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 look at each of these skills closer...
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 (MLD) is a technique developed by Dr. Emil Vodder is the early 1930’s. Dr. Vodder discovered that through gentle manipulations over the face or body, immune function was enhanced, and oedema and inflammation were greatly reduced. With a series of treatments the results were even more impressive. MLD assists in the removal of waste products from the body tissue and helps to absorb fat- soluble nutrients, produce antibodies and white blood cells to destroy bacteria, yeasts, viruses and other harmful organisms.
Pre-operatively, it will enhance the body’s ability to undergo the surgical procedure. This is done through stimulating the body’s immune function. The skin is more radiant due to exchange of vital nutrients and vitamins. Post- operatively, the wound healing response of the body takes effect more rapidly thus shortening the recovery time. This treatment also allows the patient to relax and induces a sense of well-being.
The recommended course of treatment is three to six treatments, once a week pre- operatively, and beginning up to 24 hours post- operatively.
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:
1) excess oil or sebum production
2) retention hyperkeratoses or retaining too many dead skin
cells within the follicle wall and on the surface of the skin.
3) propionibacterium acnes or p.acnes in the follicle
4) 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 what is prescribed as home care for this patient.
There are 4 grades of acne, most of which are treatable with in office procedures such as gentle deep cleansing, chemical exfoliation, removal of microcomedones and comedones, topical antibiotic application, anti inflammatory topical application (i.e. azelaic acid) and cryogenic therapy to name a few. These treatments must work in tandem with homecare; colloidal oatmeal cleansers, astringents, topical antibiotics, possibly oral antibiotics, and benzoyl peroxide topical gels. Grades 3 and 4 should be monitored by the physcian.
8. Methods of Exfoliation
There are several options in professional exfoliation available in the clinical setting, AHA’s (glycolic), BHA’s (salicylic), PHA’s (blends of glycolic and salicylic), TCA’s (trichloracetic acid), Jessner’s Solution (lactic, salicylic, and rescorcinol), enzymes (papain, bromelain, yeasts etc.), medical micro- dermabrasion, and ultrasonic scrubbing to name a few. The method of exfoliation will be determined by the skin type, skin condition, patient’s sensitivity and reactivity.
You must have proper training and certification where required. This is an area that many estheticians can have questions regarding the scope of practice. Always check with your state board, as well as your insurance agency. Chances are if your insurance company will not cover you to perform certain procedures; 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 following chart was developed by Dr. Fitzpatrick; and is beneficial to assess the potential for pigmentary changes based on a patient’s sensitivity to UV exposure.
Fitzpatrick Skin Type Classification:
|
Skin Type
|
Reaction to Sun |
Skin Color |
|
I
|
Always burns |
Very White or freckled |
|
II
|
Usually burns, difficulty tanning |
White |
|
III
|
Tans, sometimes burns |
White to Olive |
|
IV
|
Tans easily, rarely burns |
Olive to Brown |
|
V
|
Very Rarely Burns |
Dark Brown |
|
VI
|
Never Burns |
Black |
Dr. Glogau developed the following chart; which
classifies Photo Aging Groups
|
Group
|
Degree of Photo Aging |
Age Range |
Appearance |
I |
Mild |
25-35 years old |
No keratosis, little scarring or wrinkling. Little or no makeup |
II |
Moderate |
35-50 years old |
Early wrinkling, mild scarring and/or discoloration. Little makeup |
III |
Advanced |
50-65 years old |
Keratosis, wrinkles, discoloration, telangiectasias. Always wears makeup |
IV |
Severe |
65-75 years old |
Keratosis, deep wrinkles, skin laxity, discoloration, scarring. Makeup is caked |
6. Universal Precautions
This refers to sanitation and sterilization practices. It is standard practice at hospitals, clinics and doctor’s 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 pouch; which is labeled, or to a container which is labeled.
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 contra- indications, and any 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 on the subject if available at your local college.
Your patients’ look to you to be the expert; with the Internet, publications and word of mouth; they are more and more savvy about what is available to them for use. They may not understand that there can be interactions and complications without your professional recommendation.
4. Anatomy and Physiology
In a plastic surgery office this is imperative if not a job requirement. You will usually be part of the pre- operative consultation and the post- operative 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. 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 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 due to delayed healing response. A delayed healing response could occur due to swelling, lack of proper nutrition, or too much pressure at the site. The dermis can take up to one week to epithelize (regrow) with proper care.
There are five stages:
1) The initiation of the cellular process, the body fights infection and controls blood loss at the site.
2) The introduction of fibroblasts, rearranging the collagen and connective tissues.
3) The scab formation, this causes the conatrction of the side s of the wound in order to close it. The basal cell layer is actively producing skin cells to cover the wound.
4) Complete epitheliazation, the scab is forced off due to the continued renewal process below. Never pull off a scab, and instruct the patient not to pull of a scab.
5) 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 effect 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 anti-depressant.
Now, let’s look at the cons of sun exposure:
1) Damages DNA, thus producing damaged cells and inhibiting the body’s ability to protect itself.
2) Inflammation, leads to decreased immune function and speeds the aging process and hyperpigmentation.
3) Immune function is decreased; this is due the destruction of Langerhan Cells; our protector cells.
4) Skin cancer
5) 80% of aging is caused by over-exposure to
the sun.
The esthetician must be able to explain this 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 reccomendations, 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 the skin must be accurately analyzed.
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. The condition of the skin will change due to 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 on each and 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 non- invasive 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.
