The Art of Skin Quality

In this episode of Conversations in Aesthetics, host Gary Goldenberg, MD, welcomes longtime colleague Dee Anna Glaser, MD, for a thoughtful discussion on what defines success in aesthetic dermatology and why subtlety, communication, and judgment matter as much as technique.  Dr Glaser begins by defining a successful cosmetic procedure as one that delivers meaningful improvement while preserving confidence and natural appearance. She describes an approach rooted in individuality, where genetics, lifestyle, age, and patient goals shape every decision. Central to that approach is the willingness to redirect—or even refer—patients when requested treatments fall outside her aesthetic philosophy, a decision she describes as one of the most challenging but necessary parts of practice.  The conversation returns repeatedly to the consultation, not as a single moment, but as an ongoing dialogue. Dr Glaser explains how she structures patient conversations over time by setting expectations, revisiting outcomes, and adjusting plans at each visit. She shares a simple but revealing exercise she uses in consults: asking patients to name two things they like about themselves. The responses, she notes, often reveal how self-critical patients can be, and how reframing around strengths can build trust and momentum.  From there, they turn to procedural strategy, with a focus on skin quality as a foundation for aesthetic results. Dr Glaser outlines why toxin and resurfacing remain core tools in her practice, and how she helps patients weigh results against downtime across options such as chemical peels, microneedling, and more aggressive resurfacing. Together, she and Dr Goldenberg discuss shifting patient preferences toward greater downtime in exchange for better outcomes.  A video demonstration anchors the episode’s procedural component, with Dr Glaser walking through her microneedling technique for the face and neck. She discusses depth selection, regional variation, priming the skin, and the use of adjunctive therapies such as PRP and exosomes, emphasizing safety, customization, and realistic healing timelines. They also explore how microneedling compares to energy-based devices, particularly in pigment-prone skin and sensitive areas like the neck.  In the latter part of the conversation, Dr Glaser reflects on her transition from academic medicine to private practice, offering candid insight into autonomy, trade-offs, and long-term professional satisfaction. The episode closes with a forward-looking discussion on where aesthetic dermatology is headed: earlier patient engagement, increasing demand for skin tightening and body treatments, challenges posed by social media trends, and the growing need for safe, effective options across diverse skin types.