Five Questions Before You Let Anyone Near Your Face
Board certification in the relevant area, at least 25 procedures a year, and a plan for complications. What two doctors who train injectors say to ask.
Most advice on this amounts to "do your research," which is worse than useless, because the entire difficulty is that you do not know what you are looking at.
The questions below separate a good choice from a fortunate one. They come from two people who train the practitioners you might end up sitting in front of: Dr. Tanuj Nakra, an oculofacial plastic surgeon, and Dr. Suzan Obagi, a cosmetic dermatologist who directs a fellowship programme.
What is your board certification, and how does it relate to this procedure?
Not board certified in general. Board certified in the thing about to be done to you.
This is the distinction that catches women out, because certification sounds like a single achievement rather than a collection of specific ones. A doctor can be entirely legitimately board certified in a field bearing no relation to facial aesthetics and still lawfully offer injectables.
Nakra's point is that certification must match the procedure. For eyelid surgery, oculoplastic training is directly relevant in a way that other surgical training is not.
Several kinds of practitioner perform injectables and laser treatments competently, and Obagi includes dermatologists, plastic surgeons, nurses, physician assistants and well-trained dentists among them. The qualification is the training rather than the letters.
How many of these do you perform each year?
The single most useful question here, and it comes with a number attached.
The recommendation is to choose practitioners performing a meaningful volume of the specific procedure you want, with at least twenty-five rhinoplasties or facelifts a year cited as a threshold for surgical work.
Twenty-five is not a large number. It is roughly one a fortnight. That it functions as a meaningful threshold tells you a great deal about how many people are doing these occasionally.
Volume matters because facial anatomy varies and complications are rare. A practitioner doing something twice a month has met the variations. One doing it twice a year has met her own two cases.
Ask directly. A confident practitioner answers without hesitation.
What happens if something goes wrong?
The question that reveals the most, and the one women are most reluctant to ask.
Nakra's emphasis is that practitioners must be able to manage complications, a lesson he draws from performing corrective surgery on other people's outcomes.
Which reframes the question usefully. You are not asking whether she thinks something will go wrong. You are asking what exists if it does.
For injectables, the specific version is worth knowing. Vascular occlusion, where filler blocks a blood vessel, is the serious complication and it is time-critical. The right answer involves hyaluronidase on the premises, a written protocol, and a way to reach her urgently.
For surgery, it concerns who manages your recovery, whether she holds hospital privileges, and what happens if you need revision.
A practitioner who has thought about this answers specifically. One who has not will reassure you that it does not happen.
Will you tell me not to do something?
The quietest signal, and the strongest.
There is a genuine tension in aesthetic medicine between what a patient wants, what will help her, and what the practice earns. Nakra and Obagi discuss the financial incentives and social pressures shaping the field openly, and those pressures do not evaporate because a particular practitioner is skilled.
The practical test is whether she will tell you something is a poor idea. Whether she will suggest doing less than you asked for, or nothing, or something else entirely.
A consultation agreeing with everything you propose and concluding with a package is a sales meeting. A consultation where someone examines your face and tells you the thing you asked for will not address what is bothering you is a clinical assessment.
That distinction is easier to spot than it sounds, once you know to watch for it.
What is causing this, anatomically?
A good practitioner is treating a structure rather than a surface.
Most of what women want addressed is not a skin problem at all. Hollowing, folds and a softening jawline are usually questions of the fat compartments beneath the skin and the bone beneath those. A young face carries around eleven fat pads on each side which deplete substantially with age, and the facial skeleton recedes alongside them.
Someone explaining your face in those terms is working from anatomy. Someone discussing only lines and where to place product is working from the surface.
Listen for whether she describes where things are going and why, rather than which brand she prefers.
And if you have been treated before, add one more: how much product is still there from last time? Imaging has shown hyaluronic acid persisting in the deeper mid-face at twenty-seven months, well beyond the six to twelve months women are typically told. A practitioner who assesses what is present rather than assuming it has gone is working from current evidence rather than from a script.
Three things that feel like signals and are not
Before and after galleries, which are selected, lit, angled and occasionally photographed at the moment of maximum swelling. They tell you what a practice wishes to show you.
Social media following, which measures marketing, a genuinely different skill from injecting. Nakra and Obagi discuss how social media has pushed aesthetic trends toward exaggerated features, which suggests the incentives of the platform and the incentives of your face are not aligned.
And how new the equipment is. For lasers and energy devices particularly, the operator matters more than the machine, and this is most consequential for women with darker skin tones, where aggressive settings carry real risk of lasting pigment change.
Why this is worth an afternoon
What makes aesthetic medicine different from most healthcare is that you are choosing electively, paying directly, and the result sits on the front of your head where you will see it every morning.
You also cannot easily undo it. Some things are reversible, some are partly reversible across years, and some are not.
An afternoon spent on these questions is cheap against that. And the questions are the point in a second sense: what you are testing is not only her answers, but whether she welcomes being asked.
References
- Dr. Tanuj Nakra and Dr. Suzan Obagi on The Peter Attia Drive, episode 355, June 2025, on certification, procedure volume and complication management.
- Long-Term MRI Follow-up of Hyaluronic Acid Dermal Filler, 2022.