Proper pre- and post-operative skin care speeds up healing time, protects the cosmetic surgery investment, and ensures the best possible results. The goal is to prepare skin for each procedure and determine the best course of action to achieve a healthy and speedy recovery. “Professional skin care is essential for optimal results after any aesthetic procedure, especially in [patients] undergoing face- and neck-lifts,” says Dr. Jonathan Brower, board certified plastic surgeon. Some suggested cosmetic procedures for mature clients for the face and neck include a face-lift (rhytidectomy), neck-lift (lower rhytidectomy), upper and lower eyelid surgery (blepharoplasty), eyebrow-lift (forehead lift), cheek augmentation, nose surgery (rhinoplasty), chin surgery (mentoplasty), and buccal fat removal (cheek reduction). 

When designing a skin care plan for face- and neck-lift surgery, it is important to consider that most clients will have a mature skin type. This skin type tends to be on the drier side and needs consistent exfoliation to increase cellular turnover and moisture. “I have a low threshold to refer clients to a qualified aesthetician if I think they need to improve their skin quality and elasticity prior to surgery, a process that may take up to one year if there is significant damage. To complement my aesthetician’s efforts during this time, I will get the client started on a neurotoxin and prescription tretinoin regimen to soften fine lines and lighten dark spots. My expectation is that clients will keep up with all these modalities for an optimal result,” says Dr. Brower.

OPTIMIZING SKIN

Erin K. Bradford, president and founder of Advanced Aesthetics Skin Care Studio, is a nationally recognized practicing skin care expert and paramedical micropigmentation specialist who has worked alongside plastic surgeons for over 20 years. She was a previous faculty member for The Aesthetic Society. She currently provides pre- and post-cosmetic surgery skin care and scar management at her skin clinic in Greenville, Rhode Island.

Savvy clients have moved beyond feel-good treatments and are looking toward result-oriented skin care to target specific skin conditions and address their individual concerns. This is especially true when it comes to treating mature or aging skin as this demographic is very often educated on the topic and willing to invest in skin care treatments and modalities that deliver results.
Turning to equipment or devices to treat skin is nothing new. The first high-frequency machine was developed by the scientist Nikola Tesla in the late 1800s. It was later used for medical purposes mainly as an antibacterial treatment before antibiotics were available. The French biophysicist Jacques-Arsène d'Arsonval later pioneered the use of high-frequency current in skin care treatments, and Elizabeth Arden helped popularize its use by introducing her Vienna Youth Mask in 1928, a device which claimed to have a rejuvenating effect by stimulating the circulation of blood through the facial tissues.1 High-frequency has been a treatment staple ever since.

Lila Castellanos has focused her energies into the beauty industry for the past 19 years, specializing in skin rejuvenation. As a licensed aesthetician, she has lent her expertise to several different environments including working as a paramedical aesthetician in the medical spa field as well as in both day spa and mobile spa business models. It was through these varied experiences, along with the interactions with her loyal clientele, that she honed her passion for improving and maintaining the health and integrity of her clients’ skin. Castellanos thrives on being able to use her extensive knowledge to customize each treatment to help her clients achieve the results they are searching for. Her adaptability and versatility are equally impressive in providing antiaging facials, treating acne, and minimizing the appearance of scarring or when addressing skin conditions that arise as a result of hormonal changes.

Of all skin concerns, antiaging continues to be the most prevalent across all age groups. The global antiaging market is expected to surpass around $119.6 billion by 2030.¹ 42% of women ages 25 to 34 and 54% of those aged 35 to 44 worry about signs of aging, like fine lines, wrinkles, and lost facial volume. More than a quarter, 28%, of the women surveyed under the age of 25 admitted that they too regularly worry about the toll aging takes on their skin. Furthermore, “millennials age 25 to 35 reported to have started using antiaging products as early as 26 years old. Their older counterparts, ages 55 and older, said the average age they began relying on antiaging products was 47.2.”²

FUTURE FORWARD

The future of antiaging skin care could look vastly different from the moisturizing creams and lotions of the past.For example, scientific research has recently discovered that reversing the signs of aging through cellular reprogramming may one day be a reality. This new technology for age reversal has been explored in the laboratory, where controlled doses of reprogrammed proteins reset what is termed, “the epigenome,” or the chemical marks on DNA that control which genes get turned on or off in a cell. As aging occurs, these markers get turned off. Reprogramming is a technology that can potentially flip the switch back, but it is still quite a way away from being ready for widespread use.³

Exosome Excitement

The use of exosomes – extracellular vesicles (EVs) that contain a specific composition of proteins, lipids, RNA, and DNA – are now being researched for their application in skin healing and antiaging. Exosomes are derived from endocytic membranes and can transfer signals to recipient cells mediating cell-to-cell communication. Exosomes play significant roles in various biological functions, including the transfer of biomolecules, such as RNA, proteins, enzymes, and lipids, and the regulation of numerous physiological and pathological processes in various diseases.⁴

Exosomes can be used as nanocarriers to deliver small molecules to promote tissue repair. Preclinical studies of exosomes in tissue engineering and regenerative medicine have been carried in the fields of bone and cartilage repair, nerve regeneration, liver and kidney regeneration, skin repair, and vascular tissue regeneration. Alginate, which is a substance extracted from seaweed such as brown algae, sea lichen, and Japanese kelp, is currently being studied to create a scaffolding for exosome release to deliver tissue regenerating extracellular vesicles.⁵

SKIN AGING DEFINED

Skin aging is caused by both intrinsic and extrinsic factors. Intrinsic aging is caused by the cell’s biology and genetics and leads to age-related cell degradation, called cellular senescence. With this, histological changes occur within the basal cell layer. As a person ages, proliferation of cells in the basal layer reduces. The epidermis then becomes thinner, and nutrition between the dermis and epidermis decreases. This decrease also leads to a decrease in keratinocytes, fibroblasts, and melanocytes. Research also finds that with intrinsically aged skin, the extracellular matrix, comprised of elastin, fibrillin, and collagen, degenerates. Oligosaccharides also degenerate, which, in turn, influences skin’s moisture barrier. 

The epidermal barrier is a collection of specific diverse functions, many of which occur primarily within the stratum corneum. These include maintenance of water content and balance (permeability barrier), prevention and responses to invasion by microbial organisms and antigens (antimicrobial barrier and immune response barrier), reduction of the effects of ultraviolet light exposure (photoprotection barrier), and mitigation of the effects of oxidative stresses (antioxidant barrier).⁷ All of these important barriers exist in skin.

Lydia Sarfati is an international industry leader with over 46 years of experience as a spa owner, consultant, and aesthetician. She is the founder and CEO of Repêchage, the first company to bring seaweed-based skin care treatments to the United States market, and the president of CIDESCO Section U.S.A, the world’s major international beauty therapy association. She appears at industry tradeshows, is the author of Success at Your Fingertips: How to Succeed in the Skin Care Business and The Repêchage Book of Skincare Science & Protocols, and is a contributing author to textbooks such as The Milady Standard Esthetics: Fundamentals, 12th Edition, and Oncology Esthetics.

One of the more challenging issues facing medical spas is effectively treating the aging client. Once a person reaches their mid-40s to early 50s, multiple forces are at work that result in poor skin quality, loss of elasticity, and the development of static lines. Formulating a comprehensive, yet easily understood treatment plan for this population is crucial. If the plan is too limited, they likely will not see significant improvement and, therefore, assume the medical spa is not skilled or trustworthy. On the other hand, if clients are presented with a treatment proposal that is too complex, they may become overwhelmed and discouraged. Striking a balance will result in a happy and loyal client.
Both intrinsic and extrinsic factors cause skin to look worse over time. Intrinsic factors include genetics, diet, hormones, tobacco use, and certain medications. Sun exposure, pollution, and the products put on skin are external forces that impact appearance. Ultraviolet light exposure from the sun causes the accelerated breakdown of elastin fibers, hyperpigmentation, increased underlying inflammation, thickening of the epidermis, and, potentially, skin cancer. Tobacco use damages the small blood vessels in the body, leading to poor circulation in skin. Oxygen is necessary for healthy cell function, and poor blood flow leads to less available oxygen for cells. Many of these influences are within a person’s control, such as choosing to wear sunscreen and not to smoke, while others, like genetics, are beyond their control.

AGING ANALYSIS
It is vital for medical aesthetic service providers to understand the aging process in order to know how to reverse it. Changes in bone, muscle, fat, and skin all contribute to aging of the face. Starting around the age of 50, bone loss occurs and is usually pronounced around the mouth, chin, and eyes. This results in skin puckering in these areas and a sunken-in appearance of the chin and the eyes.
Muscle movement leads to lines on the face that, with time, become permanent and are present even at rest. This is most commonly seen in the forehead, around the eyes, and in between the eyebrows. Etched lines at rest result in the appearance of angry or sad expressions.

Dr. Lisa Jenks began her medical career in emergency medicine. In 2007, she transitioned into aesthetic medicine, opening Genesis MedSpa. Since then, she has grown Genesis into a 10-treatment room facility with a staff of 22. Under her direction, Genesis has won many awards as well as the Better Business Bureau’s Excellence in Customer Service Award four times. Dr. Jenks serves on the advisory board for Skin, Inc. and consults with physicians across the United States who are interested in a career in aesthetic medicine.

Medical-Grade Myths 

There are many misconceptions regarding the regulation of skin care products and services. Creative marketing terms only further the confusion. 

In the United States, the licensing board of each individual state regulates the scope of practice of skin care professionals. Those professionals include, but are not limited to, aestheticians, nurses, and physicians. Depending on state regulations, performing some types of skin care services may only be authorized to doctors or aestheticians working in a medical spa under a doctor’s supervision. Examples of those services are higher-strength chemical peels and lasers. In short, aestheticians, and often nurses, are limited in their scope of practice while physicians are not limited at all. In the cases where a desired service is out of the professional’s scope of practice, they may choose to work under a doctor’s supervision and give up some of their income to compensate the medical doctor, or they may be on the doctor’s payroll as an employee. However, the term medical aesthetician is not regulated either, and there are no medical aesthetician licenses.

Catherine Atzen is an innovator and trendsetter in the spa and wellness industry and was recognized by DERMASCOPE Magazine as an AIA Legend for her lifetime contributions to the field. She is credited with coining the term “day spa” and setting industry standards for high-end, clean, and effective skin care. Atzen has trained over 20,000 professionals worldwide and has had 225 articles published. She founded ATZEN which has more recently became ATZEN Superior to Organic Skin Care when she took the line to new heights by incorporating the best organic ingredients with naturally derived high-performance cosmeceuticals to truly transform one’s skin.

It is not always possible to avoid a medical malpractice claim. However, there are certain standards and procedures that every practice should have in place to minimize the risk of a claim and assist in the defense of any claim.
The key elements of every type of medical malpractice claim are that the practitioner deviated from the standard of competent care, and the deviation caused injury to the client. Or, the client did not consent to the treatment or procedure. In order to defend against malpractice claims, there are several key components to incorporate into your practice.

DELEGATION
First and foremost, all practices must know their state licensure requirements and be aware of what types of services can be offered and by whom. The degree to which the services can be delegated to an unlicensed health care provider or allied health care professional and what type of supervision is required varies by state. Therefore, it is imperative to know the specific requirements.
Any practitioner that decides to delegate a task must be able to perform the same tasks themselves. You cannot delegate a task to staff members that do not know how to perform. Delegating a task to a person who is not properly trained to perform the procedure or who is not permitted to perform the procedure can lead to a malpractice claim for negligent hiring, retention, training, or supervision.

Allyson Avila is a contribution author for the American IV Association (AIVA). AIVA is a national association for owners, operators, and providers of IV hydration therapy services offering reliable guidance about evolving industry legal requirements, regulations, and best practices. AIVA’s resources enable members to improve practices, manage risks, and develop effective compliance. Visit for more information.

Age brings about several changes to skin, including the appearance of wrinkles and other age-related blemishes, loss of elasticity, a shift in tone and texture, and more. Makeup’s adhesion to skin also evolves. So, even if you have applied your makeup the same way since college, there are a few things to be mindful of as you age. And no matter your age, these tips will help you feel confident and beautiful.

HYDRATE FIRST
A good skin care routine is vital to perfect makeup application, and the best way to maintain the look, feel, and overall health of skin as you age is to keep it well-hydrated. As you get older, skin’s ability to hold on to moisture decreases, so it is best to use a thick moisturizer before putting on makeup. It helps keep skin looking supple and prevents skin care products from clogging fine lines.
Make sure the moisturizer you choose contains elements that hydrate, revitalize, and mend skin, such as glycerin, hyaluronic acid, and ceramides. In addition, everyone should use a moisturizer with sun protection factor, regardless of age or skin type.

Beauty scientist, Chicago native, wife, and mother, Victoria “Tori” Prince is a highly sought-after licensed aesthetician, international educator, continuing education sponsor, and the creative founder and CEO of Tori Prince Beauty, LLC and the Chicago Skin Lab. As a self-care expert, Prince wholeheartedly believes in building self-esteem by prioritizing self-care in one’s everyday lifestyle. Her favorite service to perform is customized corrective skin care treatments because it allows her to personalize each service to her clients’ needs while practicing the art of aesthetic and cosmetic science. Tori Prince Beauty provides refined products and services that transform clients’ skin and wellness from the inside out while coaching industry experts to encourage proper understanding and representation of women of color within the beauty and skin care industry.

Most people don’t sleep enough or get quality sleep. I wish I could tell you that I’m writing this article because I always get enough rest. However, the truth is, I struggle just like you. As a single mom of two tweens and a teenager, a business owner, and head of household, getting proper sleep is my biggest downfall. My goal for 2023 is to focus more on myself and sleep is a self-care must, which I am improving on. Getting enough sleep is important and lack of sleep affects overall health, so knowing how to schedule your sleep can make all the difference. 

THE IMPORTANCE OF SLEEP

Because life is so busy, you might be avoiding or putting off sleep, almost like it is an inconvenience. However, lack of rest puts the body under stress and produces cortisol. This causes a decrease in productivity because your brain needs sleep to recharge. Yet, many struggle with sleep because of an active brain. When you sleep, your organs repair themselves, which is essential for skin as it is the largest organ of the body. If you don’t get enough sleep, your organs can’t function properly, which not only leads to health problems but also accelerates the aging process. Skin care professionals are supposed to be experts at slowing down the aging process, yet most aren’t sleeping enough – the foundational rule of age management. 

References: 

1. Partial sleep deprivation linked to biological aging in older adults. American Academy of Sleep Medicine – Association for Sleep Clinicians and Researchers. (2018, March 9). Retrieved February 22, 2023, from https://aasm.org/partial-sleep-deprivation-linked-to-biological-aging-in-older-adults/

Samantha Dench is a 15-year licensed aesthetician, author, speaker, and owner of Skin Deep. Dench’s passion goes beyond treating skin to include internal health, so she can achieve healthy skin for her clients by finding the root of the problem. Dench loves to educate groups of women and share her knowledge and passion for skin through her book and speaking engagements.

The excitement of beginning and operating a business created simply from one’s love of aesthetics is the dream for many solopreneurs. Parts of this dream are exhilarating and fulfilling, like transforming a client’s skin and seeing them love the way their skin looks. Having satisfaction in one’s contribution to someone’s happiness is priceless. Other parts of solo business ownership may not be as much fun.  

An all-too-often-overlooked aspect of business ownership is insurance. There are simply too many solopreneurs risking everything because they do not know where to start in relation to insurance for their business. Each solopreneur should do the research they need, specific to their individual business. Consulting with an insurance agent is highly recommended. Business insurance policies can be much more complex than personal policies, and very few Americans actually understand their personal insurance. Prior to meeting with a professional to assess the business’s needs, the solopreneur should know some basic information about the types of insurance a business can have. There are many more insurance types than there is space for here, but this space will cover the most popular and pertinent to solopreneurs in the industry.  

Nichelle Mosley’s passion for aesthetics was born out of a desire to help others, after failing to find help for her own acne as a young adult. Licensed in 2015, she has worked in clinics, plastic surgery practices, dermatologists’ offices, and with family practitioners. She then opened her own clinic in 2017, Queen City Beauty Group + Wellness. She focuses on integrative aesthetics and holistic solutions to clients’ skin concerns. As a member of the International Association for Applied Corneotherapy, Mosley seeks whole-person solutions while delivering results for clients. She is also the 2019 Skin Games Age Management Champion and 2018 Skin Games Acne Finalist. 

Ever wonder why an individual chooses a certain brand over another similar brand, like Target over Walmart, Coke over Pepsi, or vice versa? Effective branding is usually the culprit. Branding is a term that gets bandied about everywhere in business although many do not have full comprehension of what it means or how it can influence human behavior. To pull back the smoke and mirror curtain, all branding boils down to getting super clear on the business’s “what,” “how,” and “why” – in other words, brand identity, brand personality, and brand story. Authenticity, consistency, and connection on an emotional level with the target perfect potential client (Make sure to read March’s installment of “Owner’s Manual” for the full description.) should be the goal when creating the spa’s unique brand. 

 Melissa Allen has lived many lives as a dance teacher, biologist, and marketing director before becoming a successful aesthetician and spa owner. All of these former positions help color her opinions, actions, and style. Allen’s career in aesthetics has also been far-reaching; she has been an aesthetician in the back of a salon, a solo aesthetician, a spa owner with several employees, and a global brand consultant. Allen has experienced many of the paths of aesthetics and is open, honest, and willing to share her adventures. As her time in the treatment room comes to an end, she is focusing on mentoring and guiding the next generation of thinking skin care professionals and spa owners.