In the second episode of Conversations in Aesthetics, host Gary Goldenberg, MD, sits down with longtime colleague and friend Mark Nestor, MD, PhD, dermatologist, researcher, clinical innovator, and educator whose career spans more than three decades. Their conversation opens with what Dr Nestor considers the central focus of modern dermatology: a holistic view of patient care grounded in health, happiness, and well-being. They begin where every aesthetic journey starts—the consultation. Dr Nestor walks through how he listens for a patient’s real motivations, distinguishes wants from needs, and maintains the freedom to say no when expectations are not aligned. He emphasizes a minimalist, science-based approach to facial rejuvenation, grounded in realism, restraint, and the belief that aesthetic work should enhance a patient’s natural appearance, not overwrite it. Together, he and Dr Goldenberg explore the importance of educating patients on aging as a continuous process, why “less is more” remains a guiding principle, and how downtime often correlates with deeper, more lasting results, especially when choosing between nonablative and ablative resurfacing. The conversation then widens to procedures and patterns they both see in practice today: the rising demand for hair-loss treatments, especially among women; the evolving understanding of autoimmune and inflammatory contributions since the pandemic; and the role of regenerative medicine, from PRP and exosomes to emerging medical foods, in supporting both clinical and aesthetic outcomes. From there, Dr Nestor introduces a concept he has studied extensively: emotional anatomy. He explains how targeted botulinum toxin injections, particularly in the glabellar complex, have demonstrated effects on mood beyond cosmetic benefit. They discuss facial mimicry, the biological underpinnings of “the real smile” versus a constrained one, and why thoughtful injection technique—depth, distribution, units, and anatomy—separates consistent, natural results from occasional ones. A video demonstration illustrates his approach to injecting the corrugators, procerus, and lateral orbicularis to lift the brows and support a more open, positive expression. As they look ahead, Dr Nestor highlights what excites him about the next decade: hybrid toxins, a renewed appreciation for ablative resurfacing, continued growth in regenerative therapeutics, and urgently needed innovation in UVA-protective sunscreens as skin-cancer patterns shift. He returns to a theme woven throughout the episode—patients seeking solutions that feel natural, are rooted in science, and support whole-person wellness. This conversation offers a thoughtful, wide-ranging tour through the art and science of aesthetics today, reminding viewers that beauty, health, and happiness are deeply interconnected and that skill, judgment, and intention matter at every step.

In the first episode of Conversations in Aesthetics, host Gary Goldenberg, MD, sits down with Mathew Avram, MD, JD, Director of the Laser and Cosmetic Center at Massachusetts General Hospital, for a grounded, candid conversation about the core of aesthetic practice—understanding the patient in front of you. Dr Avram emphasizes that elective procedures are a different kind of medicine. Patients arrive with hopes, vulnerabilities, and expectations shaped by personal experiences, social media, and cultural trends. The work, he notes, begins long before any syringe or device is in hand. It’s in the consultation; how to listen carefully, assess whether expectations are realistic, and sometimes, when to choose not to treat. Together, they discuss how aesthetic dermatology has shifted over the past two decades, from patient demographics to the influence of selfies and video calls, and how psychology plays an undeniable role in patient satisfaction. They explore Dr Avram’s approach to expectation-setting, which includes how he frames outcomes for skin tightening or fractional resurfacing in ways patients can genuinely understand. The conversation then turns to today’s procedural landscape: the rise of botulinum toxin as a first-line aesthetic entry point, vascular and fractional lasers as foundational tools in Dr Avram’s practice, the evolving role of acne lasers as alternatives to systemic therapy for select patients, and emerging energy-based and micro-coring technologies, including where they fit and where caution is needed. Throughout, Dr Avram and Dr Goldenberg return to a core idea; aesthetic dermatology is not just about looking better. It can also support skin health and regeneration, and reflects a growing overlap between aesthetics and wellness. This episode offers a thoughtful lens on practicing aesthetics with clarity, restraint, and intention. Reminding us that the most meaningful part of the work often happens in the conversation, not the procedure.