Disclaimer: In some states, only medical professionals are allowed to perform procedures. Each state has specific governing rules and it is your responsibility to contact the proper governing body for approval before using any of the featured equipment.

 

WORKING WITH PHYSICIANS

Working with Physicians
by Peter Fodor, Md
published in Skin Inc. July 2004

An increasing number of baby boomers are maturing and beginning to investigate surgical procedures and dermato- logical treatments to conceal the signs of aging. Due to this appearance-oriented trend, physicians are experiencing a surge in their businesses. Frequently, estheticians play a role in pre- and post- operative surgical procedures, as well as offer preventive treatments to further postpone the appearance of fine lines, wrinkles and sagging.
This combination of medical and esthetic practices is an increasingly popular phenomenon. In an effort to maintain industry standards and safety practices, professionals have voiced areas of concern, including the overlap of esthetic and medical arenas. Several issues and questions include the following.

-What procedures can a licensed esthetician perform legally in conjunction with a physician's practice?

-Does a doctor have the authority to delegate procedures outside the esthetician's scope of practice?

-What is the physician's ability to delegate esthetic procedures to other, non-cosmetology licensees such as registered nurses?

-What are the limitations and conditions of such delegation?

-May a physician refer cosmetic treatments to an unlicensed individual, and, if so, what are the
limitations and conditions of such referrals?

-How can the title or services be advertised for an esthetician in conjunction with a physician's office?


In some states, estheticians with a facility permit from the state's Bureau of Barbering and Cosmetology may perform cosmetic services under the guidance of a physician. These trained individuals can offer skin treatments including, but not limited to, light chemical peels and microdermabrasion. To meet the highest industry standards and to best service clients, it is the esthetician's job to undergo proper education, obtain necessary licensing and be knowledgeable about current events in the cosmetic surgery industry. Also, one of the greatest skills an esthetician can have is to know when it is appropriate to ask a physician for guidance. There are particular occasions
where an esthetician may notice potentially harmful skin conditions, such as skin cancer, while treating patients.
Following are suggestions and information for estheticians seeking further knowledge to aid patients in combating signs of aging or seeking additional business opportunities with a cosmetic surgeon or dermatologist.
Training
Estheticians can.supplement their knowledge through specialty training to become estheticians in a medical setting. This can include attending classes and completing additional course work for a specified number of hours. In certain states, an individual must be a licensed esthetician or a licensed nurse with a skin specialty certificate. Course work may involve education on chemical peels; a trip to a medical clinic to meet with physicians and medical staff members; or attendance at lectures on dermal disorders, skin pathologies, scar treatments and more. Frequently, product manufacturers will offer training for cosmetic procedures such as chemical peels-this education also may be useful to estheticians.
Client records
Under the American Medical Association's (AMA) Code of Medical Ethics, patients have certain rights to privacy. Physicians may not reveal any information associated with the treatment or medical records of a client. A patient-physician relationship is a sensitive matter and is confidential. The AMA code is not binding by law; however health care providers have an ethical duty to protect their patients. Under the care of physicians and estheticians, pa- tients should feel free to reveal personal information with the knowledge and assurance that the professionals will protect the confidential nature of the information disclosed. Estheticians must be aware of the AMA code and should understand that the protection of client records is a priority for patients and physicians. This subject may arise when both the esthetician and physician are treating the same patient.
Industry news
The potential for working with physicians opens up a myriad of possibilities for the esthetician. This is an opportunity to explore the rapidly growing and changing esthetic industry. Estheticians must
keep abreast of medical and health news by attending seminars, and reading news- papers and trade publications. Industry trends, as well as new products and techniques, continue to surface on a regular
basis.


Team work
The aging population has an increased awareness of skin damage from environmental and sun exposure. As a result, there is a growing demand for Botox* , chemical peels and microdermabrasion treatments. These procedures are three solutions to aging that could lead to physician and esthetician collaboration.

Botox. Botox is the trade name for a purified toxin named botulinum toxin type A. Originally a treatment for lazy eye and uncontrolled blinking, Botox injections have been used to reverse the visible signs of aging by softening and smoothing fine lines and wrinkles since 1989. Botox only should be administered by a licensed physician, however estheticians should have a thorough understanding of the procedure.
The treatment blocks impulses from the nerve to the tiny facial muscles that are related to expression lines. It relaxes the muscles so they do not contract. After Botox, the overlying skin remains smooth and unwrinkled while the untreated facial muscles contract in a normal fashion, allowing regular facial expression to be unaffected.
The most common, trusted and best-trained physicians to provide Botox services are those specializing in otolaryngology, or ear, nose and throat, plastic surgery, dermatology and some ophthalmologists. Though an esthetician cannot perform the injection, this is a cosmetic procedure where their expertise could be utilized.
There is a limited amount of pre- and post-care procedures for Botox..

Massage and facials are not recommended treatments. Botox injection side effects may include minimal bruising and swelling at the injection sites. Application of airbrush makeup by an esthetician may be helpful to a Botox patient. This technique especially would be useful post-Botox because a patient's face will be sensitive to pressure apd massage.

Chemical peel. A chemical peel is a resurfacing facial procedure using a chemical solution to improve the texture of the skin by removing its damaged outer layer. It especially is helpful for patients with facial blemishes, wrinkles and un-even skin pigmentation. It even may be performed in conjunction with a face lift.
Glycolic, lactic or fruit acid peels are milder in strength and can be administered by estheticians in most states.
These estheticians are permitted to use the following products when performing chemical peels.

-30% alpha hydroxy acid (AHA) that includes glycolic, tartaric, malic and lactic acids with a pH of 3.0 or lower strength.

-20% beta hydroxy acid (BHA) that includes salicylic acid.

-Trichloroacetic acid (TCA) With levels less than 20%. .

-Jessner's solutions.

-2% resorcinol acid.

-Proteolytic enzymes such as papain and bromelain when used with an accelerator.

Most states require that phenol or TCA chemical peels be performed by a physician. These peels are stronger, deeper and are ideal for patients with coarse facial wrinkles, areas of blotchy or damaged skin caused by sun exposure, or pre-cancerous growths. A physician carefully will apply a dilute acid to skin that may cause a stinging sensation. After a peel, a thick brown crust, or scab will form. Post treatment, baby powder can be used if facial weeping or oozing is profuse. An ointment, such as Neosporin*, and vitamin A and D, are additional treatments that patients in the crusting stage can apply after separation of crust to soothe ; skin. The underlying skin appears reddened and usually requires three to six months to return to a normal hue. Patients should avoid ultraviolet (UV) light exposure for three to five months and, when outdoors, must use sunscreen SPF 15 or above to pro-,
tect newly forming skin. Patients may find themselves in the pre-treatment stage up to a month before the
actual peel is given. Tretinoin or alpha hydroxy acid often is a pre-treatment for chemical peels. It is used to thin the skin that will allow the acid to penetrate evenly and deeply into facial tissue. Moreover, a bleaching agent such as hydroquinone may be used in conjunction to treat pigmentation problems before the actual chemical peel.

An esthetician could administer an oxygen treatment a week after a patient receives the procedure. Applying oxygen to recovering skin is a highly effective healing and soothing treatment. Estheticians also should be able to make recommendations about preferred skin care lines to aid and maintain results.
The chemical peel is a safe treatment when performed by a qualified physician. However, there is some level of risk associated, such as the potential for infection or scarring. The results from a phenol peel will be more dramatic than a TCA peel due to the strength of the acid. Patients will notice an improvement in skins texture and pigmentation, and a decrease in fine lines, wrinkles and blemishes.
Microdermabrasion. Microdermabrasion is a cosmetic sandpapering technique designed to smooth skin, even texture and refine pores. The procedure is effective in reducing fine lines, crow's-feet, age spots and acne scars, as well as stimulating the production of skin cells and collagen. It is an ideal treatment for patients seeking a mild solution for sun damage and aging. Microdermabrasion can be performed by a physician or licensed esthetician.
A closed vacuum system emits tiny crystals of aluminum oxide that impact the skin. Simultaneously, skin debris is suctioned back through the tubing into a waste compartment. Aluminum oxide is a safe, non-toxic substance and will not cause any adverse skin reactions. Patients with sunburn or certain skin disorders, such as rosacea or facial telangiectasia, may be advised not to undergo a microdermabrasion treatment.
Results
A cosmetic surgeon and an esthetician ultimately have the same priorities in mind-to provide patients with treatments and services that improve the appearance of their skin. Through a collaboration built on trust and excellent results, the two can work together to help clients combat the aging process and achieve their ultimate skin care goals. Botox, chemical peel and microdermabrasion are three procedures known for their effectiveness in reversing signs of aging, reducing fine lines, wrinkles and acne, as well as enhancing skin texture and pigmentation.
There have been questions raised by patients and professionals regarding the collaboration of physicians and estheticians. Estheticians can be an asset to the businesses of physicians in that they aid patients in preparation for cosmetic surgery and assist in enhancing the surgical effects post procedure, Currently they may not perform Botox; however estheticians are licensed to administer mild chemical peels and microdermabrasion in most states.
Whether you are an esthetician in training or a seasoned professional, there are continuing opportunities to expand your business through alliances with physicians. Know your client’s needs, know the industry trends and know the limitations of esthetic licenses. .