By Your Fren Nancy

Meet Nilufer Rustomji, MHS, PA-C

How long have you been a provider?


Nilu: I've been working as a physician assistant for 6 years. Prior to becoming a PA I worked in clinical research in psychiatry for 4 years.


What made you want to specialize in aesthetics?


Nilu: I've always loved using my hands and performing procedures. I knew I didn't want to work full-time in the OR (operating room) though because I love being able to work intimately with my patients and well... they're asleep in the OR lol! I started my PA career in dermatology which was the perfect blend of minor surgeries, procedures, and direct patient care. This introduced me to the injectable world, and I fell in love! I knew that I wanted to pursue this full-time to master my craft. 


When someone is new to injectables, how should they choose a provider?


Nilu: Injectable treatments and medspas are becoming more commonplace in recent years which is wonderful as I think it is dampening a lot of the stigma that used to be attached to aesthetic treatments. But with more and more people providing the treatments, it's becoming more and more important to choose a provider you trust! 

Research your provider and check that they have the credentials to legally perform the procedures in the state they are in (for example, do they hold a medical license such as MD/DO, PA, NP or RN?). 

How long and how often are they performing injectable treatments? Often times, a provider may work in a clinic with various lasers, body contouring devices, and medical dermatology services which is great, but does this mean they are only doing injectable treatments one, two or three times a week? Ideally your provider is performing these treatments multiple times a day throughout the week with at least a year or two of practice under their belt. 

It is also good to know if your provider has managed complications from these procedures and if not, are they equipped to do so? Unfortunately, with any cosmetic treatment, complications are always a potential risk, and you want to ensure your provider knows how to handle these rare events if they occur. 

A provider's before and after photos from patients they have treated may be helpful too. This can give you a better sense of the provider's aesthetic eye/style.

Finally, getting to know your provider through a consultation visit and seeing how your personalities mesh is a great way to start your search. Ultimately, you want to feel heard and comfortable with your provider and have it be a fun experience! 


If a patient came in with a small budget of $1000, what would you recommend?


Nilu: If a patient is coming in with a certain budget, I always ask them what their primary goal/concern is. We may not be able to address everything in one visit or with a certain budget, but at least we can start with an area that the patient will notice a nice difference with. If the patient is new to injectables, starting with Botox in impactful areas like the frown lines, brow lift, or softening forehead lines can go a long way! If the patient is primarily concerned with acne and/or scarring, starting with good skincare and a chemical peel or microneedling can make a huge difference. If a patient desires an overall "refreshed" look, but has a budget of $1,000, doing upper face Botox with an impactful dermal filler area like cheeks is a good start. However, setting realistic expectations with a patient with a certain budget is important -- you don't want your patient to be underwhelmed if they need more product but were not able to budget for it in one visit. Educating them that they likely will need more for optimal results will give your patient the understanding of what to expect and plan for in the future.


What are great alternatives to filler or if someone isn’t a good candidate for filler?


Nilu: PRF (platelet-rich fibrin), previously called PRP (platelet-rich plasma), is a great alternative to dermal filler and it's 100% natural! This entails a quick blood draw in office, then this blood is spun in a centrifuge, and the patient's platelets that are rich in their own growth factors and stem cells are extracted and can be injected or microneedled back into the face. Though the results usually aren't as long-lasting as filler, it can give patients a nice alternative to filler in various areas such as under-eye brightening, nasolabial fold softening, and skin rejuvenation/brightening. 

Sculptra is also another alternative to dermal filler. Sculptra is what we call a biostimulant -- it is an injectable treatment that slowly creates your body's own natural collagen over the course of 6-8 weeks. It helps to restore areas of volume loss, similar to filler, but usually takes a few weeks to months to see results. Patients often notice a "glow" to their skin about a month after treatment which is an added bonus! Sculptra is not injected in certain areas of the face such as the lips or under eyes, so it's important to talk to your provider about which treatment is option is best for you.


Let’s say a new client just moved into town and wants lip filler. They have previous filler elsewhere about 2 years ago, what do you recommend and how would you approach it?


Nilu: Obtaining a good medical and aesthetic history is key. Were they happy with their previous filler treatments? What product, how much, and where was it placed? Were there any issues? What are their lip filler goals now?

It isn't always necessary to dissolve old filler before re-treating the same area and often times this isn't feasible. But, by performing a good physical exam prior to treatment, you can often prevent any potential issues in the future. For example, if they had filler in their lips 2 years ago, but have old filler bumps or filler migration, it is possible that dissolving and starting with more of a "blank slate" would allow for better results.


Do you have a favorite part of the face and tweakment that you love to do?


Nilu: Cheek, chin and lip filler is so fun! They are classic "highlight" areas of the face and can be very impactful. By restoring volume and support in these areas you can create a very natural but refreshed look for the full face. 

Sculptra is always fun too! It is a great tool to treat the "full face" but in a subtle manner. Patients notice they look "better" but can't quite put a finger on why -- this shows me that they are getting improvement but in a natural way where they don't look "done", but simply refreshed and more youthful appearing.


What do you encourage people to do in preparation for their appointment?


Nilu: Taking Arnica a few days before and after and avoiding any blood thinners such as alcohol, Aspirin (if appropriate with their PCP), Ibuprofen/Aleve, tumeric, fish oils, etc. can help with any potential bruising/swelling. Staying well-hydrated, taking Vitamin C and even zinc a few days before and after can help. We always instruct our patients to avoid any dental work and vaccines 2-4 weeks before and after dermal filler and Sculptra treatments. If they are sick this can potentially affect filler results and so we ask they reschedule 2-4 weeks out from any illness, autoimmune flare up, or antibiotic use.


What kind of tweakments are requested from you the most lately?


Nilu: Botox and lips  


What trends do you see coming up in this industry?


Nilu: I think bio-rejuvenative medicine will really take over the industry by storm in the next few years! This includes more "natural" treatment options for patients such as biostimulatory procedures, advancements in exosomes and PRF. I also think we will see other advanced neuromodulators like longer-lasting Botox alternatives coming to the market.


What are some of the stigmas you’d like to debunk about tweakments and this industry as a whole?


Nilu: Tweakments can be done very naturally without looking "over done". The industry has advanced so much in recent years with more advanced technology arising every year which allows for more natural, long-lasting results.


How often should clients come back for each treatment?


Nilu: It depends on the treatment and the patient. Ideally, we like to see our neurotoxin patients (Botox, Dysport, Daxxify, etc.) every 3-4 months. For some patients it may last 5-6 months. Depending on the dermal filler product and treatment area, filler can last anywhere from 6 months up to 2 years! It's important to talk to your provider about your future treatment plans at your current visit to get a better idea of when to return to maintain your results.

I like to do a resurfacing skin treatment such as a chemical peel or microneedling at least once a quarter.


What are the common misconceptions you hear new clients are nervous about?


Nilu: New clients are often nervous about "doing too much", especially with dermal filler. 1 syringe of filler is equivalent to a blueberry in size. It's a very little amount! So, if we are trying to address large areas of the face such as cheeks, temples, or the jawline, several syringes are often recommended for best results while still maintaining a natural look. 


Like everything else in life, there are risks. What are some of the risks involved when we come in for a tweakment and what precautions do you take?


Nilu: Every medical procedure does have its potential risks, benefits and side effects. Common risks of injectable tweakments are bruising and/or swelling at the injection site which is usually managed with ice and Arnica and avoiding blood thinners before your treatment. Slight asymmetry while the treatments are settling in are normal as well and usually self-resolve.

There is also a very rare but potential risk of something called a vascular occlusion with any dermal filler treatment. Unfortunately, there is no way to completely avoid this risk, but there are things that we do to treat patients as safely as possible. This includes knowing our anatomy extremely well, injecting in a safe plane and speed and performing a good physical exam. Additionally, having tools on hand and knowing how to manage these potential complications is key.


Do your clients have realistic expectations when coming in to see you?


Nilu: Usually, our patients have realistic expectations coming in, but it is always our (the provider's) responsibility to properly educate our patients prior to treatment and set realistic expectations with them. We want our clients to be happy at the end of the day and a lot of that is educating patients on what to expect. 


What are some of the things you do to help ease new nervous clients?


Nilu: I like my patients to be fully educated about these treatments and be an active partner in the treatment process. I always educate them on how these treatments work, why we do certain things/treat certain areas and what to expect. I allow time for my clients to have all their questions answered and also give them my contact information in case they have questions after they leave. I think making the patients feel heard about their goals, concerns, and fears is crucial. If they feel heard and safe, they can begin to trust you and the experience can be a lot of fun!


If there was one thing you can fix/solve in this industry, what would it be?


Nilu: I think the industry has improved on this already, but continuing to talk openly about complications and how we can better avoid and manage them. As injectable tweakments continue to rise, it is important for providers to remain up to date on the latest information about these procedures so we can provide the safest and best treatments for our patients!  


Thank you so much for sharing all of this valuable information, Nilu! Where can we find you if we wanna see you for a consultation?


Nilu: You can find me at Skin by Lovely in Santa Monica!


@skintimatewithnilu  @nilu_skinbylovely