Join LiVDerm as we chat with Jason J. Emer, MD, board-certified dermatologist and expert in surgical and nonsurgical facial sculpting and body contouring. Dr. Emer takes us through the secrets of redefining perfection and shares his knowledge as one of the nation’s top cosmetic dermatologists.
Transcript edited for clarity.
Dr. Emer: Thank you so much. I’m excited to be here.
Dr. Emer: As you know, I started in Beverly Hills. August will be eight years since I moved here from San Francisco. I was a young male dermatologist and there weren’t that many male dermatologists treating patients here, so I said, how am I going to stand out? I realized I had to present myself as the male dermatologist to go to for male facial and body contouring. Unlike before, it is now commonplace for men to get facial enhancement or augmentation procedures, what we call male facial sculpting with fillers.
I started doing videos and they became really popular. Now, 60% of my practice is actually male facial rejuvenation and body rejuvenation. And as the years have gone by, so many more males have come in, not only for contouring or feature enhancement, but also for skin care, prevention of skin sagging, like laxity, and doing the overall full treatment plans that many of our women were always doing for preventative treatments.
Men are increasingly coming in and it’s not just men that you would assume care about their looks, for example, the gay population or those in entertainment or on TV. It’s everybody. They all want to feel and look better. In your early 20s, you start to notice some dark circles and wrinkles starting to form around the eyes. In the 30s, you start to notice some laxity and volume loss in the face, and the lip volume starts to go down. And for so many men, their nose tends to be the focal point of their face, especially because most men have a little more broad and curved of a nose. It tends to be more masculine to have that larger, thicker nose. They tend to want it a little more slender, and balanced to their face so they don’t appear to be unapproachable or too masculine. Guys that have a little bit of these feminine features now tend to be a little more approachable by women and by men. That started stimulating guys coming in looking for nonsurgical options. Obviously, men were a little more scared of surgery, I would say, eight years ago. Now I feel like it’s a little more commonplace.
So, we’re doing a significant number of nonsurgical augmentation on the nose with fillers, specifically on the dorsal part of the nose, to camouflage bumps and also the tip of the nose to give a little bit of elevation in the nose and make it more balanced to the rest of the face. But I will very rarely do just a nose. We’re doing full facial contouring. We’re doing harmonious balancing or dynamic filling, where you look at the person’s face and see where they need their features enhanced at their age. Is it the jawline, chin, or cheeks? Is it temple hollowing? Are we balancing out the nose so it fits their cheeks? Lips tend to be an under-treated area in guys. Guys tend to lose a lot of volume – and if they have beards like is the trend right now – they have less lip volume. So it is a huge trend right now, especially in my practice. I have men coming in with their significant others, their girlfriends or boyfriends, and they are having treatments done together because they’re so into it.
I have many men coming in for monthly facials. They’re following my skincare routines, my Emerage Skin Aerify routine, which is a kit they do every two weeks. They’re really getting into this preventative aging. They want to prevent the sagging process by doing energy-based devices. Using things like PiXel8 microneedling radio frequency for tightening, and lasers on the surface of the skin, like Moxi by Sciton, for example, which is a great two-to-three-day light peel, making their skin look amazing with very minimal risks. So, if you haven’t been treating males, it’s really important because so many want it. But it does require a very specific aesthetic eye and you cannot treat the males the same as females.
Dr. Emer: I treat patients in Boca, Florida, Manhattan, New York, and Los Angeles, California. and there is a different vibe in each area. I tend to have a naturally enhanced aesthetic look. It’s not overdone. So, all the clients in those areas tend to want the same things when it comes to my treatments. But, I will say on the West Coast, there’s a little bit more of that willingness to push the limit. Some people are in entertainment. I have a lot of drag performers and transgender patients. I have a lot of people that are a little more out there with regard to their social media and their entertainment. So, they’re willing to get bigger lips and have a more lateral contour to their cheek that makes it pop when they’re wearing makeup. They’re willing to look a little bit more overdone and push the limit when it comes to filler injections with lasers. I find that people are wanting to do bigger treatments less frequently rather than smaller treatments more frequently on the West Coast.
But my New Yorkers, on the East Coast want to come in every month or two and do something light. They want to do little bits just to have little bits of enhancement. I feel like because I’m a dermatologist in a very prominent area with celebrities and entertainment, I’m willing to do these big combination procedures, multiple lasers at once, threads, fillers, all at one time, because my patients want to do the big bang for their buck. But they’re also willing to have a little bit more noticeability. They want people to know they have that high cheekbone from filler. They don’t mind having that Russian lip that stands out. And sometimes we push the limit a little bit, but again, my aesthetic tends to bring in the patients that want a little bit more natural of a look, more preventative, and what people don’t really know was done.
I was watching Netflix the other day and I took a picture of a guy and sent it to my manager, and I’m like, Wow, his jawline is so perfect. That’s the type of jawline that I need to be creating when I’m treating someone because it doesn’t look done, it just looks perfect. And he goes, “Jason, that’s your client.” I had no idea. I don’t even remember treating that client and his jawline because it was so natural. But it would definitely look too perfect. It’s one of those things where my patients are willing to push the limit, but they still want to look natural. I’m going to bring that combination approach, that bigger bang for your buck treatments to SBS: West Coast Derm. I think it’s going to be great to be able to work with other dermatologists to see what they’re doing. I know I’m allowed to be a lot more innovative and progressive here because my patients are willing to take the risk. In some areas I know some dermatologists aren’t, so I think there’s going to be a lot of learning from the things I’ll be able to present.
Dr. Emer: I know. That happens to me so frequently because I treat everybody the same. I don’t change my pricing for anyone. It’s all the same. To me it’s about artistry and the long-term development of a relationship with the patient, watching them as they age, and keeping them looking as good as they can and as young as they can for that age. I don’t even really notice what people do until I’m told by my staff or I see it on TV.
Dr. Emer: The interesting thing is there are a lot of conspiracy theories. I think there’s a lot of hype on social media about plasma pens because it looks really cool. It’s a little pen that creates all those dots. We use it specifically in areas of thinner skin, like around the eyes, fine wrinkles around the mouth, neck area, elbows, and knees. I’ve done it as a combination for acne scars. We use it for wrinkles on the forehead. Each of these little dots peel and over three to five days, develop a little pink spot. That pink spot will fill with collagen, so you get a lot of tightening with minimal downtime. With lasers on the other hand, like those I use on the eyes and mouth, aggressive CO2 lasers, or contour Erbium treatment from Sciton – amazing results but two to three weeks of downtime.
I think a lot of people are excited about what it looks like on social media because it’s attractive. It’s like Dr. Pimple Popper – you just want to keep watching it. It gives an amazing result, but it just takes more treatments. It’s more of a less invasive treatment for tightening and for the improvement of fine wrinkles. The issue with it is improper training, the wrong device, or not having adequate pre and post-skincare protocols. I’ve actually developed protocols with my own skincare line, Emer Skin. It is specifically designed to help it heal faster and prevent hyperpigmentation. We use peptides and retinols. I have a nonbleach lightening serum and also a weekly mask called Aefity that people use and it gets an amazing outcome. But if you don’t do that, some of the consequences can be devastating. There can be prolonged red dots or what we call post-inflammatory erythema. You can have hyperpigmentation or hypopigmentation. You can get streaking and you can also get irregular texture, what we call chicken skin. So even though it’s an amazing new progressive technology, it’s really important that you’re trained properly in how to use it and how to take care of the patients that get it done. We’re combining it with lasers. We find that the results are even better, specifically in those that want less downtime. The Moxi laser from Sciton has very minimal downtime. A lot of red carpet patients that do interviews in front of 4K cameras use this and their skin looks unbelievable. For those that want more aggressive approaches, we can combine with ablative lasers or even a halo hybrid fractional laser to get amazing outcomes. But skincare is super important and this technology in the right hands can give amazing results.
I see many doctors on social media saying, “Don’t do this treatment”. The issue is they haven’t done it enough. When you’ve done as many treatments as we have – we’re probably doing 10 to 15 every day because I’m combining it with every laser that I do – you get really good at understanding how to use it. It’s all about understanding and using it properly. I think that this right now is the most hyped new treatment. But other treatments are going to be coming up in 2022 for tightening that I think will be what really paves the way for what we’re looking for nonsurgically, which is the prevention of sagging. Because right now, it’s really difficult to get. And although people are posting things like doing the jowl area with a plasma pen and full faces, it does not get the tightening that you would think. This is for texture, not tightening, except for around the eyes. We will see what’s upcoming in the near future but I think that’s the way. Right now we’re over-flooded with lasers. We can get any result with the lasers we have on the market for almost every skin type that’s out there, but for tightening we’re limited. That’s where the future is going to be.
Dr. Emer: Anything you do on the surface is going to make you look younger. I just did an Access Hollywood segment using skincare and a combination of BBL and Moxi by Sciton. Just the skincare alone for two weeks prior to treatment decreased the age by three years on infrared. When we combine the two, the laser and the light treatment, which is what we call a Tight and Brite, or a Hollywood Spotlight treatment, further decreased the age by another seven years. So it combined to make 10 years. So combination therapies always make people look way younger. Do chemical peels or skin care affect Botox? No. Do chemical peels or skincare affect filler? No. Because they’re treating something different. Botox is on the movement lines. That’s on the muscle. Filler is on the bone or in the tissue giving contoured filling folds. So together, they’re not really going to enhance each other. But overall, when you use them as part of a treatment plan: the chemical peels; lasers; skin care for texture and tone; fillers for volume and contour; and Botox for movement lines, you’re going to look more youthful. So it’s really important to do it all. When someone comes in and says, “What should I do first?”, I say, you have to do it all, because that’s what’s going to prevent aging. It’s just like going to the gym. If you go to the gym and you don’t eat right, take supplements, sleep, drink water, and do all the things that you need to do, you’re not going to get the best result. But if you do all of that, your body looks way better and you feel better. It’s the same thing with the face. You have to address all areas of aging: the laxity, the volume, the texture, color, tone, and the movement lines altogether. If you do that, you get a better result.
Dr. Emer: No. Each area independently does not affect the other. So can filler be done with Botox? Yes. Can Botox be done with a peel? Yes. Can Botox be done with a filler? Yes. Can filler be done with peels? Yes. You can basically do them all. It’s just in each category of aging, there are different levels of aggressiveness and ways to approach [treatment]. So if somebody comes in who has never done anything before, maybe we start with a filler and Botox on that day, and then a facial and some skincare for their texture. These steps get them ready for a laser a few weeks later. We start that process where every quarter you’re doing a bigger laser or a peel and every month you’re doing a facial and a lighter peel. This is why I made my Aerify Kit from emeragecosmetics.com. It’s a kit you use every two weeks, a light micro peel. And you’re doing that just to keep your skin turning over and get rid of sun damage. But every three or four months, you’re doing a bigger peel or a bigger laser for that texture and prevention, as well as a plasma pen for tightening. During that time, you’re doing your Botox every three months and your filler a couple of times a year. And then you’re doing your tightening procedures once a year. Things like Thermage and therapy for tightening the tissue. Things like threads for lifting once a year.
There’s a full protocol that’s set that I feel all aesthetic providers need to provide their clients. My clients tell me they’re not given that full treatment plan when they go to initial consults in most practices and they’re not followed up for that type of treatment plan. They don’t even know those exist. If somebody comes to me, we’re addressing all areas of aging at each age group and determining what they need. I’ll give you an example. I had a 62-year-old guy come in yesterday. He had never done anything before. He had a lot of skin sagging, a lot of sun damage, and almost no facial contour. We went through all of this. What did he do? He did his facial contouring with fillers yesterday. He did his Botox. Now we have his jawline, cheeks, chin, lips, and temples all filled. It looks really nice. Much better volume for his age. Botox will set in and some of the wrinkles will subside because he’ll stop moving. But he did a facial that day and took skincare home. So now he’s starting his skincare process. In two months, we’re going to do a big laser and then he’s going to do a facelift. He is 62. He needs that at his age. Once we do the facelift, we’ll maintain his skin every three months with tightening procedures to protect his investment and keep his skin tight. This is the protocol that needs to be happening in a practice. You have to do your initial immediate results and then start the long-term plan.
Dr. Emer: He went to three doctors before and they just told him to do his lips and no one even offered him a facelift. I told him, You’re 62. Your skin is all the way down here. If I’m going to keep using fillers on you it’s going to look unnatural. You need a facelift. What do you think? He’s like, “I’m willing to do that”. And it was a man. A lot of people assume that men aren’t going to want to do surgery or that they’re not willing to take a more aggressive approach. I’m very honest and straightforward about what somebody needs for their age, but if you say no, I would never do that. I’ll tell him that I can never get the result that I would want, but I could make improvements that would make him look better, like starting the lasers and skincare, because remember, that can reduce the age by 10 years. I proved it on Access Hollywood. Just that alone. After adding a little filler for contour yesterday, he was so happy. He had a jawline, popped out his cheekbone, and his temple filled so he didn’t look like he was emaciated since he is very lean, being a runner. All of that just created that harmonious balance and now he’s going to Italy for two months for trips. He said he’s going to feel great taking selfies. And then when he comes back he’s going to do his big surgery.
Dr. Emer: That’s a great question. I actually have an entire article online about how I kind of created the heart-shaped look. Everybody knows that as you age the squareness or width of the face falls down. That’s why as you age you become less of a heart and more of an upside-down heart, or what we call a ‘triangle’. That is less attractive. People like to see the width much higher in the upper middle third going down to a focal point of the chin that gives the face a more slender, contoured look. That’s what has been deemed most attractive in many studies done on facial attractiveness. I have done many lectures on this, looking at if you create that look in a male, you can feminize him. This is a feminine look. So in general, a heart-shaped look may be great for a female but it may not be the perfect look for a male. But the concept of having the face lifted in a more youthful look is very important. You always want to focus on trying to create that – lifting the area, volumizing the area, and keeping the areas lifted.
For the past 10 years, most people were focused on the middle face. But more recently, for the past five years, people are more focused on the upper face, like brow lifting, the fox eye or the Cleopatra eye, or the open eye look, because they elevate the face even more. It makes the face look more lifted, open, and youthful. You want to create that look. How can you do that? By addressing each area of aging. Botox to stop movement lines can lift the brow when placed appropriately and open the eye. There’s even an FDA-approved eye drop now called Upneeq, that we sell at emeragecosmetics.com. You drop it in the eye and it opens the eyelids making you look more youthful. You can use threads to pull the area up and contour the cheek, making the middle-to-third of the face lifted. Then, using fillers for contouring, not only for the cheek, but also the temple, brow, all the way up into the forehead, to lift the face and pull the face back. Same thing along the jaw to create more of a point. When it comes to a female or some squared-off look for a male that gives them that more masculine sort of heart-shaped look.
Dr. Emer: I think the most important thing is that there’s collaboration in our industry because there are so many people less experienced that are doing treatments. I did a dermatology residency and fellowships that got me very knowledgeable on anatomy and the ability to do more complex surgical procedures, for example, scar revisions and liposuction, as well as things that a lot of people are just not trained in anymore. And if you’re a new aesthetic provider, let’s say a nurse or a resident that didn’t get a lot of experience or a fellowship, you really need to learn to progress in the field from those that are experts and have experience. By going to panel meetings that are not related to just a discussion of a device, but about real-world experiences, you’re going to learn so much more. Additionally, there’s going to be some hot debate, especially with me. I’m very controversial. I was written up as the ‘cowboy of aesthetics’ on the West Coast in an article last year. So, I feel like when that is the case there’s going to be some heated debate. Not everybody’s approach is the perfect approach. Sometimes, the approach you need is based on your own techniques and goals, as well as your patients. Some patient populations are a little bit different. Mine are a little more aggressive. Some are not. So, I think working together and being collaborative, whether it’s a heated debate or not, is going to really help progress the field and help younger, less experienced providers learn a lot more.
Dr. Emer: No, I’m very excited to be joining SBS: West Coast Derm. It’s going to be phenomenal. I really want you guys to join. I’m going to be talking about our complex combination procedures, things that you’ve never heard of or seen before, results-driven technologies and treatment combinations, and the increased use of skincare to promote enhanced results with energy-based devices. We will be talking about newer, more progressive treatments like plasma pen and threading and overall just getting a good conversation going on how to be an excellent provider. So, please join me at SBS: West Coast Derm. I’m really excited about this first-ever meeting. I think it’s going to be fantastic for all the providers.