Each day, millions strive to unlock the secrets of blemish-free, luminous skin, yet many find this goal frustratingly out of reach. In a market saturated with quick fixes and fad trends, it’s vital to cut through the noise and understand what truly works. Our skin is our largest organ and the shield between our bodies and the outside world; it deserves more than just a superficial approach. As part of this series, we had the pleasure of interviewing Leslie Fletcher, NP-BC.

Leslie Fletcher, NP-BC, is a board-certified Nurse Practitioner and globally renowned aesthetic nurse injector. For nearly 25 years, she has worked alongside top dermatologists and plastic surgeons and was named Best Aesthetic Nurse in the U.S. in 2019. Her Los Angeles clinic, founded in 2010, is ranked in the top 0.05% nationwide for neuromodulator and filler use and was recognized as one of Inc. 5000’s fastest-growing companies.

An international speaker and trainer, Leslie has educated nearly 10,000 practitioners and published more than 20 peer-reviewed articles advancing the field of Aesthetic Medicine. She serves as a contributing editor for several journals and has received multiple educational grants from Allergan Aesthetics for her unique training content.

Leslie is the creator of trademarked Botox® techniques such as MicroTox®, NasalTox®, and TheraTox® and the only patented dermal filler technique in the world called ArqueDerma® Artistic Restoration Lift®, practiced by over 500 professionals worldwide. She continues to lead innovation in aesthetic medicine through her training company, The InjectAbility® Institute, where she trains more practitioners in the field of aesthetics than anyone else in the US.

Thank you so much for joining us in this interview series. Before we dive into our discussion about networking, our readers would love to “get to know you” a bit better. Can you share with us the backstory about what brought you to your specific career path?

Prior to nursing school, I dabbled in interior design and clothing design. I continued that path, throughout nursing school where I learned there was a career choice in nursing that would allow me to use my creative and artistic side and blend that with the scientific side. Soon after graduating, my career in aesthetic medicine began and I have been obsessed with the innovation in this field for the past 25 years.

Can you share the most interesting story that happened to you since you started your career?

Watching the transition in this field from primarily physician dispensed aesthetic injections to the majority (85%) non-physician injectors. The progression has been slow and not without its challenges for both parties but has culminated in a subtle shift in leadership at conferences and through pharmaceutical companies to where both non-physicians as well as physicians can contribute to the field equally. The consumer (patients) isn’t typically aware of this subtle shift. There are some that still desire to have their non-surgical treatments performed by a physician, but most simply care that their Botox® and filler injections are done well and without complications. Consequently, the field has made another positive shift towards high level post-graduate education both private and industry (pharmaceutical company) supported.

You are a successful business leader. Which three character traits do you think were most instrumental to your success? Can you please share a story or example for each?

1. Humble: No one wants to work at or visit a clinic that is dominated by an arrogant leader. Additionally, humility is necessary to maintain an open mind for learning new techniques, especially important in a field that has only existed for 25 years and is ever changing.
2. Accessible: Remaining available and approachable both to employees and patients. The more successful you become, the less time you have for quality relationships. I have tried to make a conscientious effort to be down to earth and appear as if my time is limitless for whatever person (patient, employee, or trainee) is placed in front of me in the moment.
3. Impactful: I approach everything I do with an aim, or problem-solving mentality of the task or encounter. If I am going to spend the time and energy on a task, it must produce change (in the person or in the behavior) because that is the only way I feel satisfied in my work. Examples: When working on a marketing post, I consider who the audience is for, what behaviors am I hoping to evoke or how I can repurpose content to have a ripple effect on more people. When training another clinician, I always begin by asking where their weaknesses are and how can we jump right in and tackle them. When meeting with a patient, I am sure to spend ample time with them before prescribing their treatment plan. This allows me assurance that we are working towards a similar goal and helps me appropriately meet their expectations for treatment and things almost always turn out successful.

Ok, thank you for that. Let’s now jump to the primary focus of our interview. What are your “5 Things Anyone Can Do to Have Healthy, Radiant, Flawless Skin”? If you can, please share a story or an example for each.

1. Sleep on your back- This is the cheapest anti-aging trick I can teach you. When I assess patients, I can tell within minutes what side people prefer to sleep on. There are creases and descent on the sleeping side that don’t exist on the non-dominant side, and don’t follow the natural pattern of creases from typical expressions. When I am treating their skin, it’s more challenging to repair the damage, when the night after I treat a crease, and nightly after that, the crease is being pressed upon for hours on end. Research shows us that only about 30% of patients sleep on their back and that the average person changes positions left, right and center 20 times per night! I love to teach patients how to retrain themselves in this aspect of ‘positive aging’. Some practical tips to retraining to go ‘back to sleep’: shoving yourself in between two pillows and supporting your legs with a few more pillows make it feel as cozy as side sleeping for most people (These positions may not be ideal, or you may need to elevate your head more if you have sleep apnea).
2. Red-light therapy- Early adaptions for LED therapy were developed by astronauts to avoid the rapid loss of bone and muscle mass that can occur in space due to weightlessness. They noted the added benefits of decreased inflammation, promotion of tissue growth and as an effective pain management alternative. There are several devices for home use that are FDA cleared that have both the 633nm & 830nm combined technology, creating the most efficacious results. This helps the light to penetrate deeper stimulating fibroblasts, increasing collagen on a cellular level. This translates to firmer, younger, smoother skin with fewer wrinkles and dark spots.
3. Stay away from the sun- UV exposure causes acute inflammation which leads to the release of enzymes that break down collagen. Collagen is crucial for the support of the skin envelope and when it dissipates at a rapid rate, the effects reveal saggy, dehydrated, wrinkled and collapsed skin.
4. Daily antihistamine- Not all allergies mean you will be sneezing and have a runny or congested nose. Some undiagnosed allergies show up on the face. If you are puffy in the morning, chances are you suffer from some sort of environmental allergy, most likely a down pillow or comforter. When histamine levels rise in our bodies, they expand blood vessels and cause the smooth muscle tissues to contract in the skin. This makes the skin appear ruddy, crepey and puffy. A daily antihistamine (like Claritin or Xyzal) can help combat these symptoms. Of course, every medication, over the counter or prescription, has their own side effects, so reach out to your primary care provider to confirm if you would be an appropriate candidate for a daily antihistamine.
5. Medical grade skin care including Retinol. There are numerous studies on topical vitamin A–based skin care containing retinoids. In fact, it is the most used and most studied topical positive-aging agents. It was developed in the 70’s to help tame acne, but the effects on the skin showed it not only helped with the acne, but also helped lighten, brighten and tighten the skin. Research shows it can help efface wrinkles after just 4 weeks, and even better effects after continued use. The way it works is it increases the cells rate of turnover and promotes fibroblasts to produce more collagen. More collagen means more support to sagging, wrinkling skin.

What are the most common misconceptions about daily skincare routines that prevent people from achieving radiant skin?

The biggest myth regarding skin care is that over-the-counter skin care can provide the same results as medical grade skin care at a lower price. Over the counter isn’t always cheaper than medical grade. For example, LaMer moisturizer is sold for $200 per ounce. I can recommend at least 10 different more efficacious types of skin care backed by solid research that would be well below that price. Additionally, the amount of active ingredient supplied in medical grade skin care is designed to have higher concentrations, as well as better formulations. The developers are only allowed to distribute to medical professionals so that if there are side effects from the stronger ingredients, they can be managed by the professionals. It’s interesting to me that patients will often leave the clinic without medical grade skin care, only to purchase something at a department store or Target. In fact, it has been studied that 91% of injectable patients (those who get Botox or Fillers) will leave the clinic and within 24 hours they will purchase something for their skin. Most often what they’re purchasing cannot even penetrate the skin barrier.

As the skin gets thicker, it becomes impenetrable and most formulated products that we put on top of it, cannot reach down to the cellular level. In attempt for better outcomes, these medically researched formulators go to all lengths to make the ingredients stronger, formulate them into smaller molecules that can pass through the skin barrier, or combine them with other ingredients to help drive them into the skin near the cells, where they can make an impact. If you are going to invest in any skin care, I recommend medical grade which can be purchased at a medical practice, and whatever you purchase should contain some sort of retinol.

Could you share your insights on how diet and nutrition directly affect skin health, and perhaps suggest some superfoods for skin radiance?

I don’t think we hear enough about the determents of the sugars in alcohol on the skin. Sugars increase enzymes called matrix metalloproteinase that break down collagen, fibronectin and elastin. These intrinsic structures support the skin envelope and when we lose it at a rapid rate, the effects of aging such as wrinkles show up prematurely and more markedly.

In my clinic, I can tell within minutes if a patient has been routinely drinking alcohol prior to an appointment. We take serial images at my clinic, and I can show you the same patient’s images taken just weeks apart without any interventional treatments, except for not partaking in alcohol, and they will look significantly brighter, more contoured, less swollen or ‘boggy’, less puffy, under eyes will be less baggy, and they will appear less ruddy. Most of these pictures occur during ‘dry January’ and are stored for reference later in the year when our patients wonder why their skin isn’t looking great again.

How do you recommend individuals tailor their skincare routine to address the unique needs of their skin type and environment?

Two of the suggestions that are included in my “5 things everyone can do to have radiant skin” are directly related to inflammation. Inflammation can wreak havoc on your skin. It manifests outwardly as red, blotchy, puffy, and bumpy skin. Causes of inflammation can vary greatly but the greatest offenders we see are alcohol consumption, sugar consumption, environmental allergies (specifically animals in the house, feather bedding, dust etc.) chronic sun exposure and stress. There are specific ways we can help lessen the look of these effects externally, but changing behavior will always be the best way to address them internally. If you are interested in what you can do to decrease the side effects of inflammation, I suggest several things:

1. Antihistamines (over-the-counter non-drowsy 24 hour and of course check with your provider to make sure you are an appropriate candidate).
2. Red-light therapy masks.
3. Daily Sun block.
4. Botox to the skin for its untapped anti-inflammatory and biostimulatory properties.

What advances in skincare science or new ingredients are you most excited about that promise to enhance skin health and radiance?

Regenerative therapies are trending right now because patients are searching for more subtly detectable results with them. Regenerative therapies can be seen in multiple forms. First, Collagen Induction Therapy (CIT or microneedling) harness’ the body’s own ability to respond to the trauma by creating growth factors and wound repair leading to autologous collagen production, something that is good for all skin types and should be added to most everyone’s beauty regimens. Another regenerative therapy that is trending would be “exosomes”. I do have a cautionary tale to tell regarding exosomes. There are no FDA approved injectable exosomes. There are some topical exosomes that do not pose significant risks; however they also don’t produce significant results which is why some clinics have experimented injecting exosomes. It’s important to note though that the function of exosomes is entirely dependent on the source of the donor cells. Exosomes can have either constructive or destructive effects, as they carry donor-derived genetic material that can influence immune responses, tumor progression, and tissue growth, all of which most consumers are not aware of.

A better, and FDA approved alternative is a product called Ariessence pure PDGF+ which stands for platelet derived growth factor. PDGF+ is new to the aesthetic space, but not new in the regenerative space. PDGF+ provides up to 300,000x the amount of growth factors versus competitive applications like autologous PRP, PRF or non-autologous exosomes.

PDGF is FDA approved for injection into humans for various therapeutic uses and is manufactured with recombinant technology to produce a pure, sterile product. There is no human-to-human transfer, ensuring safety, and consistency in purity and results. In certain procedures, results can be seen as early as the first day, especially when used for wound healing. However, when used for skin plumping, increased glow, decrease in fine lines and acne scarring, results take two to six weeks after treatment. PDGF+ is used on label by drizzling in after microneedling as a means of delivering the growth factors or PDGF can be used off label by injecting directly under the skin for various applications to drastically enhance skin quality or can be used to encourage hair growth on the scalp.

Can you describe a holistic approach to skincare that encompasses not just topical treatments but also lifestyle and wellness practices?

The lifestyle changes that I think have the most impact on the skin would be:

1. Wash your face twice both morning and night. The first time gets the makeup or grime off and the second time releases the oils out of the pores. (There was an interesting study out of the UK where a journalist didn’t wash her face morning or night for 30 days straight. According to her dermatologist’s skin scans, her skin had aged 10 years in just 30 days).
2. Sun avoidance- sunscreen every day regardless of if you are “going outside” or not. I have patients who spend thousands of dollars on fillers to address wrinkles. We get them to a place where they’re happy, and then they go and spend hours in the sun every day. That exposure breaks down collagen faster than the fillers can make new collagen, and it ends up being a waste of their money.
3. Stop smoking or associating with people who smoke. The decrease of oxygen in the tissues causes premature breakdown of the cell matrix.
4. Drinking ample amounts of water helps the skin cells to work more efficiently facilitating water in and out of the cells.

You are a person of great influence. If you could start a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. :-)

I wish I could change the stigma in the media, amongst friends, and on social platforms that taking care of your skin is somehow vain and superfluous. Your skin is your largest organ, making up about 1/7th of your body weight. It is the first line of defense against bacterial intruders. It’s also the first thing people look at when you meet them and gauge the skin as a sign of health. It can be the accessory that greets people with a shine wherever you go, giving you an extra dose of confidence and mood elevation. It’s unfortunate when people of influence deny having skin enhancing aesthetic treatments. That simply perpetuates the negative stigma, and it also makes the average woman feel bad about themselves as they compare themselves to these celebrities that spend thousands of dollars a month on their skin investments. Hopefully these tips I’ve given you today will be easy and affordable to implement and will get you thinking about setting your skin on the right path to optimal skin health.

How can our readers further follow you online?

@injectabilitybeauty @lesliefletcher_np InjectAbilityClinic.com

Thank you for the time you spent sharing these fantastic insights. We wish you only continued success in your great work!

About the Interviewer: Athalia Monae is a product creator, published author, entrepreneur, advocate for Feed Our Starving Children, contributing writer for Entrepreneur Media, and founder of Pouches By Alahta.