About Adam Medlin, FNP-BC.

The usual path into aesthetic injecting in the United States is a one- or two-day hands-on course. You can be treating patients the week after. Most injectors do.

I took a longer route, for one reason: I didn’t want to put filler into a face until I could see what was already in it.

Before I injected a single patient, I worked through the didactic programs from the Allergan Medical Institute, the Galderma Aesthetic Injector Network, the American Academy of Facial Esthetics and the American Academy of Cosmetic Medicine — and studied extensively with Dr. Tim Pearce, whose work is about how injectable complications actually happen and what to do about them. That took about four months.

Then I bought the ultrasound, a Clarius L20, and learned to read it before it was ever pointed at a patient.

Then I did two in-person hands-on courses.

Then I started injecting.

I’ve since completed Dr. Pearce’s 8D Lip program, which is the framework I now use to assess every lip before I choose a product or a technique — eight separate things I look at before anything is injected. I’m currently working through his full technique library, which is less about learning more techniques than about knowing which one a particular lip actually calls for.

I’m Adam Medlin, FNP-BC, a nurse practitioner with autonomous practice authority in Virginia and 10 years in clinical practice before aesthetics. The person who scans you is the person who treats you.

None of that guarantees a perfect result, and I won’t claim it does. What it means is that when something looks wrong, I have spent a lot of time studying why these things go wrong — and I can image the area rather than guess at it.

• Filler under ultrasound guidance — why I inject under ultrasound in the higher-risk areas.
• Ultrasound-guided filler dissolving — imaging the filler before dissolving it.
• How to tell if your lip filler has migrated.
• When tear trough filler doesn’t look right.
• Hyaluronidase: the enzyme that dissolves hyaluronic acid filler.
• The equipment we use.