The Art of Aesthetic Judgment

In this episode of Conversations in Aesthetics, Gary Goldenberg, MD, sits down with Susan Weinkle, MD, for a wide-ranging conversation on how aesthetic dermatology has evolved, from the earliest collagen fillers to today’s broader understanding of facial aging, biostimulation, devices, and treatment planning.  Dr Weinkle reflects on the shift from simply filling individual lines to thinking more globally about proportion, movement, skin quality, and the way the face changes over time. Much of the discussion focuses on the cosmetic consultation itself: starting with what the patient sees in the mirror, identifying where treatment can make the greatest impact, setting expectations early, and building a gradual plan rather than trying to correct everything at once.  The conversation also explores changing attitudes toward filler, including concerns about overfilling and growing interest in biostimulatory approaches. Drs Goldenberg and Weinkle discuss how they counsel patients on response, longevity, and the importance of matching the treatment to the individual rather than relying on a single formula.  From there, the focus moves below the jawline to what Dr Weinkle calls the “neglected neck.” She walks through her approach to platysmal bands, horizontal neck lines, hyperdilute biostimulators, and the anatomy and technique that shape her treatment decisions, while emphasizing that meaningful improvement often requires a combination of modalities and more than one session.  Throughout, the episode is grounded in the kind of practical judgment that comes with experience—know what your patient is asking for, know what your tools can realistically deliver, and have the confidence to say no when the treatment is not right.