Working with Estheticians

Esthetic services are the perfect complement for medical cosmetic procedures. Here’s how to make the relationship work.
MedEsthetics May/June 2019

Estheticians are a natural fit for medical aesthetic practices. They specialize in beautifying the skin and can provide pre- and postprocedure care that improves outcomes and helps patients maintain their results long-term. Successfully integrating esthetic services requires both good communication between providers and a commitment to supporting these services through marketing and patient education. On the following pages, physicians and estheticians share how they are working together to promote and deliver a full range of cosmetic and esthetic treatments under one roof.

Smart Promotion

There are several ways to get the word out about your esthetic services. DeLozier Cosmetic Surgery Center in Nashville keeps discount cards along with a service menu at the front desk to promote its licensed estheticians, including Emme Simpkins. “We do all of our surgeries on the first floor and the esthetic treatments on the second floor,” she says. “We offer discount cards downstairs to introduce the surgical patients to our esthetic services.”

At Las Vegas Dermatology, H.L. Greenberg, MD, works with licensed esthetician and certified laser technician Autumn Varis, who offers a variety of treatments including facials, chemical peels and laser hair and tattoo removal. All new patients fill out a cosmetic interest questionnaire to help the practice better understand their concerns and interest level in different procedures.

“Some patients, despite putting on their intake form that they are not interested in these services, end up being very interested in esthetic services. So you should discuss this in consultation as well as on the questionnaire,” says Dr. Greenberg.

He promotes Varis’ services on the practice’s social media pages and, after learning that many patients were unaware of the range of medical and nonmedical treatments offered at the practice, he and his team decided to create graphics for the treatment room doors that list the services offered in each room. “It’s a different way to get people talking,” he says. “It opens the door to discuss all of our offerings without being pushy.”

While internal and external marketing are important in promoting your estheticians, one of the best ways to help patients reap the benefits of esthetic treatments is to include them as part of your pre- and postprocedure care regimens.

Pre- and Post-Care

At Shafer Plastic Surgery & Laser Center in New York City, licensed esthetician and certified laser specialist Graceanne Svendsen performs a Hydrafacial treatment two weeks before facelift surgeries. “This gives the skin a drench of hydration,” she says. “We blend it into the pre-op appointment, which is when we also discuss medications and topical products that need to be stopped prior to surgery.”

Post-surgery, Svendsen, who is also a holistic health coach with IIN (Institute of Integrative Nutrition) certification, performs lymphatic drainage to reduce swelling and Candela Vbeam laser treatments to improve the appearance of scars. “The Hydrafacial device has clear glass cups with gentle suction—it’s a blend of lymphatic drainage meets cupping, only without the heat so there is no redness and no downtime,” she says. “Our facelift patients come to see me at the two-week mark because we have found that is when they are most uncomfortable. By doing a very delicate lymphatic massage, I can relieve a lot of the swelling and buildup of lymph. Oftentimes they have some bruising as well, so I will do a light Vbeam and put them on a health-coaching protocol that includes having them limit their salt intake and increase their water intake.”

Svendsen also offers Clear + Brilliant Permea (Solta Medical) skin resurfacing treatments followed by Hydrafacial treatments to rehydrate skin. “Ideally they come in two weeks before and two weeks after. But most commonly, they come see me two weeks after, because it helps debride the dead skin and enhance the hydration. Then you really can see the glow from gently removing the dead skin cells with the Clear + Brilliant,” she says.

Practices are finding that esthetic treatments are a good complement to dermal fillers and botulinum toxins as well. “If a patient is doing Botox or fillers, we try to get them in with me first to do a chemical peel or Hydrafacial or microdermabrasion,” says Varis. “We like to do it before because they have to wait two weeks following injectables to see me. So if I can get the skin ready and then Dr. Greenberg does the injections, they have beautiful full-face results right away.”

In Nashville, Dr. DeLozier offers a fully ablative skin resurfacing treatment called Helios. “It’s a fully ablative treatment using a Bovie that is propelled with helium,” says Simpkins. “It’s a very aggressive treatment with significant downtime. Post-Helios care is kind of my niche in the practice.”

Dr. DeLozier developed and began offering the procedure about five years ago. He and Simpkins have worked closely together to fine-tune the postprocedure care regimen. “It’s really cool because Dr. DeLozier trusts me and I trust him,” says Simpkins. “We sit down and say, ‘What’s working? What’s not working?’ There has been a learning curve because it’s not the same regimen for every patient.”

Today, patients are scheduled to see Simpkins four days after the procedure to receive their post-skin care kit and instructions. “Immediately after the procedure, we put a layer of Stratamed (Stratpharma) on their skin, which has really cut down on the postprocedure redness, and they use that for the first four days,” she says. “On day four, I do pictures and go over the postprocedure kit with them and give them detailed instructions.”

Typically at this appointment, the patients are moved from Stratamed to Avene Cicalfate and Thermal Spring Water as well as EltaMD Replenish all-physical postprocedure sunscreen. “If I see anything abnormal, any swelling, oozing, bleeding or crusting, I have them see Dr. DeLozier or one of the nurses right away,” says Simpkins.

Two weeks after the procedure she sees the patient again to clear them for makeup. “We carry Oxygenetix makeup. I color match them and give them their foundation, and then I see them again at their six-week appointment to talk about how to protect the skin and maintain the results,” says Simpkins.

Open Channels

Practices that are offering both medical and nonmedical cosmetic and esthetic services find that one of the key benefits is that patients—as they become aware of the full-range of treatments—often move between the two providers. “We always talk with our clients about their concerns and target outcomes, and if it is an issue of volume loss or muscle activity, I can introduce them to one of our medical providers or get them on the books for a consult with Dr. DeLozier,” says Simpkins. “I check my clients out and I have access to everyone’s schedule. If someone is interested in a medical procedure, I can schedule an appointment for them right then.”

If Dr. Greenberg feels a patient will benefit from a combination of medical and esthetic services, he has Varis and his cosmetic coordinator take part in the patient consult. “For example, if the patients needs three microneedling treatments, three Venus Viva treatments and three chemical peels, ideally we have Autumn, myself and the cosmetic coordinator in the room talking to the patient. If that’s not possible, the cosmetic coordinator has a grid and on that grid she will schedule out the treatments,” he says. “And it works both ways because Autumn may be performing a service and say, ‘You have sebaceous hyperplasia. You should see the doctor.’ She can work with the cosmetic coordinator to schedule an appointment with me.’”

Shafer Plastic Surgery also has a cosmetic coordinator on staff to help coordinate care. “The protocols are in place. She puts together a spreadsheet for me that covers when I need to see pre- and post-treatment patients and when I need to take before-and-afters,” says Svendsen.

Varis and Dr. Greenberg meet weekly to review how everything is going in the practice and share ideas about how to improve care. “It’s really important to have good communication between the provider and the esthetician,” says Varis. “We all have to work together and be on the same page. We do come together weekly and have a meeting to discuss what needs to be done and share any feedback or recommendations on what we can do better.”

When interviewing estheticians to join his practice, Dr. Greenberg looked for someone with experience who was not afraid to ask questions. “Before I hired Autumn, I had a facial done by her myself to see her technique,” he says. “Ideally you want someone who has experience and you want someone who has good judgment and asks a lot of questions.”

For the practices we spoke with, adding esthetic services has been a win-win. “I brought in Graceanne because I wanted to offer a full-service menu for patients,” says Dr. Shafer. “I only do cutting and needles, but esthetic services go hand-in-hand with surgery.”

“We all have our niche in providing patients what they are looking for,” says Simpkins. “Working on the full 360 degrees of aging gives patients the best outcomes.”

Inga Hansen is the executive editor of MedEsthetics.

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