In an era where misinformation spreads faster than facts, the public sees a side of aesthetics that doesn’t represent the exceptional work that you safely deliver every day. While hyaluronic acid (HA) injectable fillers continue to deliver transformative, natural-looking results for patients around the world, public perception is often skewed by viral horror stories, influencer clickbait, and outdated myths. Aesthetic injectors have the power and responsibility to change that.

Learn more about what patients are looking for from their HA filler treatments at AmSpa's resource page: Achieving Natural Looking Results with HA Filler Treatments.

What consumers really want

According to The Aesthetic Evolution: The Hyaluronic Acid Injectable Fillers Report from Allergan Aesthetics:

• Nearly 90% of consumers indicate they are satisfied with the outcome, noting natural-looking results as their top satisfaction point.
• 78% of consumers strongly agree that today, people want a more natural look.
• Over two-thirds of consumers use social media and online videos to learn about HA fillers.
• Over 75% of consumers believe that more people will use injectable HA fillers in the future.

The biggest misconceptions about HA injectable fillers

Let’s bust the myths that hold patients back:

Myth: Dermal fillers will make me look like a different person.
Fact: HA injectables are minimally invasive and help restore and refresh your look without surgery and with minimal downtime.

Myth: Dermal fillers move under the skin after being injected.
Fact: Migration is rare and often due to poor technique.

Myth: HA is an unnatural substance.
Fact: HA is naturally found in the body, most commonly in the skin.

Myth: It takes time to see results.
Fact: Results are typically visible immediately and can last 6 months to 2 years depending on the product and area treated.

Myth: HA injectables are permanent.
Fact: HA fillers can be dissolved and removed if necessary.

Myth: All fillers are the same.
Fact: HA fillers vary in thickness, flexibility, and purpose, and are tailored to different facial areas.

What patients value most

• Natural-looking results
• Minimally invasive procedures
• Safety when administered by professionals
• Immediate results
• Customizable treatments for different facial areas

Practical tips for injectors

1. Educate proactively. Use social media, newsletters, and in-office materials to address common concerns.
2. Show, don’t just tell. Display before-and-after photos with syringe counts to set realistic expectations.
3. Be transparent. Explain product selection, anatomy and treatment plans clearly.
4. Stay agnostic. Choose products based on patient needs, not brand loyalty.
5. Train continuously. Invest in cadaver labs, rheology education and advanced technique workshops.
6. Support your team. Give injectors time and tools to create educational content.

“You don’t have to reinvent the wheel. Just talk about a paper you read that week. Share what you learned.”
— Brittony Croasdell, MS, FNP-BC, APRN

Inject positivity into the algorithm: Flood the feed with facts

We can’t let the loudest voices be the least informed. As Croasdell and AmSpa’s Alex Thiersch emphasized, the only way to shift the narrative is together.

“We’ve got to flood the airwaves with the truth… It’s gotta be all of us.”

Visit the resource page for statistics, education and tools that you can leverage in your practice and in communication with your patients: Achieving Natural Looking Results with HA Filler Treatments.

Trainer, injector and entrepreneur Brittony Croasdell shares her insights

AmSpa founder and CEO Alex R. Thiersch, JD, sat down with Brittony Croasdell, MS, FNP-BC, APRN, co-owner of Fulcrum Aesthetics & Surgery, to unpack the evolving conversation around hyaluronic acid (HA) injectable fillers. From viral misinformation to the stigma surrounding aesthetic treatments, Croasdell shared real-world insights from her Chicago-based practice and dove deep into the findings of The Aesthetics Evolution: The Hyaluronic Acid Injectable Fillers Report.

Listen and subscribe to Medical Spa Insider to take an in-depth look at today's aesthetic entrepreneurs, with insights on hot topics affecting your med spa and the aesthetic community.

Alex Thiersch, JD, AmSpa founder and CEO: Alright, everybody. Welcome to the AmSpa Clubhouse. This is the official AmSpa clubhouse, I feel like. This is Alex Thiersch here with Medical Spa Insider, and we are here live for the very first time in our new facility, I guess, which is 99.9% finished, shooting a podcast with the amazing, lovely and talented Brittany Croasdell. Brittany Croasdell, NP extraordinaire. You've been in the business for a long time. I think the last time I saw you and we were communicating, I can't remember when it was. But then, snap your fingers and now you're like married. You have a new baby. You've got a new practice. Everything is changed. How the hell are you? What's going on?

Brittony Croasdell, MS, FNP-BC, APRN, co-founder of Fulcrum Aesthetics and Plastic Surgery: I'm doing great. I'm doing great. And thank you so much. 

AT: New practice, right?

BC: Yeah. New practice. I'm, yeah. At the last two and a half, three years have been a whirlwind. Yes. The first time I met you, and you may not even know this, the first time I met you, I actually started at a med spa that well, we're not gonna mention, but they were, we didn't have any policies, procedures, protocols. Right. We didn't use Hylenex. And I had reached out to the manager and I was like, ‘Hey, I really think we need this stuff. And there are certain things that, ways that, from what I've heard from this guy named Alex that needs to be done. With good faith exams, with the aestheticians. And we reached out to you and we met with you. And this was before, I think you had maybe just started AmSpa.

AT: I remember that. Yeah. It was a while back.

BC: Long time ago.

AT: Yes. Because you were one of the first people that I met in this industry after we kind of got going. And then there was a time when you were off doing your thing. Really? So that was a bit ago. Yeah. Yep. And look at you, blowing up like I knew you would. But now you're, I mean, honestly, you've been you've had your own practice for a while and then you've moved around a bit. Tell me about where you are right now. What your current med spa is. Name. Who your ideal patient is, a little bit about what's going on. 

BC: Sure. So I currently co-own Fulcrum Aesthetics and Surgery. And it's in Lakeview. So we offer everything from functional medicine, hormone replacement. We have one of 44 menopause certified practitioners in the state of Illinois. There to help our patients out. We do, of course, full injectables. We have plastic surgery and skincare. Lots of lasers. Lots of microneedling. So yeah. We're just super busy. And growing. We just hired three new injectors this week. 

AT: Really? That's incredible. What's the, you know, I always talk to folks about different spots, because we're always traveling, but I never kind of take a look where we are. What's the, how's the market in Chicago? What's it been like?

BC: So I, from our personal experience that we opened when the market started a downturn. But because I had a regular book of clientele, I think we, we did fine. We survived. Certainly a lot of, some patients were a little bit more hesitant to get dermal fillers. But during that time, they would come in, maybe they'd come in every, say three to four months for a neuromodulator. And they'd always ask about their annual touchup of filler. Maybe they pushed the filler out, I would say probably about two years. What ended up happening were, patients were a little bit nervous about it, uncertain, asking a lot of questions, much more informed and maybe incorrectly so. But once they saw their face start to deflate, they started to see early signs of aging. They were right back in the door wanting to get fillers.

AT: So it's a perfect segue. And part of the reason we're here, there's a bunch going on in the industry right now. This has been a very interesting – I think that's one way to put it — time for us. But we're gonna get into some of the misconceptions on HA fillers, misconceptions, and some of the misinformation that's coming out just around the industry in general. How we're fighting back, how our good friends at Allergan are fighting back. They've got a brand new report out that we're gonna get into, which is an amazing resource for you to, for everyone to see. I think actually it should be dropping—that's the word that we use in the industry, drop—today, I think. Right. This is being released. So we will put a link for that in the show notes, and you can see that. But kinda leading into that, you mentioned that some of your patients were a little nervous about getting fillers or talking about fillers. And that's kind of a perfect segue into what we're gonna be talking about. Why is that? What were some of their concerns and how did that conversation go?

BC: So, some of the misconceptions I found, they stemmed from beauty influencers and sharing their worst case scenario. Right? So it gets sensationalized, it's shocking when you see dermal fillers go wrong, when you see even dissolving patients swell up and it looks jarring, right? Yes. And so it's click bait. So people are looking at it, reading maybe a portion of the story, not understanding that that swelling from hyaluronidase is not actually Botox or neuromodulator. Right? Right. But they think, oh, don't get Botox, don't get fillers. But that's also very temporary and so few and far between. But that's what gets shared. And you don't really, patients aren't seeing the great results, because a lot of times people want to fly under the radar. They don't want people to know they're getting these treatments to help enhance their looks. It helps them feel good.
And there is still a stigma attached to getting these procedures. So often, more often than not, patients don't want to share their before and afters. They don't want to talk about it even with their family or friends because they feel judged by it. So what we're lacking in social media is seeing the good natural results in the masses, which is far more prevalent, far more common. And what we do see, and what we are inundated with, are the poor outcomes. And with the poor outcomes, once you click on that, one poor outcome, someone that shares that, that is now your algorithm, that's your, that's fed to you constantly. So that's all you start seeing. And then also, you know, these influencers, they build themselves off of that because, you know, it's clickbait,

AT: It's clickbait. That's what gets them followers. It's really, what you're talking about with fillers, is something that we as an industry are dealing with. And I mentioned this report from Allergan, which we're gonna get into a little bit as far as some of the specifics. It's really, really cool. I think, what they've done, and I think it's going to be very helpful to all of us. But it's also a microcosm a little bit of what we're dealing with as an industry. This has been for the past probably 18 months, two years, we've been dealing with what you said on a much bigger scale, which is just this kind of constant drumbeat of bad PR, a lot of times flat out misinformation. Some of it, admittedly, I think from our perspective, is self-inflicted. Because there are groups out there, there are providers out there that are doing really stupid things, and they get magnified.
But your point about the good results, the good practices aren't really being magnified because they're good. They're doing a great job. They have a solid following. Their patients are happy. They're happy. There's no need, you know, to splash over the front page when there's been a positive, you know, Botox treatment, right? Or anything like that. It's only when the bad things happen. And that's created this atmosphere where, especially this year, it's just been one after another of these constant stories that have really exemplified the negative. And we're fighting back And that ends today. Like, we're like, really part of the issue is that we haven't had a unified common story to tell in opposition. And that's been difficult. So one of the things that we're doing is we want to change that narrative.
We want to tell a positive story, tell about the good things, the positives, the safety aspects, the professionalism. Allergan in the report that they put together is doing the same thing about kind of what's positive about HA fillers. I'm curious when you see – and just by way of example, there was a recent story, I think it was in ELLE magazine that came out that was just. I mean, look, they're reporters, there's reporting, but it's not reflective on what the industry is like. I'm curious, when you see those types of stories and the surgeon in your practice, what do you think when you see those? And what's your reaction to those types of stories? 

BC: Truly. So it depends on who, I always look up who the writer is, and then I'll see who they interviewed as their sources. Kind of same thing when we're reading our white papers. Who sponsored that study? How long was the study done? Was it, you know, was there a control arm? I do the same type of investigative work when I see this come out.

AT: As we should. That's the whole point. Yeah.

BC: And there's actually, there's a beauty editor I had reached out to a couple of years ago, be when it all kind of all started, when there was one really wild thing going around online, which was completely misunderstood, misinterpreted. And she didn't want to hear the good. She didn't wanna hear, actually the truth. She wanted the sensationalism of it. And the negativity. So it didn't, the conversation didn't really move any further. And now I know this particular doctor has been trying for the last two years to really overcome this negative media that had come out. And she still hasn't been able to. Because she gets like 300 views. And one beauty influencer got 22 million views on this.

AT: Yeah. There was the feature that came out on John Oliver recently on HBO. And man, we must have, I've gotten calls daily from other reporters who are now working on stories that have come from that. And it's all about the negative things that are happening. But they're focused on this subset of med spas that is such a small subset. It's the total outliers. Same thing with respect to what you were talking about. It's not the norm. And yet we're dealing with that. So what we need to do—I truly believe this, and I've been kind of thinking, and we're doing a campaign on this, and I appreciate what Allergan is doing—we've gotta have a counter narrative. We've gotta have, we've gotta flood the airwaves with the truth, right?
And something that I thought was very interesting when we were talking with, when we were going over the report with some of the folks that developed it was the algorithm issue. In that when providers push back against some of the negativity. So when you get a negative story about filler, someone who looks terrible, and it's posted by a beauty influencer, and it goes viral, and you're trying to fight back and say, ‘No, the truth is this.’ And you post it yourself, that only amplifies it and further embeds the algorithm. I didn't realize that. It makes perfect sense. 
And so as we move forward, what do you say to your patients? 'Because this is the time to educate. You've been dealing with this already. What should we be saying? What should we tell our members and our providers for what they should be saying when these kind of crazy looking photos pop up and these stories come up? What's the proper response so that we don't inflate the negative, but we perpetuate a positive story?

BC: So I think it's twofold. I think it's what you can do as a provider on your social media platform or on your website, and then what you do in the treatment room with your patients. The conversations that you have. I myself, I just started this, I just started, I blocked off one day a month for content. And it's just educational content. And I try to make a quick little script of common questions that I've had from patients that month. So I can answer the previous month's, like common questions that three or more patients have come in asking. I'll make a note on my phone. I want to address this in my content day. Because if three or more patients are asking me that, they're getting that fed to them from somewhere, likely social media, and maybe I can squash their concerns by addressing it on my page.
Now when I see them in the treatment room, it's more of understanding where their fears are coming from. And a lot of patients, there's two things. They don't want public shame. So they don't want their friends or family or spouses, a lot of women don't want their husbands to say anything negative about it. If a husband happens to make a comment, like I've had patients say, oh my gosh, you made a comment. They said, my lips look so big, or my cheeks look so big. And then after, but they had just been injected, you know, they're swollen. And it's that comment that lingers with them after they're healed and they look beautiful, natural, it's still, they'll look at themselves and they'll be able to say, objectively, I do look better. This looks great. Right? Oh. But that comment, like, my husband said this.
And so it's kind of, I now talk to the patients before we do treatments, and this is big with surgery, is preparing your friends and family around you if you can. If you're comfortable with it, saying, ‘Hey, I'm getting injectables today. I don't wanna hear a word out of your mouth.’ You know? I'm gonna look a little bit swollen. I'm gonna be a little bruised. I'm gonna look a little haggard. Normal, expected. It's because I'm in it for the long game, you know? And so I think a part of it is also helping combat the psyche, helping combat the damage that family can do with those little kind of backhanded comments. And they don't mean to hurt you at all. They're just making a comment kind of like, ‘Oh, you're really swollen. Why, are you hurt?’

AT: Well, who are these husbands though? I need to have a conversation with them. Everybody knows not to do that! My god.

BC: Thank you. And then, you know, I also think it's understanding where their fear is, so they don't wanna look abnormal to their friends, family at all. And then some of them just don't want anyone to know they had anything done.

AT: Now are you still seeing that? Even now? Because that was a big thing, you know, the early 2000s. I feel like it's, that's lessened with all the social media attention. But you're still seeing that even today.

BC: So what's really interesting, I, during COVID, patients, we went – again, the pendulum always swings, right? So during COVID, lot of patients coming in, very busy practices. And I had a patient who was upset and emailed me afterwards because I didn't ask to post her before and after. And she thought that I didn't like her outcome, my results on her, because I didn't wanna post about it. And now it's kind of back to when I first started practicing. Patients don't wanna be asked to post before and afters. They don't, it's one of two things. They either want it for free if you're gonna post it because they understand that it's being used. It's, it is. You're posting before and afters on your social media. It is slightly commercialized. Yeah. No, I'm not getting kickback. We don't get paid for it. Right. Obviously it's sharing information, but it does help with that trust building and it helps bring new patients in. And so they either want it for free, which– 

AT: That's not gonna happen. 

BC: Yeah. You can't do. Yeah. Or they again, they just don't, they don't want the comments of the ‘Wow, you look really good, but it's because you had Botox.’ You know? They don't want that.

AT: Yes. Which I get.

BC: Yeah. They don't want their natural beauty to be diminished because they're seeking out these procedures.

AT: That's interesting because I feel like it's almost like the way these treatments are being talked about and the way that you as a provider are offering them, it's evolving with the treatments themselves. Right? Because that, when we first started out, when I first got in this industry, it was very much people didn't want anyone to know, just 'cause they didn't want them to know they were treated, period. Right. Yeah. Now, from what you're saying, it's almost like that's not as much the issue, but they just want, they don't want to be judged, Yeah. By either someone's thinking they're overdone because of some of this negative stigma that's attached to it. They wanna feel natural. Their husbands are gonna say something, or their family's gonna say, which I actually have had that happen with someone I know their mom said something to them.
Yeah. And she still talks about it to this day, even though you're right. A week later or whatever it was, everything looked phenomenal. Yes. And it was just, I just couldn't believe it. Real quick, I wanna make sure that I get this because I didn't mention it. The, this report, which by the way, you will post below. So you can see it, The Aesthetics Evolution: The Hyaluronic Acid Injectable Fillers Report, which is by Allergan, but it is very much agnostic as far as brands. It just talks about kind of the entire industry as a whole. You were asked to be a part of this and provide some insight. I'm curious, what was, when you were approached about this, what was your reaction and what was the impetus behind you wanting to be a part of this report and just kind of helping do what you do right now?

BC:I really, I was really impressed that Allergan was doing this report. Yeah. Because again, it is unbiased, right? So it includes all brands. It's not just specifically theirs. They're doing a ton of market research. And I really wanted to see, I wanted to share what I am experiencing in my clinic in Chicago, right? Yeah. So this is our demographic across the country. So it might be unique to someone else in New York, someone else in, you know, a small town in Denver. So I wanted to share my experience, but I also wanted to hear what the market is saying and is what I am seeing in my practice reflective of what the market is showing.

AT: The market, yeah. Did anything surprise you?

BC: You know, what did surprise me was that consumers are, they trust a medical provider more than the influencers. And I felt like—

AT: That’s good.

BC: That's great! Great news. And it's encouraging. That's why I'm now carving out content days because I didn't feel that way, because a lot of the information, while they're coming into my room and wanting or DM-ing me, or emailing me, asking for clarification on what they just saw sometimes again, it just leaves a lasting impression. And while they might believe the information and they're educated, they still like there's that lingering kind of like gut or mistrust that can ensue. And so I, that to me was the, it was a happy finding. Yeah. But I was a little surprised. 

AT: I'm surprised that you were surprised. Yeah. But at the same time, I'm not because that's the power of where we are. Yeah. Like there was one, I've got some of the statistics here and one of the ones that jumped out at me— And among people who are considering aesthetic treatments, the social media accounts were their, were the most used destination for finding out information often from their providers though, which is great. But they're getting, people get the information about safety of these treatments from social media. They're, and until they go and actually talk to their provider, they're not gonna be fed this information from anywhere else. So it's almost like as providers, you have an obligation to make sure that you are educating them, because if you're not, you can't assume that they're just getting the right information. 

BC: Correct. 

AT: Because they could well be getting wrong information. Yes. And are you seeing that? I mean, I've always thought that patients were getting more educated, but are you seeing some of this kind of misinformation seep into what they're saying to you as they come in?

BC: So they are, patients are far more educated, but they're getting miseducated. And that's what I see. Okay. Is it definitely, it's either a misunderstanding, it's a partial grasp of information that was shared, but not understanding it fully, not able to connect the dots. Or just completely and wholly wrong and incorrect. And it depends, again, like there are certain groups that are super anti neuromodulators, super anti dermal fillers. And there'll be, some people in those groups kind of almost stalk medical providers and their pages. And will just like troll the comments. And that's what I also, I will see those questions coming in. ‘Well, I read this or I read that.’ I'm like, ‘Oh, that was a comment by someone who is very much misinformed or had a really poor, unfortunate outcome and is now kind of fear mongering.’ 

AT: Yeah. And it's, when you look at the data, some of this, like 97% of consumers indicate they were satisfied or very satisfied with their last HA injectable treatment. Yes. And that's huge, huge. I mean, what type of, how many treatments get that level of satisfaction?

BC: And I would completely agree with that.

AT: That's crazy. Yeah. Like, that means that people are very, very happy with what they're getting. And yet for some reason, there's this, if you were to ask, you know, man on the street who's never had a treatment, they would be like, [hesitant]. You know? And then similarly, nine out of 10 thought that, of women who got injectable HA injectables thought their look was improved or very much improved. So there's no question that these are being accepted by folks who are doing them and who are going to the right places. And this is kind of what gets to the heart of the matter, is that the data and what's actually happening out there, the people who are getting them, the people who are providing them, folks like you, providers like you, providers who are part of our association, we are suffering by virtue of the fact that there's this narrative out there, that it's just not true.
And it really kind of [irks] me a little bit. Because it's just not fair to what we're doing. And so I, you know, I don't want to get up on my soapbox, but it's really, it's difficult for me to stomach sometimes. And I think it's time that we do it. And coming from you, I mean, Chicago is Midwestern, so you're probably not gonna get as much of the overfilled kind of, it's a very natural kind of place anyway. Yeah. So but it, what's the number one fear that you get from patients?

BC: The number one fear is looking weird and they don't wanna look weird. And they've heard that HA essentially grows legs and moves around your face. Yes.

AT: Yes. That's one of the myths that's out there.

BC: Yes. That's the biggest one. And then also that it never goes away. And what we do know is hyaluronic acid lasts a lot longer than we thought it initially did. What I tell my patients is, ‘Hey, this study stopped at 15 months. The study stopped at 24 months. But what I'm seeing clinically is it lasts years, some patients, it can last longer than that.’ And it just depends on your body. We don't know if your body is gonna hold onto it for 10 years. It depends on how your body, if it encapsulates it or not. And then there are some patients too who swear, like, I have two patients in my clinic now. I inject their lips every, this is just two patients by the way, every four to six months. It does not look like I have ever put filler in their lips.
It just goes away. Their body gobbles it up. Now, what's interesting is their midface, temples hold filler really well, that HA does not go anywhere. But the HA in their lips goes away. So again, this isn't cookie cutter. Everybody, every patient is unique. How your body's going to break it down is dependent upon that patient. So that it's more about educating them. So their biggest fear is if I inject their cheeks, then potentially that filler is gonna grow legs, move down to their jaw or give them, you know, a little turkey neck. Yeah. And then it's gonna stay with them for decades. Yeah. Right. And that's not what happens. 

AT: Like, that doesn't happen.

BC: Exactly. Filler will occupy the space that it's injected into. Right. And so if you do inject it into a space that has a larger fat pad, it over time can go through, it will spread throughout that fat pad. It just relaxes into, it's called filler spread. But it does not migrate outside of that space.

AT: Yes. And there's a huge, one of the, there's a section in here that's kind of fact or fiction, and that is one of the big ones is that people think—here I can actually pull it up right now. 

BC: You know, and this is what I tell my patients too, is if your filler looks great, what's wrong with it lasting a long time? Yeah. You want it to last a long time, it saves you money. Fabulous.

AT: I know. But like, there’s a percentage of folks who believe that filler is gonna migrate and that it's automatically gonna make, it's unnatural, it's going to migrate, it's not dissolvable. And these are all things false that are all not only false, I mean, they're completely false. Yeah. They're completely wrong. How often, how frequently are you having to debunk myths like that in your practice? 

BC: Every day. Every day. 

AT: Really? 

BC: Literally every single day. I have another patient who had gotten injected a couple of years ago in California, and she's seeing me because we have ultrasound in our clinic. And she wants me to dissolve her hyaluronic acid via ultrasound only because she read online that it can only be done via ultrasound, which is not wrong, but it's also not accurate. Right. If you can see the filler, you can dissolve it. The only time that you really need ultrasound guided is if it's for complications. Like a nodule that you're trying to isolate and reduce the amount of hyaluronidase that's being used to dissolve that HA. Absolutely, ultrasound's indicated for that. But if you're just doing pan-facial hylenex just to get rid of your filler, because she heard that she needs to get rid of her filler.
Looking at her when she came in, I was stunned. Because she's beautiful. Doesn't look like she really had—the only reason why someone might say she's had anything done is because for her age, she looks about 15 years younger. She looks, she's stunning. She is not overfilled at all. 

AT: That's not a bad thing, I don't think. 

BC: No, not a bad thing. And so I was like, ‘Hey, listen, I am happy to dissolve you if you just want this out of your face and you're concerned. But let's address your concerns.’ And then on top of it, I need to talk to you about ‘You haven't seen your face aged in 15 years.’ Once I dissolve it all, what I've experienced is patients freak out and they wanna get refilled immediately. 

AT: Yes, yes.

BC: And hyaluronidase is not innocuous. There are risks that also come with that. Right. So, you know, to just do it just because they're, you saw online that, you know, a bunch of people are doing explant surgery, understandably. So now they just wanna get rid of their HA filler. That's not smart for everybody. And it may not be the right choice for you just because an influencer is telling you to do so. 

AT: Yeah, I totally agree. That's, it's again, frustrating when you hear stories like that because number one, that patient, as you mentioned, looked amazing to begin with. So it's like, it's kind of a false flag in that there's no reason for her to be upset. Number one. Number two it almost is gonna perpetuate the problem because once the fillers are dissolved, she's gonna feel not great about it. Correct. And then it's like, okay, then you've gotta go through the whole process again, and the whole experience just isn't gonna be great. Right? Yes. And it's gonna kind of influence the whole thing. One thing you mentioned was in the I can't believe I'm even gonna ask this, the comments of your social media, how often do you get in and correct people in your comments about some of the mistakes that they're saying?

BC: So it depends. It's tough. Sometime, and a part of it, it just depends on how much time do I wanna give to it. 

AT: Yeah. Because that's gotta be exhausting.

BC: It's exhausting. Sometimes I'll just delete them. Yeah. Sometimes, like, as I said, some people are a little stalkerish and threatening, so I'll block them. But when there's a lot of misinformation in the comments, if it's gross misinformation, I will correct it one time and then they'll usually snip something back and then I just leave it.

AT: Yeah. Still like, so let me throw a few a few stats out here and you can tell me what you think about this. First of all, you have a great quote in here. Which one, 78% of consumers strong—this is not your quote—but 78% of consumers strongly agree that they want a more natural look. And you said the pendulum always swings and a more natural aesthetic is definitely key now. Yes. Was that ever not the case though? 

BC: Yes.

AT: Really?

BC: Yes. Okay. So this is a great question. So the pendulum definitely always swings. When I first started injecting, people would say they wanted natural, but the pictures they would show were, it was pre-Kim K. era, but they were very much moving in that direction. And then it moved to just being kind of the same thing we see with BBLs. Like voluptuous, a little bit obvious, a little overdone, you know, we're seeing rib remodeling now. People are making it very obvious they're having work done in body modification. I saw that with dermal fillers and I had a patient tell me that it's a status symbol out West to look overdone because you're kind of showing how much money you're putting into your face. I haven't,

AT: I heard that. That just doesn't make sense to me.

BC: I know. Yes. So, absolutely. When I first kind of started injecting, some people would say they wanted to look natural, but really what they wanted, they were saying natural, but they wanted completely frozen, no movement. That's not natural.

AT: Like people have to know that I've spent money on this. 

BC: Correct. Yes. Yeah. 

AT: That is bonkers.

BC: And so it was kind of like mob wife, which the clothing style kind of came back for a minute and has gone away. But now things are, when I say natural again, when patients come and say they want natural, it's so subjective. So I'll ask them what does natural mean to them? And I'll ask them to show me pictures. Do you have a picture of yourself in a decade that you like, or year that you like? Let me see what you like about yourself. And if, is this the goal that we're going towards? Is this the natural? And even when they loved how they looked the most, they often wanna augment or enhance a certain area.

AT: Yeah. Because that's also, I mean, I just turned 50. I can't say, ‘Well, my twenties.’ Because that's just not realistic.

BC: Right, right. And what does twenties, I didn't know you in your twenties. Do you have a photograph? So I can see what did you like, what can I match? You know? And I think that's so important to tease out. Another thing that I find patients will come in, it's a little bit conflicting, and this is our job as providers to really, really tease out is when they say they've come to you for a dermal filler enhancement but they don't wanna look any different. And I'll straight up ask them. Now, if you don't wanna look any different, why are you here? Because I, under what you're telling me, what I think you're telling me, is you don't wanna look weird. You don't wanna look unnatural. I've got you. That's not a problem. But if you don't wanna look different, I am going to make you look slightly different. You're gonna look better. And that is different.

AT: And there is definitely a distinction between looking, having no difference and having a difference that people can't really tell, right? 

BC: Yes. Yeah, I had a patient yesterday who, she came back for her followup after we did filler. And she was like, I absolutely love it. I can see the changes. And she was like, my little jawline looks better, my cheeks look better. She's like, ‘But my husband says he doesn't think, doesn't look like I had anything done.’ And she was like, ‘I was so happy that he said that.’

AT: That's the best thing. Now are you seeing, so one of the other stats in here, 91% of Gen Z and younger millennials believe “provides natural looking results” is an extremely or very important factor. Are you seeing any sort of an age difference with the way that your patients are approaching natural looking? Or is this kind of across the board that people want more natural looking results?

BC:  So the younger patients are really actually, they come in for prevention. They're saying, I don't wanna look like my mom, my grandma. “My mom told me she wishes she started this earlier, so she wants me to do it now.’ 

AT: I guess that's natural. In a way.

BC: Yeah. And their goal is to not look quote unquote “weird” later on in life. That's the goal, certainly. 

AT: Yep. And certainly when you think about the types of searches that are being done, it's things like “natural” “healthy” which is a, I think a big from the positive side of things, which is another when we talk about setting the narrative and setting kind of the positive algorithms for how we deal with search terms and social media, we have to focus on those types of things as opposed to just flashing up and always talking about the negatives. The natural, healthy I think is a big one. And I see that too. It's like, man, these folks that don't wanna look natural, I just don't, I don't get it. I mean everyone, to each their own.

BC: So I'll say I don't have a ton of those patients coming in, but it's also not my aesthetic. And I think you, you get what you put out there. And so I certainly notice the more I post about, you know, let's say PLLA and lasers, I have a lot more inquiries about that. And so if I were someone who loved an overdone look and that's all I posted, that's likely all I'm gonna get. Coming back into.

AT: And so despite all of that many women considering ha injectables say they're concerned with not looking natural as being the top barrier to them getting treatment. So we have all this data showing that you will look natural. You can look natural, you're going to be satisfied, you're going to be happy. People won't be able to tell. And yet still there's this pervasive feeling that, from women especially, that they're not going to look natural and that's why they're scared to do it.

BC: So we have in our clinic, every single room has before and afters on the TV and in the main waiting room as well. And a lot of patients are like, ‘I'm so happy you posted these before and afters.’ And in the before and after, I list how many syringes are used. For me, it's really important, complete transparency. Because if this is the outcome, you like this outcome on this patient, and you are here for that, understand this may be four or five syringes and you are afraid of one. So we've got a big knowledge gap that we have to overcome. Immediately. So for me, in my practice, helping show before and after pictures definitely helps overcome that fear because they start to understand, ‘Oh, okay.’ And there's that analogy of like, one syringe is a fifth of a teaspoon. Patients don't necessarily get that 'cause a lot of them aren't cooking at home. So they really don't know what that means to them.

AT: To me that's a lot.

BC: Right. But what helps them is seeing a before and after picture and saying, ‘Hey, that was four syringes to achieve this outcome, if you like this.’ And even still in that outcome, you still see slight hollowing, slight shadowing. And if you don't want that, that's gonna be an additional syringe or two, depending on your body. So I think it's really helpful. And we're backed in my clinic to staged approaches where it was during COVID, everybody wanted one and done, pump in the syringes. They of course wanted natural, but they wanted to see that immediate change.

AT: And then be done and not have to come back for a bit.

BC: Yes. And now people are like, ‘Okay, let's just do a little bit at a time. Let's just do, you know, the deep remodeling. And then let's come back and take a look again.’ Which I think is, it's a great way to do that too.

AT: Yeah, no, I love that.

BC: And you get more time with your patients. 

AT: Yeah, I mean I love that. So just kinda looking ahead because this has been great. I think the way you've been, the way that you approach these things. I wish everybody was more, a little more circumspect with this. Because there are folks out there unfortunately who just are really trying to pump as much, and get as much money out of it as they can. And I think it's very, very, that's negative. And we've gotta get that to stop. What do you, if there's one thing you wish some of the, like younger providers coming up would know about this issue? Training and, in terms of training and educating them on how to address some of these misconceptions, some of the ways that folks are addressing how they look with fillers, what would that be? What's the kinda one or two takeaways?

BC: For newer injectors, I do believe it's key to, you have to know your anatomy and you have to have to read these studies. You have to please read these studies and then share that with your patients. Let them know that you are putting in extra effort and work outside of your clinical hours because you believe in it. You believe in their safety that much. And you also stand behind the products that you are injecting. I think that's key. And it, that will help bridge that knowledge gap and also the trust gap because when you're a brand new injector, patients are a little bit more hesitant to inject with you, to be injected by you. But if you can show them that you've gone above and beyond, you're highly knowledgeable, you've put in some extra time and education with cadaver courses with books, post about it, share what you're learning.
Not just post you reading, but share what you learned so they can deduce what, who you are as an injector and a provider for them. I think that's key. And then why I do train for two companies. I'm pretty agnostic. I pride myself on that. And it's been a battle with all of the companies that I've trained for. As a provider, my duty is to the patient. It is not, I'm not married to any one brand. And I think that when you're brand new, it can be kind of glitzy and glammy to align yourself with one company. Don't do that. Don't do that. Know rheology. Learn everything you can about every product that's available in the U.S. market and choose accordingly for your patient.

AT: Now, why is that important? I mean I know why, but what's the detail behind that?

BC: So there's different makeup of HA fillers. There's different structures. So it could be thicker, could be thinner. So it depends on the depth that you're injecting it, if you're injecting it more superficially. But also some patients are a little bit concerned by the type of cross-linking that's used. So you want to be aware, all companies and some companies that have proprietary cross-linking, learn about it. Read about it. So you are not fed just the information from the companies. You as the provider have the responsibility to the patient.

AT: Yeah. And are you kind of a related question are you seeing quite a bit folks coming in and saying, ‘I want this particular product.’ Even though you know, name the brand name, even though maybe it's not in your view, the best one for them. And then how do you deal with that within the context of, you know, them saying, and this is what I want, this is what I see on social media, this is what is being fed to me. Difficult to do, but at the same time, you know, you want to make your patients happy, but you want them to be happy. And so that's kind of something that I've, that I've felt has kind of come up a bit as well. And I think it's important to be agnostic, but at the same time, you know, marketing works.

BC: There's reward programs, yeah.

AT: Yeah. All those things are out there.

BC: So it's interesting you asked that. I have actually had more patients come in saying, ‘I don't want this product because I've heard this.’ 

AT: Well, I guess that makes sense in the context of what we're talking about.

BC: Exactly. Yes. They've heard someone say this type of filler does this. And if I were gonna choose that filler, I'll say, this is a filler I would've chosen for you and I still choose for you. I can go like, there's a sister filler that can get you there too, but it probably will require another half a syringe or you know, an extra syringe to get you to the same point that this one syringe could have gotten you, but you just told me you don't want that.

AT: Now. And when they, I don't want to name any names or anything, but when they say that, what's the typical misconception when they say that ‘I don't want this?’ Is it because of they think it's not dissolvable or the migration?

BC: So they think it's hard to dissolve and filler migration.

AT: And migration.

BC: Which is really just filler spread or poor technique. Often.

AT: And how is that, how is that kind of myth perpetuated?

BC: I think there's a misunderstanding. Even, bring it back to the lips. There's a misunderstanding that the lip shouldn't have a white roll. A young lip does have a white roll that's this portion of the lip {gestures}. And we enhance it when we fill it. In plastic surgery, that was the goal also with fat transfers, with lip lifts. But we've, with fillers, I think we got to a point where we filled a little bit, we overfilled it, and we also filled outside of the lip margin, the lip compartment. And it became more obvious and people would say—and it could be migration, sometimes it was migration, but often it was just filler spread and it was injected right along the white roll or into the white roll. Yeah and large copious amounts. I remember years ago seeing that kind of like monkey upper lip.
And so patients say, ‘Oh, it migrated.’ It didn't migrate. It was literally just injected right there. And now over the years it's broken down a little more, filler spread, but it hasn't migrated. It's where it was placed. So it's more of patients seeing on TikTok, ‘Hey, look, I had this product and look at what it caused.’ And really that was just what filler does. It spreads. And I think there, again, this comes down to training. When you think of a product that you're injecting, you really do need to think 3D because when you're injecting it, it's not just plumping in one direction, it's plumping 360 degrees. So you have to think about the product pushing backwards, pushing the soft tissue into the patient's face, around. Not just projected outwards that you see. And I think there's a little bit of a misunderstandingbof that. And that's product rheology. So understanding that, and that's why I think it's also so important, and not every portfolio in the U.S. offers everything. So not one company has the entire portfolio that you don't need to pull from another yet. We just don’t have that here.

AT: First of all, thank you again for coming. I know this has been a long podcast. Thank you so much for, for sharing your wealth of knowledge. And congratulations on everything I do. You know, kind of in conclusion with all of this this has been, you know, obviously there's so much to do. One thing that we are gonna be doing at AmSpa that we are doing, we've got a whole campaign going on right now about safety in med spas. How med spas are safe, what to look for in a safe med spa, how we wanna make sure that the public is armed with the right information. We wanna make sure the providers are educated so they're doing the right thing. When it comes to issues specifically of safety, professional med spas, but then also specifically as it relates to HA fillers you know, we talked earlier about providers educating, right.
And that's really what is needed. Because as we can tell from this report patients get their information from their providers. They trust their providers. No matter where, where it is. But if they're not getting it from their providers, they're gonna get that information from social media, wherever, and they're gonna believe it. So the providers have to educate. But that's not always easy because not everybody is comfortable. So you have a brand, you're out there already. It takes time to do that. How do you get people excited? How do we, how does AmSpa get people excited about educating on this issue, natural looking fillers, how to educate your patients, how to get providers to educate in the right way so we're not perpetuating this negative algorithm. What do you think?

BC: So I'll share something that we do in our clinic. We have a social media, all of our employees sign a social media contract. And we carve out time in their work week for them to also educate. And I am constantly texting our injectors different studies, different papers. You, so you don't really have to like reinvent the wheel, just talk about a paper that you read that week, talk about that, or show a quick before and after. And if you don't wanna see yourself on the screen, which sometimes is tough, just show your before and after and do a voiceover of what you did. Because we know as injectors, there are certain outcomes I cannot achieve without a hyaluronic acid filler. I can only do it with an HA only. so that tool is here to stay. It will never leave my tool belt. I actually love, I do a lot with HAs and the more that you educate patients on it, because it is dissolvable. A lot of patients do like that, that it's dissolvable. They prefer that. So I think us as providers, our job is to continue to educate them. As business owners, as employers, it is to give our injectors time and the resources and knowledge on what to share. 

AT: Well, and I think that one, that's what we're doing right now. And again, kudos to Allergan for what they're doing. Because we have a lot of resources now. We can say like, there are things you can show and say on social media that, and the more that we all collectively do that and get out the right information, the more hopefully that algorithm will build and we'll start getting more of those right things. We are gonna be doing a lot of PR and trying to get some of these stories out there. I think we have to get the positive correct information out into the world collectively. Not just you and not just me. It's gotta be everybody. 

BC: Everybody. I agree. 

AT: Because if we're just doing it, it's not gonna work. It's gotta be all of us. Why don't you hold it? You have a copy of the report just for our viewers at home. I mean oh my goodness.

BC: It’s beautiful.

AT: It is very nice. And thanks. I appreciate them for allowing us. They came to us and asked us to talk about it, so we were happy to do that. But we're gonna have a lot more on this and a lot more of things that we can say. A lot more ways to educate. Brittony, thank you so much. Thank you so much for your time and best of luck. And you're killing it. Come back sometime soon. Once this is all done, we'll have you, you know, come over. We'll throw a party or something.

BC: Yeah, I'd love that. And then are you gonna be in Terranea?

AT: Absolutely. Yes. You're gonna be in Terranea too? 

BC: Yeah, I’ll see you at WALC!

AT: That's gonna be awesome. I mean, I can't wait. You're gonna be there doing what? A Q&A or a chat, I think?

BC: Yes, it'll be a chat about HA fillers.

AT: Right. But you're gonna be there. So any of you listening, come out to Terranea, WALC in the first weekend in October. That's gonna be amazing. 

BC: Oh, that resort is so beautiful. 

AT: Can't wait. It's so incredible.

BC: We stay there every Christmas. 

AT: Of course you do! I expect nothing less. Alright, thank you again!

BC: Thank you so much for having me.

Visit www.naturallyyouwithHA.com to view The Aesthetics Evolution: The Hyaluronic Acid Injectable Fillers Report.