In this episode of Conversations in Aesthetics, Gary Goldenberg, MD, sits down with dermatologist and Mohs surgeon Joel L Cohen, MD, Director of AboutSkin Dermatology, Denver, Colorado, for a detailed conversation that starts where many consults do: a patient asking for “a little Botox” and pointing to a single area.

From there, Dr Cohen walks through how he approaches the person in front of him. Not all lines are the same, and not all treatments are interchangeable. Early dynamic changes may respond to neuromodulators. Deeper, etched lines may call for filler, if the tissue allows for it. And when the surface has shifted entirely and the skin takes on that “peau d’orange” texture, the conversation moves to resurfacing.

What follows is a broader look at how those decisions come together in practice. In Denver, where sun exposure is constant and cumulative, photodamage is frequently the primary driver. That reality shapes both the consult and the plan. How aggressively to treat, how much downtime is realistic, and how to sequence interventions, from volume replacement to fractional or full-field resurfacing.

The discussion also moves into technique, including the timing of neuromodulators around resurfacing, what energy-based devices may or may not affect filler longevity, and how to think through anesthesia and recovery for more intensive treatments.

Throughout, the pair returns to a simple principle: match the tool to the problem. The goal is to do what actually works for the skin in front of you, based on its structure, degree of damage, and what the patient can realistically tolerate.