoever and so it's like people are going to get hurt and get hurt badly um not everything needs to be done at home and it's not it's not just an easy cookie cutter yay it's beauty it's kind of thing where, you know, when people come in and they're new to this stuff, what are the risks? It's like, well, there are risks, you know, we're not going to sugarcoat it and make you think that there's nothing bad that can go wrong. Hopefully it doesn't. But if it does, we're very trained and experienced in how to handle that. And sometimes that's the most important part is like knowing what to do when something goes wrong. Yeah. And that's why I really love hiring nurse practitioners as injectors that have worked in the emergency room or high stress situations, because I'll tell you when you do get about It's scary. Do you know what to do if something goes wrong? And a lot of times the ER doesn't know. Do they even know what it looks like when something's gone wrong, right? Yeah, they don't even know what to worry about. It's not like a wound necessarily. So yeah, that's... And then you don't have resources. You'd have to find a med spa or injector that knows what's going on. We have ultrasound now so that we can... there's sometimes vascular occlusions that are kind of encapsulated that you have to inject hyaluronidase under ultrasound and actually watch it going into like a nodule. And so we have that ability, but the public probably doesn't know that that's even a thing, that we need to have that ability. But I know I worked in the ER for a long time, and we were never taught in the ER what to do for like a filler complication. So Who are they? Who's their resource? They're not going to go to the ER. They're not going to know what to do either. And then there's the whole, like, you have to wait a period of time, most likely, for an appointment. It's like you can call and say, I need to get in today. Sure. So that is definitely not a good idea to be doing injections at home. Yes. It's like, I don't even know how that became a thing. I think, honestly, so many people look at the aesthetic industry as... non-medical treatments and I think it's so important to recognize that all things that are happening in your your business all things that are happening aesthetically it is a medical treatment absolutely that would be like going home and doing surgery on yourself that is a medical treatment same exact thing same exact thing and we go to cadaver labs yes and practice injecting and then open that up and see where our filler actually ended up and I'll tell you, there's been a couple of times where in those cadaver labs that makes me so thankful for those that I'm like, wow, my filler was right around the facial artery dancing around it. And it changes my practice significantly. You know, when we're injecting at the whole time, I'm thinking, okay, well, here's this artery. Here's the labial artery. Let's go at this angle because i want to avoid this artery or let's i'm changing my injection technique constantly and that's all that's going through my head is basically seeing what's going on under the skin and seeing x-ray vision x-ray vision yeah because i've studied it so significantly and it's like okay there's a nerve there that's why they're feeling a little twinge of pain where there's a nerve there's a an artery and a vein you know you just have to know your anatomy and know what you're afraid of, you know, and a healthy fear is good. Totally. And then when you don't have a healthy fear because you're doing it at home and you don't know what you don't know, it's just there is probably nothing more scary to me with that situation. It's terrible. It is. So when people are shopping for injectors, kind of in that same vein of safety, what would be some red flags for consumers when they're looking for an injector? What is something to avoid? What are you looking for? I would avoid, of course, like fly by night, if they just pop up out of nowhere, everyone has to be new and has to learn. But I think their transparency is very important there. So we all have to just be transparent that we're learning. What I see a lot is it advertised as like, I've got 20 years in the medical field. And I've ran into this a few times where I'm kind of cleaning up the mess. And when I find out, it's like, oh, well, this person said they've been doing it for 20 years. And you really have to ask, how long have they been injecting Botox and fillers specifically? Because I have 25 years in the medical field, but not all of them were injecting Botox and fillers. I wasn't learning the facial anatomy at that time. You know, I went to nursing school. I went to nurse practitioner school. I got my doctorate. There's not once I learned anything about the facial anatomy during any of that. And so I have sought out myself years of conferences and travel and training and one-on-ones and been all over the world to learn techniques and to go to cadaver labs. And so you really have to have a consultation with someone, talk to them and ask that question specifically. how long have you been injecting Botox and filler and like I said we have new injectors in our office too so they're everyone's new at some point right but you need to be able to make that decision they need to have a mentor in-house so you need to know hey they're new but they have a resource in case of emergency yes the plan do you have the supplies in case I have an allergic reaction or in case I have a vascular occlusion are you prepared to handle that you know those can those questions for the consumer are really important And not just, oh, my friend went there and, you know, she looks okay, so I'm going to try her out. Or they're the cheapest. I was going to say the price shopping always blows my mind where they'll call around to every spa in town and see who's got the cheapest. And it's like, you don't want discount Botox or sushi. Those to me should raise a red flag. You get what you pay for in life. Always. Yeah. So you're often not just paying for the product. Yeah. Like, oh, we don't want sushi sales. That's not where we want to be. So I'm always like, it should raise some red flags when things seem a little cheaper. And I happen to see from time to time, I know what it costs to buy it at wholesale. And for some of the prices that It'll be advertised sometimes. There's absolutely no way it is from the U.S., from an actual company that we use. I'm like, that's got to be from Canada or China because they're charging less than what you can even buy it for. And so that's scary too. So that can be done in the United States? It can. There's not any kind of regulation on that? Nope. There's nobody that checks it. There's nobody that goes around to the medical spas to make sure they're buying from Allergan or Galderma or an actual company that's got an FDA approved product. There's no oversight. There's people injecting that aren't even licensed to be injecting. And there's nobody that oversees it. Nobody that does anything. Basically, there's people are like, well, if their medical director's fine with it, then, you know, that's on them. And so then you've got a medical director that's often not related to this field at all, because there's places popping up that are like, oh, let me get my friend, Dr. Bill, who, you know, does orthopedics and he's willing to sign off and be my medical director. Well, it's like, he doesn't know what to do if you have a problem. And so I've also, our medical director is a retired plastic surgeon with, you know, 40 years of experience. And that's important to me too, because I need a resource if things go bad and even though I've been doing this a long time and I don't call him a lot you gotta have somebody yes so I shudder to think what you know if I really got in a bind and I needed someone who would I call if I didn't have him and I just had a director that was completely unrelated to the field but I think even physicians don't know that there's problems that can occur. They too think that it's like, oh, yay, this is like throwing a dart. Yeah, it's just like, whatever. It's just Botox. And they don't realize the problems that can come about as well. So that's my big hope for this industry one day is that there is some oversight and some rules in place that will protect people because it feels like the Wild West. Yes. Cheapest is not always best. And you can go to a weekend course and learn these things you might get one or two models to work on and then you can come back and just start injecting people and you know it takes troubleshooting and seeing things go wrong and learning how to fix them and multiple multiple like anything you know you're not good at it until you've done a lot of repetition yeah with it and so it's like I remember being put in that situation when I worked at the first spa they sent me to Nashville for basically a day and got back and they were like here you go now start injecting and I was like I don't know what I'm doing right And so I ended up myself paying to go to Chicago and spending a week up there to get trained because I was terrified that I was going to mess somebody up. And again, that goes back to that healthy fear. It's like those people that come back with all the confidence in the world. The truth is the longer that you do it, the less confidence you get because you know all the things that can go wrong. So you're just more on high alert. That's what makes you great. It is. You know what you're looking for. You do. You know what you're doing. You should always know that like something go wrong and And I'm not too good for that to happen. And my new injectors often they'll be like, I just feel like I'm getting worse because I'm constantly second guessing and worrying that I'm messing something up. And I'm like, no, it's because you're getting better because you're learning the things you didn't know in the beginning. In the beginning, you were like, oh, whatever. I know this. I'm good. And then you start doing it longer and you're like, oh, this doesn't fit the cookie cutter. You know, this doesn't fit this search and situation. I'm worried about X, Y and Z. So anyways, I think that that's important as well. It's just always being aware that things can happen and knowing that you're prepared to handle them. Yeah. What's your favorite area to treat? What do you enjoy doing the most? Um... think cheeks probably yeah because when they're done well they really make a big impact and people just love them it's often something that they're a little nervous about doing because they always think cheeks that they're going to be huge and they're going to look like abnormal abnormal or they're going to their face is going to look more full and they're like I don't want my face to look fatter and I'm like nobody does it's never been a request as long as I've been doing this but when it's done nicely in the same way that you contour your makeup you do it like in a lateral way that really reshapes the face and kind of puts it back into their own facial structure. It just lifts it back up to where it used to be and it's a really cool lips are fun lips everybody's lips i think they're beautiful lips are just kind of a a fun one that always has a fun outcome where people love to show them off and stuff but cheeks is just kind of like that a secret sauce that i think can go a long way yeah i think so too yeah So let's talk for a second about men. So men in the aesthetic world as patients, do you see very many coming into your practice? It used to be probably about 10%, and I think it's starting to grow into maybe around 20%. Why do you think that's so low? I think it's because they're afraid, again, that people are going to know they're getting stuff done. I do have a lot of them, too, that are like, I earned these wrinkles, and I'm going to live with them. And then they think they're going to look like boyish if we get rid of them. And so... I know my husband was terrified to have it done because he thought he was going to look crazy and people would know. And, you know, now he'll be like, hey, can we do my Botox? He likes it because people compliment him when he goes back home. He's from Boston. When he goes back home, people are like, wow, you look younger every time I see you. But I think that's the biggest thing is they're afraid it's going to look strange or people are going to know. But men are kind of a fun thing. fun dynamic to treat because you do want to leave some lines you know you treat their crow's feet in a little bit but you still want them to have a little bit of crow's feet you know it looks distinguished and we don't want them to just look oddly like the rest of them doesn't match their face because they have no wrinkles you know and you don't want them to look like a young boy with no wrinkles whatsoever so it's teaching them that there is a spectrum that we can work within where it's like, it doesn't have to be an all or nothing. We don't have to freeze you or do nothing. We can just soften lines to keep them from getting deeper and still make you look like you know, again, we don't want anyone to know, but you know, when you're doing it, when your injector knows how to treat men, you can do it in a really nice way where they still look manly and you know, can feel like they're kind of refreshed a little bit. It goes back to that art form, the different art form for men versus for women. You know, women, it's like, I want every wrinkle on my face erased. Yeah, completely. I do want to look 20. Whereas with men, to your point, I mean, I think that there is a level of, you know, that they want to look more youthful without looking like they are in their youth. Right, like a little more rugged. You know, they just want to look. That's a good word. Yeah, I tell them, I'm like, we'll keep you looking a little rugged. Yes. And so I think that's important. But they do take more, their muscles are thicker and their skin's thicker. So you've got to go a little deeper and you've got to dose them a little higher. So it is from even just a medical standpoint of how you inject and how you dose them is different. So they're fun. And hopefully that'll continue to grow as they start to, it starts to be less taboo for them to get this done. We have more and more that are doing skin treatments and stuff, which is great. It's even being marketed now for men. Brotox. It was funny the first time I heard that I was like, hmm, weird. But I mean, like when you look into it, there are significantly fewer men that are walking through the doors coming in for aesthetic treatments. And that's unfortunate because men want to feel good about themselves too. Sure. As they should. Yeah. You know? Yeah. Are there treatments that you think for men outside of Botox that they can benefit from. Definitely. I mean, they're a great one for a biostimulator, too, because, again, there's that gradual improvement. It's not a drastic difference. A few men will do filler in the face regularly. even it's actually like my much older men that are kind of like 60s 70s that are comfortable with it usually their wives have told them to come in and get it done whatever she says yeah they're like whatever she told you i need is fine yeah um but then the younger ones is more botox but they're they're just doing skincare treatments too um but i mean we're seeing a lot more of that yeah with the biostimulator is a really cool a lot of jawline actually lately now that i'm thinking about it they're We're getting more wanting filler in the jawline. Or chiseled. Yeah. Yeah. And that's probably a result of more men doing like the GLP-1s and stuff. They're starting to lose some weight. And so they want their jawline accentuated now. Yeah. it's funny because with men, like in my setting in dermatology, you know, the focus is on let's get away from this one-stop shop that washes your hair, your face, your body. Like you don't need a one product for all of that. Right. It's like men deserve to have good skincare too, you know? And then they'll buy in when you, when they start to see the difference. They do. I'm constantly having to like, my husband's like, well, how come that's not in my shower? Yeah. That product that you're using. Do I need that? Or they take yours. Yeah. He He takes mine. That's why I tuck it away. And he's like, wait a minute. Why is that not in my little area of products? And I'm like, that's for me. That's my good sunscreen. That's my good stuff. You stay away from it. But there's more and more products, too, that are coming out that are like one product. As far as putting their face, like, I don't know if you use a lot of Pavise, but we like Pavise for men because it has some of those great things for skin and the sunscreen. Because I find that just is too much. They're like, don't want to do multiple steps. You're right. I think definitely keeping it simple and effective. always is the goal for anybody male or female right but especially for males what can they be compliant with what can they that's right how can we get their skin moisturized and get a sunscreen on if we're doing those two things it's like we're winning we're winning yeah you're exactly right so for people who are considering going down the road of aesthetic treatments but they haven't quite gotten brave enough to come in for a consultation yeah What would your message be to them? I would say, for one, bring a friend. Oh, yeah. Because that just takes the pressure off. It is overwhelming. They will look at our website or any other website, I'm sure, and they're like, I don't know what I need. I don't know what any of this means. And so... The consultations are completely free. They don't get anything done at the consultation, so there's no pressure. We're certainly not going to try to sell them on anything. They're not going to need to make any sort of commitment to doing anything. So bring a friend and then have your questions ready to ask and then just gain as much information as you can. Ask around to people, but make sure it's someone you feel comfortable with. But like you said, getting through that door is the hard part and so i think just having someone with you whether it's someone that's been to that practice before that can kind of be like hey this is my friend so and so you know that's super helpful um but just knowing that you're coming in for information only and that I'm only doing my job right if I'm giving you all the options. You know, it's like, I'm not just going to say, this is what you need to do, period. You know, it's like, okay, well, here's, there's a range. We can start very conservatively or we can go aggressively or somewhere in between and you go home and you think about that. And then when you're ready, that's when to do it. I'll have people often where they're like, I want to do this, but I'm so scared. They'll come in, they'll talk to me and they're like, I hear what you're saying. I'm just not brave enough yet. I'm not there. And I'm like, You come see me. Then wait. You're excited. It's not time to do this. If they're not sure and they're not excited about it, I mean, of course you're going to be nervous. I was nervous my first time too. I remember it vividly. Me too. Yeah. So you're like, you're not going to get rid of the nerves altogether, but you need to get to that point where you're like, I am ready to do this. I'm excited about it. A little bit nervous, but I trust her. And I know, you know, that it's going to look good and that I'm going to be happy with it. And if you're not there yet, it's not the time. you know, wait till you feel good about it. Cause then you're going to ultimately go home and be excited about your results and never want anyone to feel like they were rushed into it. And then they're not excited about what, what they've received. They regret it. Yeah. And you don't want that. I like those easy wins where they're like, I don't like this. Can you make it better? And I'm like, yes, I can. And then they go home and they look in the mirror and they're excited. So that's how it needs to be. That was me. I said, get rid of this wrinkle right here. And you said, done. I got you. Sign me up. Well, Alicia, thank you so much for coming on today. Thank you for having me. You can find Alicia and her injectors, her staff located North Chattanooga, Hickson, East Brainerd. You got it. Thank you. Thank you so much for having me. Absolutely.