In this episode of Conversations in Aesthetics, Gary Goldenberg, MD, sits down with dermatologist Nicholas Brownstone, MD, for a conversation about building an aesthetic practice, developing confidence with procedures, and recognizing when the right decision is not to treat.

Dr Brownstone reflects on his path from plastic surgery training to dermatology and the experience of establishing an aesthetic patient base early in practice. The discussion kicks off with practical ways to grow that work organically, including introducing aesthetic options to existing medical dermatology patients, learning from treatment follow-up, and becoming fully comfortable with the physics, terminology, and clinical endpoints behind laser procedures.

The conversation then turns to the aesthetic consultation itself. Drs Goldenberg and Brownstone discuss beginning with the patient’s concerns, recommending treatments within the clinician’s skill set, and being candid when surgery or another procedure may offer a more meaningful result. Throughout, they emphasize education over selling, realistic expectations, and the importance of knowing both the capabilities and limitations of the treatments being offered.

A substantial portion of the episode examines body dysmorphic disorder and the challenges it can present in aesthetic medicine. Dr Brownstone reviews behaviors that may raise concern, questions clinicians can use to assess whether a patient is an appropriate candidate, and the role of the entire office team in recognizing warning signs. He also discusses how clinicians can respond with empathy and validation while avoiding procedures that are unlikely to resolve, and may worsen, the patient’s distress.

The episode closes with a rapid-fire look at Dr Brownstone’s preferred injectables, lasers, and aesthetic procedures, including his particular interest in vascular and pigmentary concerns. Across both the clinical and practical discussion, the message remains consistent: build trust, understand what the patient is truly asking for, and remain willing to draw a line when treatment is not in their best interest.