TOP TEN MUST-HAVE SKILLS OF GREAT MEDICAL ESTHETICIANS
by Chandra Bredel
Reprinted with permission from Les Nouvelles Esthetiques, American Edition, July 2005, all rights reserved

So you want to be a medical esthetician … so, why not be the best? There are 10 key skills that every great medical esthetician possesses. Depending on which type of medical setting you are in, a plastic surgery or dermatology practice, the following techniques and areas of knowledge are a necessity. Let's countdown and look closer at each of these skills …

10. Manual lymph drainage
This is very beneficial to the end result of any cosmetic surgical procedure; whether it is performed on the face or the entire body. Manual lymphatic drainage is a technique developed by Dr. Emil Vodder in the early 1930s. Dr. Vodder discovered that gentle manipulations over the face or body enhanced the body's immune function and greatly reduced edema and inflammation. With a series of treatments, the results were even more impressive. MLD helps remove waste products from body tissue and helps to absorb fat-soluble nutrients, produce antibodies and white blood cells that destroy bacteria, yeasts, viruses and other harmful organisms.

Preoperatively, MLD will enhance the body's ability to undergo a surgical procedure because it stimulates the body's immune function. The skin is more radiant because of the exchange of vital nutrients and vitamins. Postoperatively, the body's wound-healing response takes effect more rapidly, thus shortening the recovery time. MLD is also a very relaxing treatment for the patient and it induces a sense of well-being. The recommended course of treatment consists of three to six sessions, once a week preoperatively, and starting up to 24 hours postoperatively.

9. Acne assessment and treatments
Acne is one of the most common skin conditions estheticians are sought out to treat. There are four major factors that cause acne: excess oil or sebum production; retention hyperkeratoses or retaining too many dead skin cells within the follicle wall and on the surface of the skin; Propionibacterium acnes or p.acnes in the follicle; and host factors such as hormonal fluctuations.

In order to treat acne effectively, a thorough assessment is crucial in determining the types of treatment that will be performed. It will also determine the prescribed home care for a patient.

There are four grades of acne, most of which are treatable with office procedures such as gentle, deep cleansing; chemical exfoliation; removal of microcomedones and comedones; topical antibiotic application; anti-inflammatory topical application (e.g., azelaic acid); and cryogenic therapy, just to name a few. These treatments must work in tandem with home care that can include colloidal oatmeal cleansers, astringents, topical antibiotics, possibly oral antibiotics, and benzoyl peroxide topical gels. Grades 3 and 4 should be monitored by the physician.

8. Methods of exfoliation
There are several options in professional exfoliation that are available in the clinical setting: AHAs (glycolic), BHAs (salicylic), PHAs (blends of glycolic and salicylic), TCAs (trichloroacetic acid), Jessner's solution (lactic, salicylic, and resorcinol), enzymes (papain, bromelain, yeasts, etc.), medical microdermabrasion and ultrasonic scrubbing. The method of exfoliation will be determined by the skin type, skin condition and patient's sensitivity and reactivity.

You must have the proper training and certification where it is required. This is an area that many estheticians have questions on regarding the scope of their practice. Always check with your state board, as well as your insurance agency. Chances are, if your insurance company will not cover your performance of certain procedures, then it is out of your scope of practice.

7. Fitzpatrick and Glogau classification
These scales of classification are necessary to determine patient suitability prior to any professional treatment. The Fitzpatrick chart is beneficial in the assessment of the potential for pigmentary changes based on a patient's sensitivity to ultraviolet exposure (see Figure 1). The Glogau chart classifies photo-aging groups (see Figure 2).

6. Universal precautions
This refers to sanitation and sterilization practices. It is standard practice at hospitals, clinics and doctors' offices worldwide and it should not be different in the world of esthetics.

As an esthetician, we must ensure the public's safety as well as our own. Always follow the office procedures for sanitation and sterilization. Make sure you are trained to use the equipment and solutions. For example, the autoclave is steam sterilization and the cycle must be complete before you remove any instruments. The instruments are then transferred to either a labeled pouch or to a labeled container.

5. Cosmetic chemistry
This does not mean you should become a cosmetic chemist, but you should have an understanding of cosmetic ingredients, how they work, and any contraindications and drug interactions that may be incompatible with your patient's health and skin care regimen.

There are many books on the subject, but I would recommend attending a class if it is available at your local college.

Your patients look to you to be the expert. With the Internet, publications and word-of-mouth, patients have become more and more savvy about what is available for them to use. Without your professional recommendations, they may not understand that there can be complications.

4. Anatomy and physiology
In a plastic surgery office, this is imperative, if not a job requirement. You will usually be part of the preoperative consultation and the postoperative care, therefore your understanding of the anatomy and physiology of the face and body is very important. Many people considering surgery do not always understand the process of how the body responds to wounds. If you can explain, in layman's terms, how these parts of the body function, and how they will feel after the procedure, you will gain the patient's confidence.

3. Wound healing
It is very important to understand that there are different stages to wound healing. Many patients assume that if the wound is closed it is healed. That is not usually the case. The etiology, depth, color and size of a wound must be identified. This will also determine the appropriate care for the wound.

A wound is defined as a break in the continuity of the soft parts of body structures through trauma. The color of the wound can be red, yellow or black. Ecchymosis or bruising can be many colors. Red means the wound site is healthy; yellow can signify infections and black can mean necrosis or dead tissue. The site can also appear paler than the surrounding skin; this is because of a delayed healing response. A delayed healing response could occur as a result of swelling, lack of proper nutrition or too much pressure at the site. The dermis can take up to one week to epithelialize (regrow) with proper care.

There are five stages of epithelialization:

The initiation of the cellular process—the body fights infection and controls blood loss at the site.

The introduction of fibroblasts, rearranging the collagen and connective tissues.

The scab formation, which causes the contraction of the sides of the wound in order to close it. The basal cell layer actively produces skin cells to cover the wound.

Complete epithelialization. The scab is forced off because of the continuous renewal process. Never pull off a scab! Instruct the patient not to pick off a scab.

Exterior of wound is healed, blood vessels are reconnected and new collagen reorganizes the underlying wound.

The entire process can take up to one year to complete. The care of wounds is not under the scope of practice for estheticians. This is done by either the physician or the nurse.

2. The sun and its effects on the skin
Without the sun, our planet and all of its inhabitants would perish. That being said, there is great deal of misinformation about sun exposure and how it affects the skin. First, let's review the pros of sun exposure: It promotes the production of vitamin D in the body and can act as an antidepressant.

Now, let's look at the cons of sun exposure:

It damages DNA and, as a result, produces damaged cells and inhibits the body's ability to protect itself.

It causes inflammation, which leads to decreased immune function and speeds the aging process and hyperpigmentation.

Overexposure to the sun decreases the immune function because it destroys Langerhans cells, our protector cells.

It causes skin cancer.

Overexposure to the sun causes 80 percent of all aging.

The esthetician must be able to explain these facts to patients seeking to reduce the appearance of age spots, dilated capillaries, wrinkles and a host of other conditions that can occur from indulging in unprotected or extended sun exposure. They must require that all patients comply with sun protection recommendations, especially during specific treatments for hyperpigmentation.

1. Patient assessment
The medical esthetician must be able to assess not only the patient's expectations, but more importantly, they must accurately analyze the skin.

The esthetician must be able to determine which products and procedures will be appropriate for each individual patient. The skin condition and genetic skin type must be determined prior to any and all treatments at each visit. Remember, the condition of the skin will change because of a variety of factors. Lifestyle, climate, general health and mental outlook are all contributory factors to the overall outcome of any procedure. A complete medical history must be taken from all new patients and updated at every visit. The patient must complete all necessary documents, such as a health questionnaire, consent forms and arbitration forms.

A key part of the assessment is whether the patient's expectations are realistic. Many times, a patient will expect a result from an esthetic procedure that can only be accomplished through surgery. All patients must be educated on the options available to them, both noninvasive and invasive. The patients should also have all information in written form and signed that they have received this information, whether or not they decide to have a treatment.

Chandra Bredel is an account executive, for Guinot Paris, which is distributed by Thibiant International, Inc. She has more than 15 years of experience in the beauty and wellness industries as a makeup artist, educator, esthetician and massage therapist. She has been a California state board instructor; medical esthetics specialist; and director of esthetics for Dr. Terry Dubrow, the featured plastic surgeon on The Swan. To reach her, call 1-800-748-5825 or visit www.guinotusa.com.

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