Los Angeles, Calif-based facial plastic surgeon John H. Joseph, MD, is known as the eye guy because of a scarless technique he pioneered that weaves sutures underneath the eyelid skin. While eyelid rejuvenation is a big part of his practice, Joseph—an assistant clinical professor at UCLA David Geffen School of Medicine—is also on the front lines of innovation due to his work at The Clinical Testing of Beverly Hills.

PSP sat down with Dr Joseph to discuss his approach to eyelid rejuvenation, the newest treatment for face scars, as well as the studies he is currently conducting. Here’s what he has to say:

1. What is your signature procedure?

My signature procedures would be facelift and eyelid surgery.

2. Tell us about photo-shoot eyes. How do you achieve them?

The best way to obtain photo-shoot eyes is to fix what is wrong and avoid altering or creating artifacts such as rounding or hollowing of the eye and lid retraction. That same philosophy holds true for facelifts. One must restore and not destroy the natural appearance that was always present but has been hidden due to signs of aging.

3. Why are so many young women having nonsurgical facial plastic procedures?

We’re seeing more patients move to such procedures simply because they did not exist 20 years ago. With new product innovation, there’s a natural draw and demand. As they say, “Build it, and they will come.” These procedures are minimally invasive but still offer pleasing results. Lastly, nonsurgical facial plastic procedures address conditions that surgery alone simply can’t, such as textural issues of the skin like fine lines, volume loss, and discoloration.

4. How do you feel about preventive Botox?

I am not opposed to the preventive use of neuromodulators such as Botox, Dysport, and Xeomin, but I don’t believe it’s necessary for the majority of people. Neuromodulators can easily reverse fine lines once patients see them form, regardless of preventative measures they’ve taken. Additionally, the more times these products are used, the higher the chance resistance to their effects will occur. So, if you want to enjoy the benefits of neuromodulators for a long time, I believe it is best to treat only when the lines begin to form and not for prevention.

5. What treatment are you most excited about?

Bellafill® for acne scars. It’s a remarkable new minimally invasive treatment option, and I believe we’ll see physicians further embrace it, given its safety, efficacy, and long-lasting results. My patients have been pleased with Bellafill® because it doesn’t require much downtime.

6. What trials are taking place at The Clinical Testing of Beverly Hills?

I am conducting trials on topical botulinum toxins; injectable agents to reduce fat; and fillers and neuromodulators from Europe and Asia that want to have access to the US market. In addition, I have trials on biologic agents to reduce hypertrophic or keloid scar formation, and I am helping with existing US Food and Drug Administration-approved technologies, products, and devices to optimize their treatments or expand their indications.

7. What technology could you not practice without?

Intense pulsed light (IPL) and fractional CO2 lasers. Although not a true laser, IPL is a section of frequencies of light which shine on the skin. These specific frequencies of light energy are preferentially absorbed by brown and red pigments in the skin. In doing so these “dyschromias,” or bad pigments, are damaged and, over time, removed by the repair mechanisms of the body. This leaves the skin with a much more clean and youthful-looking palate.

Fractionated CO2 lasers use a very old laser technology in a novel way. Instead of burning the entire surface area of the skin, only a fraction of the skin is injured (20% to 30%). That is what one would have expected from only treating this small fraction of the total surface area.

8. What is your practice philosophy?

I want my patients to look good for their age. Patients often have the misconception that if they have a procedure done, they’ll look 20 years younger. Simply put, this can lead to disaster. I like to deliver on realistic expectations.

9. How did you build your practice?

I’m proud to say I built my practice the old-school way: work hard, do a good job, treat everyone as you’d like to be treated. Word of mouth and referrals from satisfied patients helped build my practice and continue to do so today.

10. Where do you get your industry news?

One benefit of being a part of clinical trials is that I have the opportunity to have face-to-face time with leaders and physicians in the plastic surgery and dermatology industries. Simply dialoguing with these experts is where a lot of my news and further understanding of new products or treatments comes from. Outside of this, I like to attend industry meetings, read relevant journals, and peruse publications like Plastic Surgery Practice.

William Payton is a contributing writer for Plastic Surgery Practice magazine. He can be reached via [email protected]