Remote consultations are a simple measure that can be used to discuss skincare regimes with patients, without them having to visit a clinical environment
In the current climate of the COVID-19 pandemic, it is fair to say that the way in which aesthetic practitioners work has changed dramatically, and, to some extent, this may have stopped some practitioners working altogether. With a second wave of the virus and a somewhat uncertain few months ahead, this may also be something that will be faced again in the future. To continue this and to keep one's head above water, it has become a necessity for aesthetic practitioners to adapt their practice and change so that businesses survive.
With the COVID-19 restrictions, it simply has not been possible for businesses to rely on the most common aesthetic treatments, such as botulinum toxin and dermal fillers. Understandably, in the past, these have been the mainstay of many aesthetic practices, and therefore, many practitioners have had to look towards alternatives such as home treatments as their primary source of income. However, this is not without its problems. How do we make the decision to make treatments virtual, rather than the usual face-to-face interaction, and how do we relay this to patients? In this article, I will look at how we can overcome this problem, and I will make suggestions on how a step-by-step process can be used to discuss various treatments and regimes that can be conducted safely at home by patients.
Getting started
Firstly, aesthetic practitioners need to consider how they are currently working and how this has to change for the lockdown period. While at the time of writing, it is possible to perform face-to-face treatments; this does not necessarily mean that all patients (or even aesthetic practitioners) will be comfortable or willing to visit a clinical environment to facilitate this. To overcome this hurdle, the use of remote consultations is a simple measure that can be used to discuss regimes with patients. It is worth noting here that, for a long time, remote consultations were looked down upon in the aesthetics sector due to issues with remote prescribing; however, this should not be a barrier to doing them. However, Malik (2020) identifies some issues with this, and suggests that up to 74% of plastic surgeons may have little or no experience with carrying out remote consultations, and also may have issues using the various platforms available so as to perform a remote consultation. It is fair to say that this study can be applied to non-surgical aesthetic practitioners. Virtual consultations are a new field for most practitioners, and it is understandable that they may struggle with it to begin with.
So, the first question has to be where we begin. How do we take the consultation forward in a meaningful way? It is important to say from the outset that there is not any right or wrong answer to this question, and I can only speak from my own experience of conducting virtual consultations where I have initiated the conversation regarding daily skincare regimes by discussing the use of moisturisers. This is a particularly important aspect of basic skincare. Moisturisers are essential not only in providing functional benefits of making the skin soft and increasing hydration, but it can be used as a vehicle to deliver products to the skin. This is supported by Draelos (2018), who suggested that the role of moisturisers is essential in basic skincare and the ability to deliver antioxidants, minerals and other products to the skin that will improve its overall condition. This is further supported by the work of Hahnel et al (2018), who conducted an 8-week trial of regular moisturising as part of a skincare regime. The results indicated that by regularly using a basic moisturiser, common conditions such as dry, irritated skin were treated effectively. Not only does this allow aesthetic practitioners to give patients quick and effective results, it also provides the opportunity to keep in touch with patients and check in with them over the 8-week period. This can be used effectively as a starting point for the basis of virtual consultations—it is the reason to keep in touch with patients and to remain so.
Next steps
It is important to remember that this is only the starting point for the consultation. So, where do we go from here? After establishing that a good moisturising regime is being used, it is important to determine what other products are being used and why, so as to see what the client is trying to achieve. At this point, it is interesting to mention that a lot of the products that are used by patients are mostly over-the-counter and cosmetic in nature, with many of them simply including botanical products. While this in itself is okay, it has to be asked what is being achieved by using them. More often than not, the products are expensive and have little or no active value other than moisturising the skin, and this can be achieved much more cheaply than by using the latest over-the-counter plant based cream. Ribeiro (2015) suggests that while there are claims made, such as antioxidant and antibacterial properties, there is little research or evidence that backs these up. Therefore, it is really important that this is discussed with patients so that the consultation can also be used to educate them on this fact, and hopefully save them some money.
Cleansing routines and irritation
Again, the same can be said with a cleansing regime. Many patients use expensive over-the-counter cleansers that make claims to have very complex delivery systems that are unique only to that manufacturer, but are essentially just very expensive. Are these actually needed? Surber (2019) casts doubts on the efficacy of such products and the claims that are made, as a lot of the delivery systems are lost during the actual cleansing process so they are essentially actually very ineffective in what they claim to be doing. It is interesting to note that this is supported by Navare (2019) who suggested that only a small amount of surfactant is required to make the skin clean, and that some products with lots of additives and surfactant can actually trigger an inflammatory response, with conditions such as acne and rosacea being triggered. So, in essence, by identifying what products are being used by patients, it may be possible to in turn discover what is actually causing the problem with their skin: the very products that they are using on a daily basis. This is further supported by Zip (2017), who argued that a surfactant level of less than 10% will provide effective cleaning, and will also will be less irritating to conditions such as eczema, rosacea and acne. One reason for this is that the PH of such products is often around 5–5.7, which provides effective cleaning without irritation to the surrounding skin. Stronger formulations that are often found in over-the-counter products effectively damage the skins ability to act as a barrier by disrupting the protein and lipid molecules in the stratum corneum, which leads to dry skin, irritation and inflammation.