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Milady’s Aesthetician Series:
Botox®, DysportTM, Dermal Fillers,
and Sclerotherapy
2nd Edition
Pamela Hill, R.N.
President, Milady: Dawn Gerrain
Publisher: Erin O’Connor
© 2011, 2006 Milady, a part of Cengage Learning
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1 2 3 4 5 6 14 13 12 11 10
Contents
xii
Preface
xiv
About the Author
xv
Reviewers
xvi
Acknowledgments
Chapter 1
1 INTRODUCTION TO NEUROTOXINS AND
DERMAL FILLERS
1
Key Terms
1
Learning Objectives
2
Introduction
2
History and Origins of Facial Plastic Surgery
4
Evolution of Neurotoxins
6
Evolution of Dermal Fillers
17
Liability Issues for the Aesthetician, the Physician, and
the Nurse Injector
22
Conclusion
22
Top 10 Tips to Take to the Spa
23
Chapter Review Questions
24
Bibliography
v
vi
Contents
Chapter 2
27 ANATOMY AND PHYSIOLOGY OF THE FACE
27
Key Terms
27
Learning Objectives
28
Introduction
28
Anatomy of the Face
29
Vascular Patterns
39
Facial Nerve Patterns
42
Muscles and Movement of the Face
51
Anatomy and the Aging Face
53
Facial Contour Analysis
57
Conclusion
58
58
59
Bibliography
Chapter 3
61 COMMUNICATION AND CONSULTATIONS
61
Key Terms
61
Learning Objectives
62
Introduction
63
Communication
66
Listening
68
Using Psychologic and Communication Cues to
Optimize Performance
69
Consultation
73
Consultation for Dermal Fillers and Neurotoxins
76
Determining Candidates
78
Body Dysmorphic Disorder
Contents
80
Maximizing Resources
81
Spa Materials
82
Conclusion
82
83
84
Bibliography
Chapter 4
85 NEUROTOXINS: EVERYTHING YOU
NEED TO KNOW
85
Key Terms
85
Learning Objectives
86
Introduction
87
History of Neurotoxins
88
How Neurotoxins Work
90
Preparation, Mixing, and Storage of Botox Cosmetic®
93
Preparation, Mixing, and Storage of Dysport
94
Frequently Asked Questions
102
Glabellar Frown Lines
102
Forehead Lines
103
Crow’s Feet
103
Marionette Lines
104
Vertical Lip Lines
106
Neck Rings and Platysmal Bands
108
Dermal Fillers Versus Neurotoxins
108
Conclusion
109
109
111
Bibliography
vii
viii
Contents
Chapter 5
113 NEUROTOXINS: TECHNIQUES AND RESULTS
113
Key Terms
113
Learning Objectives
114
Introduction
114
Consultation
116
Introduction to Treatment Techniques
117
Indications
124
Contraindications
125
Glabella
131
Forehead
139
Crow’s Feet
145
Perioral
149
Platysmal Bands
151
Neck Rings and the Decollete
154
Treatment of Hands, Feet, and Underarms for
Excessive Sweating
156
Conclusion
156
157
158
Bibliography
Chapter 6
161 DERMAL FILLERS: EVERYTHING YOU
NEED TO KNOW
161
Key Terms
161
Learning Objectives
162
Introduction
Contents
163
History of Dermal Fillers
166
How Dermal Fillers Work
168
Durability of Dermal Fillers
181
Neurotoxins Versus Dermal Fillers
182
Combining Dermal-Filler and Neurotoxin Treatments
185
Dermal-Filler Consequences
185
Dermal-Filler Side Effects
186
Dermal-Filler Complications
186
Conclusion
187
187
188
Bibliography
ix
Chapter 7
191 DERMAL FILLERS: TECHNIQUES
AND RESULTS
191
Key Terms
191
Learning Objectives
192
Introduction
193
Hyaluronic Acid Fillers
213
Collagen
214
Indications and Contraindications for Other Dermal Fillers
222
Topical Anesthetics, Dental Blocks, and Field Blocks
224
Conclusion
224
225
226
Bibliography
x
Contents
Chapter 8
229 INTRODUCTION TO SCLEROTHERAPY
229
Key Terms
229
Learning Objectives
230
Introduction
232
History and Origins of Vein Therapy
232
Evolution of Injection Sclerotherapy
233
Evolution of Lasers for Vein Treatment
234
Who Develops Varicose Veins?
235
The Aesthetician’s Role in Vein Therapy
236
Conclusion
237
237
238
Bibliography
Chapter 9
239 ANATOMY AND PHYSIOLOGY OF VEINS
AND ARTERIES
239
Key Terms
239
Learning Objectives
240
Introduction
240
Circulatory System
246
Diseased Veins
248
Conclusion
248
249
249
Bibliography
Contents
Chapter 10
251 OPTIONS FOR VEIN TREATMENT
251
Key Terms
251
Learning Objectives
252
Introduction
254
Sclerotherapy
265
Endo-Venous Laser Treatment
268
Conclusion
269
269
270
Bibliography
271
Glossary
277
Index
xi
Preface
Botulinum toxin A and dermal fillers are more popular today than ever
before. It is the possibility to look younger and more refreshed without
surgery that makes these treatments so appealing. Furthering the success of dermal fillers is the ability to use the materials in new and creative ways by correcting tear troughs, jawline, and cheeks, to mention
just a few. These new methods enable the injector to provide a lifting
and projection to the face never before realized. Nothing is quite like a
dermal-filler or botulinum-toxin treatment for the client seeking nonsurgical improvement to his or her appearance.
Botulinum toxin A has become the fastest growing treatment segment
in the medical spa over the last 5 years. Now with the introduction of
Dysport® there are two choices for botulinum toxin A treatment, which
has lead to a speculation that another leap in consumer consumption will
begin. In order for the aesthetician to be prepared to answer questions
about botulinum toxin A, it is important to understand more than just the
basics. This book presents information that includes injection techniques,
risks and complications, and anticipated results. The book arms the aesthetician with the information that is needed to answer the questions of
the client.
The dermal-filler industry has grown from a single product, bovine
collagen (in 1981), to a multidimensional sector that includes hyaluronic
acids, calcium hydroxyapatite, and poly-L-lactic acid, to mention a few.
There are at least six injectable fillers to choose from to treat a patient’s
lines, wrinkles or folds, or lipodystrophy. Do you know about all of the
fillers, what are they, and their benefits? How do you plan to uphold
your reputation as a knowledgeable clinician without advanced study in
this area? Although the aesthetician is not an injector, accurate information on the injection process is important to know. Armed with this
information, the aesthetician can answer questions posed by the client
and provide necessary support to the client before and after the injection
process. Being well informed about the different fillers and the
xii
Preface
applications enables the aesthetician to uphold his or her reputation as a
knowledgeable and first-rate practitioner. Until now the aesthetician’s
resources on this subject matter have been limited to lay press articles,
hit-and-miss articles found in trade magazines, and the occasional trade
show presentation. This book changes everything.
This is not a cookbook, or a how-to guide for injectables. Rather,
it is an answer to the requests that I often hear asking for more information. The chapters are organized, one on top of the other with essential,
must-have information on injectable treatments. To this effect, general
knowledge is expanded upon. Insightful hints and recommendations
enable you to optimize your knowledge, which will insure your success.
Each chapter has questions and the “Top 10 Tips to Take to the Spa”
common to this series to assist you well beyond your training, and give
you the facts that are helpful well beyond the classroom.
There’s no doubting that injectable treatments are here to stay and
those with the satisfactory answers to the clients’ questions will be
revered as “the best aestheticians.”
xiii
About the Author
Pamela Hill
xiv
Pamela Hill, R.N., CEO, received her diploma from Presbyterian/
St. Luke’s Hospital and Colorado Women’s College. She followed through
to practice as a registered nurse for more than 30 years with her initial
emphasis in cardiac surgery and then in cosmetic surgery and medical skin
care. In 1992, Ms. Hill founded Facial Aesthetics®, a network of medical
skin care clinics in association with John A. Grossman, M.D. Since then,
Ms. Hill has been an industry pioneer in the growth and development of
the medical spa industry. As the president and chief executive officer of
Facial Aesthetics, Ms. Hill has been a proactive member and pioneer in
the evolution of the medical spa model and the integration and union of
cosmeceuticals and nonsurgical skin care. In addition to her leadership in
the medical spa industry, she has also been actively engaged in the research
and development of the successful Pamela Hill Skin Care product line.
Ms. Hill has devoted her passion for nonmedical skin care to the
instruction of a higher level of education and skill for those aspiring to
be the aestheticians of tomorrow.
Reviewers
I would like to thank the following individuals who have reviewed this
text and offered invaluable feedback. This very important task, although
time consuming for each reviewer, is a critical component to the success
of a book. I am grateful for your time and honest comments.
Helen Bickmore, Spa Director,
Jean Paul Spa
Albany, New York
Kimberly Coleman, MEd,
LMT, LE, Instructor,
Ofallon, Missouri
Sallie Deitz, Clinical
Esthetician, CFFPLS
Bellingham, Washington
Jean Harrity, Educator of
Esthetics
Bartlett, Illinois
Ruth Ann Holloway, Dermal
Dimensions Progressive Skin
Therapy
Providence, Utah
Tracy Johnson, RN, LE
Owner Tracy Johnson Skin
Care, Flowery Branch, GA
Laura Todd, Licensed Master
Esthetician, Certified Medical
Esthetician and Esthetic Laser
Technician.
Institute of Advanced Medical
Esthetics
Mechanicsville VA
Linda Rae, Medical
Esthetician, ASS
Linda Rae Skin Care, Sunrise
Intracoastal Plastic Surgery
Center
Aventura, FL
Jan Walters, Certified
Paramedical Esthetician
Esthetics Program Director
Colorado School of Paramedical
Esthetics
Lakewood, CO
xv
Acknowledgments
Long before the concepts of a medical spa were considered, nurse injectors were injecting bovine collagen. For the first time, we shared with
our patients the delight of improving appearance without the downtime
associated with surgical procedures. Similar to many nurse injectors, my
medical spas were born from this pivotal point. I began by injecting collagen and added skin care and later Botox® treatments to our menu of
services.
Communities of original nurse injectors, as well as the company
representatives, fought for the rights of nurses to administer injections.
To these individuals—too many to recognize—I would like to say,
“Thanks.” This industry would not have grown and thrived without
their perseverance and determination.
Finally, without joy in our lives, works such as this text would never
have come to fruition. The joys in my life are my family; my mother;
my husband, John; my daughters, Alysa, Galen, Kyle, and Caroline;
their husbands; and all the grandbabies that make my life a blessing.
PHOTO CREDITS
Chapter 1: Figure 1–2: Photograph by Margaret Bourke-White, courtesy
of Getty Images. Figure 1–3: Courtesy of Allergan Corporation.
Figure 1–4: Courtesy of Pamela Hill, Facial Aesthetics, Denver,
CO. Figure 1–7, parts A and B: Courtesy of Pamela Hill, Facial
Aesthetics, Denver, CO; Figure 1–10: Courtesy of EditEuro Spa,
Denver, CO.
Chapter 3: Figure 3–1: Photograph provided by Getty Images. Figure 3–2: Courtesy of Pamela Hill, Facial Aesthetics, Denver, CO.
Chapter 4: Figures 4–5 through 4–9, A: Courtesy of Pamela Hill,
Facial Aesthetics, Denver, CO.
xvi
Acknowledgments
Chapter 5: Figures 5–1, 5–2, 5–5, 5–9, 5–10 through 5–12, 5–18,
5–19 through 5–21, 5–27, 5–28 through 5–31 and 5–42: Courtesy of
Pamela Hill, Facial Aesthetics, Denver, CO; Figure 5–3: Courtesy of
Allergan Corporation.
Chapter 6: Figure 6–4, 6–13, 6–14, parts A and B, 6–17: Courtesy of
Pamela Hill, Facial Aesthetics, Denver, CO;
Chapter 7: Figures 7–5, 7–6, 7–10, 7–11, 7–19 through 7–22, 7–23,
7–25, and 7–29: Courtesy of Pamela Hill, Facial Aesthetics, Denver,
CO; Figure 7–17 ( Hylaform products): Courtesy of Medicis Pharmaceutical Corporation.
Chapter 8: Figure 8–4: Courtesy of RESINAG AG, Switzerland.
Chapter 10: Figure 10–1 (Sclerovein): Courtesy of RESINAG AG,
Switzerland. Figures 10–5, 10–6, and 10–7: Courtesy of Pamela Hill,
Facial Aesthetics, Denver, CO.
All other photographs by Larry Hamill, Columbus, OH.
xvii
Introduction to
Neurotoxins and
Dermal Fillers
Key Terms
blepharoplasty
Botox®
career plan
contraindications
dermal fillers
dynamic muscle
movement
Dysport®
glabella
Health Insurance
Portability and
Accountability Act
indications
mission statement
nasolabial
nonsurgical aesthetic
skin care
platysmal
professional ethics
ptosis
Retin A®
technique-sensitive
Chapter
1
Learning Objectives
After completing this chapter, you should be able to:
1. Explain the history and benefits of neurotoxins and dermal fillers.
2. Outline the importance of training as it pertains to neurotoxins
and dermal fillers.
3. Identify the licensure and liability issues associated with
neurotoxins and other injectables.
1
2
Chapter 1
Aesthetics is the study of the
theory of beauty and of the
psychological responses to it,
specifically the branch of
philosophy dealing with art, its
creative sources, its forms, and
its effects. (Terino & Flowers,
2000)
nonsurgical aesthetic
skin care
Any noninvasive procedure that is
intended to improve overall skin health
and appearance.
INTRODUCTION
B
eauty is sought after and desired, it inspires attention, and it
affects our status in society. Although perceived beauty can
vary by region or culture, uniformities in perceptions of beauty
do exist. When we speak of the face, these uniform perceptions of beauty
are symmetry, balance, proportion, and harmony. Studies have concluded
that people who are perceived to have these qualities are more likely
to be perceived as being attractive. In a study of the uses of neurotoxins
and dermal fillers, the ability to define beauty will influence the decision
to provide treatment and furthermore influence the volume and placement of material.
Whether it is through TV, magazines, or their peers, clients are
flooded with information on plastic surgery, neurotoxins, dermal fillers,
and aesthetic skin care: An attractive appearance is a central theme in
our youth-oriented society. Looking younger and attractive demands
attention from others; it is that simple (Figure 1–1). Lines, wrinkles,
and sagging skin that were once considered an irreversible consequence
of the aging process are now considered unwarranted and unwanted.
Earlier generations begrudgingly accepted them as a right of passage
into the golden years, wearing their lines proudly as a testament to their
survival of war, depression, or oppression. As the baby boomers now
pass into their own golden years, they have helped create a multibilliondollar industry called nonsurgical aesthetic skin care. In an effort to
sustain a youthful appearance, these baby boomers and the generations
that followed them have forced the skin care industry to develop products and services to meet their needs. Neurotoxins and dermal fillers are
a large component of the nonsurgical aesthetic skin care industry,
and their popularity is growing daily. Therefore let us examine this
exciting trend.
H I S T O R Y A N D OR I G I N S O F F A C I A L
PLASTIC SURGERY
Figure 1–1 A youthful face
is full and void of wrinkles,
sagging, depressions, and
discolorations.
Since the beginning of time, humans have pursued the art of physical
self-improvement. Beginning with the Chinese, whose appearance and
hygiene were considered to be defining characteristics, skin care and
beautification has held a place in every culture, including that of the
Egyptians, Greeks, Romans, Indians, and Africans, through to the present day. From decorating and celebrating to masking and concealing,
Introduction to Neurotoxins and Dermal Fillers
every culture through history has placed a value on the face as defining
a person’s appearance. Currently, a more scientific and medical approach
is used that not only enhances the appearance of our faces but also
improves the skin down to the cellular level.
Plastic surgery is a broad category that involves both reconstructive
and aesthetic surgical improvement. Plastic does not mean artificial, but
rather to mold or to shape, derived from the Greek term plastikos.
Although the term plastic surgery was not coined until the early 1800s, the
technique had been in use for hundreds of years before. Egyptian physicians circa 3000 B.C. can be considered the first to attempt reconstructive
plastic surgery (Ciaschini, 2005). The surgeries included the care of trauma wounds, especially facial trauma. Later, specific data can be linked to
the treatment of noses in incidents of facial mutilation in India. Historical
documents relate information about surgery to the nose as a form of punishment: “The nose is a symbol of dignity and respect in many societies
throughout antiquity” (Ciaschini, 2005).
The progress of the medical specialty known as plastic surgery fell
into decline with the fall of the Roman Empire and in the barbaric times
known as the Middle Ages. However, the Renaissance in the fourteenth
century saw a resurgence of science and art, including plastic surgery.
Procedures and techniques were developed and refined, mainly in Sicily.
In the late 1800s, plastic surgery gained popularity among physicians
in the middle European countries. At this time, Carl Von Graefe began
to use the term plastic surgery routinely in his work. Procedures such as
cleft lip and palates, burn therapies, and skin grafting were becoming
routine during this time.
In the late 1800s and early 1900s, the aesthetic influence began to
surface in plastic surgery. Previously, because all the research and procedures were devoted to functional reconstruction, little work had been
done in the aesthetic arena. However, with unprecedented improvements in surgery and medicine, aesthetic surgery began to grow. The
specialty met with resistance from physicians who believed that these
procedures were not real medicine; they did not save lives and were not
worthy of academic attention. The efforts of plastic surgeons were realized while saving lives during World War I. Split-thickness skin grafts,
advances in techniques, and positive results in the treatment of maxillofacial injuries did much to improve the reputation of plastic surgeons
and thrust the specialty into a respected position within the medical
profession. Infection control improved the outcome of plastic surgery
procedures, and the progress of infection control techniques further
improved the outcome.
Most historians agree that World War II marked a defining period
for plastic surgeons (Figure 1–2). It is a matter of pride that before the
3
4
Chapter 1
Figure 1–2 World War II saw the real beginning of plastic surgery as we
know it today. (Courtesy of Margaret Bourke-White and Time & Life Pictures.)
start of the war, the United States had 60 plastic surgeons compared
with Britain’s 4. By the end of World War II, 70 divisions of plastic
surgery had been formed in universities around the United States.
By the early 1990s, cosmetic surgery was flourishing, and today it
has become a way of life; in fact, it has become a right of passage for this
generation’s aging process.
E V O L U T I O N O F NE U R O T O X I N S
Figure 1–3 Botox, a popular
neurotoxin, as it is supplied
from Allergan. (Courtesy of
Allergan Corporation.)
The fine lines of crow’s feet or deeper glabellar frown lines show the age
of a person. These lines are associated with dynamic movement. It is
well known that the animated face shows age more than does the sullen
face. Additionally, people with dry, fine skin will wrinkle more quickly
than will those with thicker, more pigmented skin.
Neurotoxins are an adjunct to the surgical tools available to the
plastic surgeon (Figures 1–3 to 1–5). In many instances, the treatments
provided with a neurotoxin address lines and wrinkles that will not be
addressed through a surgical procedure. Before the availability of neurotoxins, the problems were frustrating and the available treatments
provided only moderately beneficial results. The treatments included
the following procedures: chemical peels, dermabrasion, carbon dioxide
(CO2) laser, erbium laser, blepharoplasty, forehead lifts (including
clipping the procerus muscle to prevent movement), and more recently
Retin A and medical skin care techniques.
Chemical peels, dermabrasion, CO2 laser, and erbium laser all work
on the lines to improve the appearance by peeling or sanding off the
upper layers of skin, encouraging the replacement of these layers with
newer healthier cells. Although these procedures help the lines to initially appear less deep than was the case before treatment, because the
lines are the result of dynamic muscle movement, continued movement means continued deepening of the lines.
In the last 15 years, the neurotoxins Botox and Dysport have
become the most sought-after cosmetic medical treatments; they filled a
void in the choice of treatments. The scope of success for neurotoxins
cannot be understated and includes the treatment of forehead, glabellar
frown line, crow’s feet, upper and lower lip, nasolabial fold, chin, and
platysmal bands of the neck. Neurotoxins have become an irreplaceable
nonsurgical treatment for lines and wrinkles, for which no other treatment option exists.
5
Figure 1–4 Dysport, another
popular neurotoxin, as it is
supplied from Ipsen.
blepharoplasty
Eyelid lift; plastic surgical procedure.
Retin A
Keratolytic agent used to treat acne
and reverse photodamage.
dynamic muscle
movement
Wrinkling that occurs as a result of
facial movement.
Botox and Dysport
Trade names for botulinum toxin, which
is injected into the wrinkle-causing
muscles, paralyzing the injected
muscle.
platysmal
Vertical bands of the neck that are a
result of dynamic movement of the
neck and jaw.
Figure 1–5 The glabella has strong muscles and is the most common site
for botulinum toxin A treatment.
6
Chapter 1
E V O L U T I O N O F DE R M A L F I L L E R S
dermal fillers
Products used to fill lines, wrinkles,
shadows, and defects of the face.
Dermal fillers are used much more than before (Figure 1–6). In the
1980s, when the original bovine collagen was released, it was used as an
adjunct therapy to facelift surgery or to augment the lip line. It was also
used to treat fine lines of the nasolabial folds, glabellar frown lines, and
crow’s feet. This first dermal filler was derived from animal sources,
specifically cowhide. A skin test is required before use of this product to
ensure that the client is not allergic to the bovine collagen, given that
roughly 3 percent of users are allergic. Bovine collagen is far from a perfect dermal filler, and many companies, including the Collagen Corporation, sought out other options to fill the gaps for clients who were
allergic to bovine collagen, in addition to complaints of poor product
durability. Today bovine collagen is rarely used and the dermal-filler
market has given way to a plethora of new fillers.
Figure 1–6 An example of a hyaluronic dermal
filler.
Enter the new world of facial rejuvenation—twenty-first-century
dermal fillers! Today’s dermal fillers are made from a variety of substances and work to replace lost volume, correct lines, reduce shadows
and wrinkles, and improve the aging face. These dermal fillers help the
plastic surgeon enhance surgical results or avoid surgery altogether. Let
us examine the options.
Naturally, the Collagen Corporation was interested in sustaining the
interest in collagen and turned to human sources for product options.
These human derivatives included CosmoPlast™ and CosmoDerm™
(from the original Collagen Corporation), Isolagen, Dermalogen™,
Cymetra™, Fascian™, and finally fat grafting. Human collagens behave
much the same as bovine collagen, but they do not require a skin test
before treatment. The initial belief held that these products would last
longer than would the original collagen, but the question of durability is
still debated. Awareness of the specific application of each product is
important for the individual administering the injection.
The next wave of dermal-filler material saw synthetic or a combination of synthetic materials and collagen. Manufacturers of these products hoped to address the client’s concerns regarding longevity, allergic
reactions, and cost. These products included Gore-Tex®, UltraSoft®
(known originally as SoftForm®), AdatoSil 5000™, Silikon® 1000, Bioplastique®, and Artefill™.
AdatoSil 5000 and Silikon 1000 are injectable silicone products for
use around the eyes and have not been approved by the U.S. Food and
Drug Administration (FDA) for cosmetic purposes. As researchers
work toward a perfect dermal filler, these products may be eventually
used for line reduction and cosmetic uses. Although these products may
be used for cosmetic purposes, their use is considered off label, and the
client and the physician employ this treatment at their own risk.
Use of Bioplastique and Artefill are considered permanent treatments. Bioplastique is a silicone particle that is enclosed in a polyvinyl
pyrrolidine carrier (Arian et al., 2005). Artefill is a microsphere encapsulated by bovine collagen.
The next group of dermal fillers is the hyaluronic acid group.
Included in these products are Restylane®, Restylane Fine Lines™, Perlane, Juvéderm®, Juvéderm Ultra®, and Prevelle Silk®. These products
vary in particle size and cross-linking, making their application specific.
Being aware of the specific application of each product before treatment
is important for the treatment injector. All these products will be discussed at length later in the text.
Non–hyaluronic acid products on the market for filling include
Sculptra® and Radiesse®. They have specific applications and will be
discussed later in this text.
7
8
Chapter 1
The attributes of a perfect filler are nontoxicity, biocompatibility,
reasonable durability, ease of use, safety, FDA approval, decreased downtime, predictability, and ease of wear. Many of these attributes have been
achieved with hyaluronic acid. Research and development in search of the
perfect dermal filler is continuing. However, for now, the market has
many options for the client. Dermal filling is a popular, nonsurgical
approach for treating the aging face, and the experienced injector has
many available products to choose from.
Benefits of Injectable Therapy
The augmentation of the lips, addition of volume to the face, and the
filling of lines and shadows, all during a visit to a doctor’s office using a
product such as Restylane or Juvéderm dermal filler, is the newest trend
in facial rejuvenation. The excitement generated by the industry cannot
be underestimated. Younger clients now have the option of staving off
the aging process by using neurotoxins, while older clients have an
option of avoiding surgical procedures initially by using dermal fillers
(Figure 1–7). All clients who choose injectable therapies will benefit
immediately with a younger and fresher appearance with little downtime,
expense, and pain associated with more invasive surgical procedures.
An Aesthetician’s Role in Injectable Therapy
As an aesthetician counseling a client on the benefits of injection dermal
therapy, a wide base of knowledge rooted in critical thinking is important. New products are introduced to the market regularly. As an aesthetician, you must be in a position to provide up-to-date information
to the client and ensure its accuracy. After all, your reputation is on the
line. This process is best accomplished by reading and having discussions with a physician or nurse injector within the medispa. Given that
a physician or nurse injector provides the treatment, an open and educational exchange of ideas must take place regularly. This exchange benefits
everyone—the client, the aesthetician, and the injector—by ensuring that
information imparted to the client is consistent.
Several general points are universal to dermal fillers and can be
addressed by the aesthetician without consequence. These include the
different types of fillers, the durability of products, the best indications
for dermal fillers, anesthesia for the treatment, and post-care.
The aesthetician should be well versed in the dermal fillers used in
the medispa, as well as in those fillers that are available on the market
but unavailable for use at the medispa. Knowing which products are
approved by the FDA and which are not is an important component of
Figure 1–7 Before (top) and after (bottom) photographs of a client who has
received dermal-filler injection therapy.
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Chapter 1
nasolabial
Nose to lip; in this case, pertains to
the crease that develops there.
glabella
Area between the eyebrows with
underlying muscle groups that
cause creasing (frown lines) as a
result of repeated squinting or
frowning over time.
the information base. Although many physicians acquire unapproved
dermal fillers from other countries, understanding why some products
are approved and others are not is important. Occasionally, a client will
question the FDA status of a product and the aesthetician’s or nurse
injector’s answer needs to be clear, concise, and accurate. This is especially true if there has been a complication with a product that
is reported by the media. The aesthetician should be armed with the
proper information to answer any question.
The durability of a product is the most common question that the
aesthetician will be asked while educating a client. Compared to other
nonsurgical offerings on your medispa menu, injectable procedures are
expensive, somewhat uncomfortable, and time consuming (two to three
appointments may be needed). For these reasons, the length of time a
treatment will last is the number one question the client will ask. The
answer to the questions on durability is determined by several variables,
among which are (1) the type of material, (2) the location of the placement, (3) the depth of the placement, and (4) whether this visit is the
primary- or secondary-injection session.
The type of material used is a critical determinant of durability.
That is to say, certain products have a higher durability than others do:
For example, hyaluronic acid will last longer than bovine collagen. As
you educate the client about product choices, begin with the fact that
certain products inherently last longer. Next is the location of placement, or the indication. In this case, the aesthetician should know that
the lips, for example, will absorb much more quickly than acne scars on
the lateral aspects of the face, and that the nasolabial lines will absorb
more quickly than will a glabella that is treated with a dermal filler and
then paralyzed with a neurotoxin (Figure 1–8). In other words, movement or friction plays into the durability of a product. The depth
of placement is also an important factor. If a product is placed deeper
than is recommended, it will absorb more quickly. The clearest example
of this concept is when Restylane Fine Lines dermal filler or Zyderm®
I (both intended to be placed in the upper epidermis) is placed into
the mid-papillary dermis. The limited correction that is provided will
last only weeks compared with the proper placement, which may last
months. Finally, an important and little-recognized component of durability is the number and date of previous treatments. A well-known fact
is that although the original result achieved with dermal fillers lasts only
4 to 8 months, the material resides in the tissues for over a year. When
a treatment is provided, for example, at 6 months after the original treatment, the correction is easier, the original product providing a foundation on which to lay new product, making the result easier to achieve
and longer lasting.
11
Figure 1–8 Nasolabial lines are commonly treated with dermal fillers.
Although the variables are not as significant with neurotoxins as
they are with dermal fillers, the aesthetician should still be aware of the
key points necessary to educate the client who is being treated with neurotoxins. When discussing neurotoxins with the client, the aesthetician
should be aware of the indications for the procedure, durability, potential discomfort, treatment consequences such as bruising, and other
complications such as eyelid ptosis.
The indications for neurotoxins are simple—frown lines, forehead
lines, crow’s feet, upper and lower lip lines, and chin pebbling—and the
aesthetician can acquire this information quickly. Of course, nuances
come with these treatment indications, such as skin laxity, volume of
lines and wrinkles, and anticipated appearance. Whether the injector
can give the client the latter’s anticipated result should be left for discussion with the injector. The aesthetician should not promise something
that he or she cannot control and does not know to be true. The durability of neurotoxins is a frequent question. This answer also has nuances,
but a timeframe of 3 to 5 months is a good response. As with dermal fillers, durability depends upon the area treated, the length of time since
the last treatment, and the desires of the client. Clients who request full
paralysis will have less durability because, once the muscle begins to
ptosis
Prolapse or sagging; drooping,
especially of the upper eyelid; related
to neurotoxins.
12
Chapter 1
move, these clients are back in the office. This return visit will usually
happen after approximately 3 months. If, on the other hand, the client
is willing to have some movement or partial paralysis of the muscle, he
or she may be happy for as long as 5 months. Neurotoxins, both Botox
and Dysport, can be uncomfortable for some people. Clients, however,
typically tolerate the procedure well and are out of the office in 15 minutes. Bruising can be a frequent treatment consequence with neurotoxin
treatment, especially around the eyes. Counseling the client to discontinue aspirin or other products such as homeopathics and vitamins,
which may contribute to bruising, 2 days before treatment can be helpful. However, clients should check with their primary physician to consider the advisability of discontinuing any medications. If the client is
bruised, as long as 2 weeks may be required for the area to resolve, especially around the eyes. Finally, the complication of highest concern is
that of eyelid ptosis. This condition occurs when the eyelid is paralyzed
and does not open fully. This complication is related to glabellar treatment, not crow’s feet. The nerves and muscles that control the eyelids
are above the arch of the brow. If the injector is not careful about the
placement of the treatment near the eyebrow, eyelid ptosis can occur.
These few tips should help the aesthetician provide basic, helpful
information to the client who is seeking dermal-filler or neurotoxin
treatment. However, be careful about the advice you give and how you
recommend the treatments so that the information is not misunderstood. The aesthetician should not be caught in the business of dispensing
medical advice.
Classroom Training
An important point to remember is that every aesthetician who works
at the medispa should have the same information about dermal fillers
and neurotoxin. Information can be transmitted to the staff in several
ways: written protocols, staff meetings, roundtable discussions, and
clinical training sessions (Figure 1–9).
Part of a new employee’s orientation should include an overview of
the procedures that are provided at the medical spa. Each procedure
should be covered; who will be providing the treatments is no exception.
The basic orientation course for dermal-filler and neurotoxin treatment
should include an anatomic and physiologic review of the skin, the muscles of the face and how they work to cause dynamic lines, the arteries
and veins of the face, and the nerves of the face. Although this training
may seem detailed for someone who is not injecting, laying the groundwork for understanding the procedures is important. It is imperative
that aestheticians who are learning to inject have this training. A broad
Figure 1–9 Clinical training sessions are essential for the aesthetician to
understand neurotoxins and dermal fillers.
theoretic understanding of the indications and contraindications for
these products should be outlined, and written protocols should be
available. Aestheticians should also learn about the principles of wound
healing so they are aware of the potential injuries and management of
care. The policy of the medispa and the aesthetician’s role in injection
therapy should be made clear.
As a matter of consistency, written protocols not only educate the
learning injector but also protect the medispa and the aesthetician. The
protocols should be reviewed during training and updated regularly
to reflect changes in the treatment processes and the standards of care,
if any.
One of the most important methods of transmitting information
and keeping the staff current on changes in the treatment protocols,
materials, and processes is through staff meetings. Although staff meetings are generally reserved for operational issues at the medispa, they
should also be used to disseminate important treatment information.
Examples of important information might be new treatments that are
available, the protocol for the new treatment, and the marketing tactics
that management has implemented to increase awareness about the new
treatment. On the other hand, if the information that needs to be transmitted is more technical in nature, the meeting is referred to as a clinical
roundtable. Clinical roundtables are usually convened on a quarterly
indications
Any sign or circumstance indicating
that a particular treatment is
appropriate or warranted.
contraindications
Any sign or symptom indicating that
a particular treatment, which would
otherwise be advisable, would be
inappropriate.
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Chapter 1
basis and address the technical aspects of a procedure. The discussion
might also include any recent complications or side effects of a particular treatment and the subsequent care that was given to the client.
Changes in the protocol should be discussed along with new procedures,
products, and technology that are being made available at the medispa.
Ongoing training is important for the medispa and the individual
aesthetician; it is also a matter of safety and provides superior clinical
results for the client.
Training for the Injector
technique-sensitive
Results of a treatment that depend on
the provider’s ability to administer
consistent results.
Injectable treatments are technique-sensitive. And while aestheticians
must understand the process of injection, it should be said at this juncture that only physicians, physician assistants, qualified nurses, and
nurse practitioners should provide neurotoxin and dermal-filling treatments. This procedure is outside the scope of practice for an aesthetician,
medical assistant, or surgical assistant.
Finding the proper training for dermal-filling treatment is often difficult. The product-manufacturing companies do not often have formal
training programs, or the programs are simply the instruction provided
by a sales representative. If training programs are provided, they can be a
cost to the physician, which is expensive and perhaps cost-prohibitive. In
many instances, practitioners attend a 1-day course of lecture and injection observation. Unfortunately, observing dermal filling or neurotoxin
therapy does not make the observer qualified to provide treatment.
If possible, the injector should acquire an instructional video that
explains the product and the injection techniques. The product manufacturer usually provides these videos. Watching these videos and attending
a seminar provide a good start to learning how to inject. The practitioner
should then find an instructor who can provide some one-on-one injection tutoring on models before treating paying clients. Remember that
the product will last 6 to 8 months, and as such, so will your mistakes.
Clients are generally not forgiving if they paid for a treatment that
produces problems that will not resolve for 6 to 8 months.
Career Opportunities
Whether you work in a day spa, hair salon, medical spa, or a cruise
ship, questions will be asked about neurotoxins and dermal fillers; these
products are the facelift of the twenty-first century. Everyone is familiar
with these terms, but even the savviest client may ask for neurotoxin to
fill her lips. Therefore education and career opportunities go hand in
hand. Once the aesthetician is educated, whether you are a nurse or an
aesthetician, the time to find the job of your dreams has come.
Creating a career plan for success is the first step to realizing your
dream. Many professionals in the area of self-improvement recommend
identifying the goal and working backward to achieve this goal.
Using this technique, identify where you want to be in 5 years and
what you want to be doing. Then create a list of objectives to achieve that
goal. For example, if you are currently an aesthetician without medical
experience and you would like to be in a medical office as an aesthetician
counseling clients about neurotoxins and dermal fillers and providing
medical skin care treatments, identify objectives that will allow you to
meet that goal (Figure 1–10). Find out where to obtain the training,
expertise, and experience that will allow you to be a valued employee in a
medical setting. Identify internships or learning situations that will help
you perfect your clinical skills. Take communication courses that will help
you learn how to communicate with clients, peers, and superiors. Take
sales courses that will help you make a contribution to your employer and
to yourself. Learn the basics of building a business. Create a professional
resume. Practice interviewing skills that will help you get the job.
Marketing yourself to a business will become an important skill in
acquiring the right job. Whether you want to land a job in a plastic surgery office, in an oral surgeon’s office, or in a day spa that offers medical
treatments, the tactics you use to get there will be the same. Remember,
just as you are looking for the perfect job, the employer is looking for
the perfect employee. Not every opportunity will be a good match for
Figure 1–10 Medical spas are comfortable and also have facilities
conducive to more technical procedures. They may resemble a physician’s
office. (Photograph courtesy of Facial Aesthetics, Denver, Colorado.)
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career plan
Action taken by an individual to set
goals and actions taken to ensure that
these goals are realized.
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Chapter 1
Career Opportunities
MEDICAL OFFICES THAT OFTEN PROVIDE NEUROTOXINS
AND DERMAL-FILLING TREATMENTS
•
Plastic surgery
•
Dermatology
•
Family practice
•
Gynecology
•
Otolaryngologist (common usage “ENT physician”)
•
Dentistry
you or the employer, and this circumstance is to be expected. However,
understanding the components of a good match will be the key to longterm success. By marketing yourself, you will have a sound understanding of what positions will be a good match for you personally.
Several components of marketing yourself should be addressed,
including your values, your integrity, your skills, and your needs. Before
looking for a job, writing the important points for you in each category
would be worthwhile. This exercise will help you ask potential employers
the right questions, the answers for which will assist in your own determination. Then practice with a friend. Remember, you are interviewing the
employer as much as the employer is interviewing you. Regarding your
individual value, you will want to itemize specifics, such as your education and your experience. Some schools have more prestige than others
do; build on this value, if possible. Indicate your advanced education,
including college (name, location, and degree), advanced aesthetic education classes (with whom and where), and include experience in the field
in which you are looking to be employed.
A value is defined as “something (as a principle or quality) intrinsically
valuable or desirable” (Merriam-Webster’s Collegiate Dictionary, 1994). Ask
questions about the business’s philosophies and goals. Businesses should
have both financial and nonfinancial goals. Specifically ask about client
care philosophies. Then discuss the values with which you can identify.
Important values to you may include being on time, following company
protocol, the quality care of clients, or even volunteering at the local
women’s shelter. Think twice about working in a spa if you believe that
your values seem to differ from those of the spa or employer.
Integrity is different from values. Integrity is defined as “uncompromising adherence to moral and ethical principles; honesty” (MerriamWebster’s Collegiate Dictionary, 1994). In this category, you will want to
ask questions about client care again, such as how complications are
handled, how unhappy clients are handled, and how fee disputes are
managed. Additionally, ask direct questions about the ethical principles
of the company. A written philosophy should be available; it is usually in
the company’s mission statement. Then consider if these ethical principles are similar or the same as your own. They should be.
Your skills are important to an employer, but sometimes the position is not exactly what you are seeking for a host of reasons. You will
need to address this issue with the potential employer. Ask questions
about the specific skills needed and respond with information about
your skills. If you are under-qualified, but a match otherwise exists,
what training will be available to help you become qualified? How
quickly will this training occur, and who will provide the training? Will
a pay raise be forthcoming once the training is complete? These questions are important to ask before committing to a position. But what
you hear at the interview and what comes to pass in a job may not
always be the same. Putting into writing some of what would otherwise
be a “handshake deal” is in your best interest. This approach eliminates
any future misunderstandings or hard feelings. If the employer is
unwilling to document your concerns, maybe the job is not a match.
Your needs are especially important but not exclusive of the
employer’s needs. The best situation is when you find a need match. List
your needs, such as salary (pay rate, pay schedule, and commission),
benefits, vacation time, sick-day policies, hours to be worked, desired
job description, and any other important needs you may have. In
advance, decide which needs you can compromise and which ones will
be deal breakers. Making this decision in advance prevents you from
tasting sour grapes if you give in and then have regrets.
Once you have your credentials, your resume, and your marketing
plan, then you are ready to go get the job for which you are uniquely
qualified.
L I A B I L I T Y I S S U E S F O R TH E
A E S T H E T I C I A N , TH E P H Y S I C I A N ,
A N D TH E N U R S E I N J E C T O R
Liability issues for the aesthetician are important factors in preparing
for a career. Our society in the United States is more litigious than ever
before. If something goes wrong, the client is always looking for someone to blame. Whether a case ever comes to settlement or trial, the
stress of being blamed will be enormous, and it is a situation in which
no aesthetician should be caught.
mission statement
Written statement of a business’s
individual philosophy.
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Chapter 1
Potential liability risks for aestheticians are inherent. Given that
these products (neurotoxins and dermal fillers) are temporary, most of
the complications associated with the injection are temporary. But some
are not. The most common liabilities for the injection practitioner are
necrosis resulting in scars, persistent allergies or hypersensitivity, blindness, stroke, the use of non-FDA-approved products, infections, disease
transmission, and failure to keep information confidential.
Although the treatment consent form is always signed before treatment, the injector is not always protected. That said, going through
the consent form, especially the risks and complications, with the client before treatment is important. The best protection, however, is
providing superior treatment without complications or side effects.
Furthermore, accurate and complete charting is a must on each client
for each visit. Not only does accurate treatment provide a paper trail
for the aesthetician, it also documents the treatment if a problem
arises. As the old saying goes, “If it is not written in the chart, it did
not happen.”
Licensure and Insurance for the Aesthetician
Before you begin your employment, be sure to call the state
board that recognizes your
license and find out what specific implications should be
noted when you are working in
a medical spa. Once you have
completed this telephone call,
the next call to make is to your
insurance agent to make sure
you have the proper coverage
for the procedures you will be
performing.
No matter what your medical specialty is, you must be licensed in the
state in which you practice. Each state is different, and no national
licensures exist for any medical specialty or aesthetic specialty. For your
security and that of the employer, confirmation of licensure should be
provided to the employer and kept in the employee record. Many
aestheticians like to keep their license hanging in their treatment room
to be seen. In some states, this display is a requirement.
Several types of insurance are available. For the aesthetician, the most
important insurance policy will be the malpractice policy. This insurance
policy covers your actions when treating clients. If something goes wrong,
the policy will protect you. When working in the medical office, the physician will sometimes have a broad policy under which you will be covered. For you, as the individual aesthetician, getting proper coverage is a
fact-finding mission. First, speak with your employer to find out what the
status of coverage for your position will be. Second, find a reputable company and consult one of the agents. Take the consultant’s counsel and
then consider a discussion with an attorney to ensure that your best interests are evaluated.
Regulatory Agencies
The agencies that regulate spas are not federalized but exist on a stateby-state basis. Therefore you must check with the licensing agency in
your state to determine if any specific requirements exist that are related
to your job, aside from general licensure. For example, you might need
a certificate indicating that you have completed a course on microdermabrasion or injection therapy to perform the treatment. These certificates may also be required to obtain insurance.
Professional Code of Ethics
The first question to ask ourselves is, “Why have a code of ethics?”
(MacDonald, 2004). The two types of ethical codes are personal ethics
and professional ethics. Although these categories may overlap, it is
important that each be documented separately. The personal code of
ethics is a highly personal document that guides the way you will live
your life and what your priorities will be in daily decision making.
A professional code of ethics, on the other hand, should be made
public and well known to all in our profession, as well as to our clients. If aestheticians are to be considered members of trained service
professionals (sometimes referred to as allied health professionals), as
are their counterparts in nursing, social work, nutrition, or others,
they should extend themselves to the highest level and this includes
statement of and adherence to professional ethics. Therefore exactly
what does a code of ethics need to include? “It should discuss appropriate and inappropriate behavior, it should promote high standards
of client care, it should be used for self evaluation, it should establish a framework for professional behavior and responsibilities, it
should identify us and create an image of occupational maturity”
(Olson, 2004).
Given all these criteria, it must be recognized that creating a code
of ethics is not an easy task. For codes of ethics to be meaningful, they
should be developed by the group that is going to use the document.
This task may appear overwhelming because the subject matter can be
broad and diverse, especially if the group that is writing the code of
ethics is large. The focus of the code is based on moral principles. The
process should begin by asking certain questions such as “Why a code
of ethics?” “What is the purpose of our organization?” and “For what
will this code be used?” For the code to be useful, it must reflect the
qualities of the group, which can be difficult, given that each person
within the group has different qualities and moral viewpoints. However,
finding a place of compromise is, as always, the best course of action.
The code of ethics must be broad enough to reflect the considerations of
the number of people using it but specific enough to direct individual
behavior. Therefore, if the code fails to provide substantive guidance for
the organization, it is likely to create confusion.
professional ethics
Set of guidelines that should set a
framework for professional behavior
and responsibilities.
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Chapter 1
Higher Standard of Professionalism
When working in the medical office, more is expected of the aesthetician
by both the client and the physician. He or she is expected to adhere to a
higher level of professionalism and customer service than may be acceptable in the spa setting. Aestheticians must train themselves to refrain
from laughing, joking, and loud behavior. Clients may think they are
being talked about or laughed at. Additionally, this kind of “party” atmosphere does not reflect positively on our image or our profession. In fact,
this behavior may negatively reflect on us in the eyes of the client. Your
ethical conduct should be present in your contact with clients, their charts
or records, and your communication with others about the client. The
information you pass along about the client to colleagues or others
involved in his or her care should be complete and comply with legal
requirements, namely, the Health Insurance Portability and Accountability Act (HIPAA) regulations (see later discussion). The client list of the
medical spa belongs to the physician, and according to this act, the information should never leave the medical office.
Professionalism in the Medical Setting
As professionals in an emerging setting, we must commit to our industry, our careers, and our clients by behaving in the most upright manner. Our behavior is evaluated each day by our clients, our colleagues,
and our physicians. Adhere to the written code of ethics in your office,
and take the time to create your own personal code of ethics. This exercise will help you through the rough decisions you may have to make on
your own or in coordination with your manager. Just as important, try
to find a mentor inside your office and create a relationship of trust and
learning. A mentor is a “wise and trusted counselor or teacher”
(Merriam-Webster’s Collegiate Dictionary, 1994). This person will help you
learn, after whom you can model your behavior and professionalism.
Finally, a word on ethics and clients. Although the client you meet
and treat belongs to you, the reality is that this client belongs to the medical spa and physician. Without the physician’s license, you would be
unable to extend your services. Therefore, if and when you leave the
employ of a spa, taking a list of client names and telephone numbers to
contact for use in your next job is inappropriate and unethical. This
activity represents poor judgment, and if you are a medical professional
(registered nurse or physician’s assistant), your professional license is at
risk. This behavior will not gain you points in the medical and professional community. If the physician for whom you are going to work asks
you for this information, you should be concerned. All you have is your
reputation not only in the eyes of the client but also in the eyes of the
physician and medical community. Some day, you may require the
21
referral of your current manager or physician or need to work with them
on some professional level, such as a committee. Do not embarrass
yourself by doing something inappropriate or, worse yet, illegal.
Health Insurance Portability and
Accountability Act
When working in a medical office, the aesthetician must understand all
the laws and regulations that affect the practice. These rules and laws
are covered by the HIPAA. Passed by Congress in 1996 and signed into
law in January of 1997, the purpose of this law is to protect the privacy
of clients’ health information. Uniform standards have now been
enacted across the nation that identify how health information changes
hands. Health information is protected by stringent rules that apply to
information in the chart, on the computer or fax, and by spoken word.
Seven categories of the relevant law have been established. These categories include (1) access to medical records, (2) notice of privacy practices, (3) limits on use of personal medical information, (4) prohibition
on marketing, (5) stronger state laws, (6) confidential communications,
and (7) complaints (Figure 1–11) (U.S. Department of Health and
Human Services, 2004).
Health Insurance
Portability and
Accountability Act
Federal regulation that dictates
procedural protocols to protect client
privacy.
Access to medical records: Clients are entitled to have copies of their
records and to look at their medical records.
Notice of privacy practices: Medical facilities are required to communicate with clients in writing about how their medical information will be
used and what the client’s rights are under the law.
Limits on the use of personal medical information: This section of the law
deals with insurance plans and how the client’s information is communicated between insurance companies and medical professionals.
Prohibition on marketing: Restrictions are put in place on how the client
information can be used in marketing purposes.
Stronger state laws: The national law does not affect stricter state laws;
however, all states must abide by the national law.
Confidential communications: Clients can dictate where and how they are
contacted.
Complaints: All clients may file a complaint if they believe that their
privacy has been violated.
The following list provides a few basic tips to keep you out of trouble and respect the HIPAA laws:
• Do not discuss clients within earshot of other clients, especially at
the front desk and near or in the waiting area.
Figure 1–11 Communication between clinician and
client contributes to a positive
outcome.
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Chapter 1
• Do not share information about the client with others, including the
client’s family.
• Do not fax medical records.
• Do not gossip about clients.
• Do not leave charge tickets where other clients can see the name on
the ticket.
• Do not make a computer screen available for the client to see.
• Do not release information over the telephone.
• Do not release copied information without a signed release by the
client.
• Take only the record for the client you are treating into the treatment room.
• Chart immediately and file the chart; do not leave charts lying
about.
• Be an ethical professional, and consider how you would like to be
treated.
CONCLUSION
Before even reading this text, we knew that certain people garner more
attention than do others. Maybe you thought the attention was about
long blonde hair or a large bustline. However, in reality, people who
attract genuine attention in our society have a definable facial beauty;
and although beauty is in the eye of the beholder, we now know that
certain markers exist for youth and beauty, which are symmetry, balance, proportion, and harmony. Whether the treatment you are discussing with your client is neurotoxins or microdermabrasion, an analysis of
the face is necessary. The process will help you determine what can be
accomplished and what cannot, and how that final result will affect the
client. In our youth-oriented society, as aestheticians in this specialty,
we hold the perceived magic dust that will help clients sustain their
youth. However, we have a responsibility to counsel our clients wisely
and recommend only the specific treatments that will provide real value
to achieving the client’s goals.
> > > Top 10 Tips to Take to the Spa
1. Plastic surgery has a broad definition that applies to both
reconstructive and aesthetic surgical improvement.
2. Neurotoxins can be an adjunct to the surgical tools available to
the plastic surgeon.
3. Neurotoxins have become the most sought-after cosmetic medical
treatment in the last 15 years.
4. Today’s dermal fillers are made from a variety of substances and
work to replace lost volume, correct lines, reduce shadows and
wrinkles, and enhance the aging face.
5. Younger clients now have the option of staving off the aging
process with the use of a dermal filler, while middle-aged clients
have the option of avoiding surgical procedures initially by using a
dermal filler.
6. Given that new products are introduced to the market regularly,
the aesthetician must be updating the information he or she is
giving to the client and ensure its accuracy.
7. Durability is based on several variables, among which are the type
of material, the location of the placement, the depth of the
placement, and whether this visit is the primary or secondary
injection session.
8. Everyone who works at the spa must have the same information
about dermal fillers and neurotoxins.
9. Injectable treatments are technique-sensitive.
10. Liability issues for the aesthetician are an important factor in
preparing for a career.
1. What is nonsurgical aesthetic skin care? How do neurotoxins
and dermal fillers fit into this treatment area?
2. Explain dynamic muscle movement. How do neurotoxins act to
remedy this?
3. What locations on the face is a neurotoxin indicated for?
4. What are dermal fillers? What types are available on the market
today?
5. What are some of the benefits of injectable therapy? What
products are on the market today to accomplish as much? How
long do these results last?
6. Explain the role of an aesthetician in injectable therapies.
7. What exactly is ptosis? How would you address a client with
ptosis concerns?
8. What are some of the considerations that affect neurotoxin
durability? How about dermal-filler durability?
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Chapter 1
9. An aesthetician is qualified to inject dermal fillers and
neurotoxin in most states (True or false).
10. What are some of the indications for neurotoxins? for dermal
fillers?
11. What are some of the contraindications for neurotoxins? for
dermal fillers?
12. Explain the importance of training with regard to injectable
treatments.
13. What training ought to be done for the injector?
14. Why might it be important for an aesthetician to devise a career
plan? What career opportunities might be available to an
aspiring aesthetician?
15. How might an aesthetician aspire to conduct a job search? How
might employer-employee compatibility play a role?
16. How does one go about assessing employer-employee
compatibility?
17. Identify some of the liability issues that exist for an aesthetician
in an environment where injectable therapies are performed.
How might you mitigate these risks?
18. Licensure and regulatory bodies are consistent from state to state
( True or false).
Bibliography
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Nahai, F. (2005). Soft-tissue fillers in aesthetic facial surgery: The
art of aesthetic surgery principles and techniques. St. Louis: Quality
Medical Publishing.
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Microdermabrasion in clinical practice. Journal of clinical plastic
surgery, 27(4), 571–577.
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http://www.ifac.org
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concept. North American journal of facial and plastic surgery, 9(3),
383–394.
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versus medicine: The non-physician practice of dermatologic
surgery. Journal of dermatologic surgery, 29(4), 319–324.
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Available: http://www.emedicine.com
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(2003). Milady’s standard: Comprehensive training for estheticians.
Clifton Park, NY: Delmar Cengage Learning.
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Delmar Cengage Learning.
Freeman, S. (May 2001). Microdermabrasion. North American journal
of facial and plastic surgery, 9(2), 257–266.
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(9th ed.). Clifton Park, NY: Delmar Cengage Learning.
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Available: http://www.pimaderm.com
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not just superficial. Cosmetic surgery times (Online). Available:
http://www.cosmeticsurgerytimes.com
Hinds, A. (August 2003). Not convinced yet? Aestheticians turn the
tide, washing in new opportunities (Online). Available: http://www
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Lee, W. R., Shen, S. C., Kuo-Hsien, W., Hu, C. H., & Fang J. Y.
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control topical delivery of vitamin C. Journal of investigative
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Chapter 1
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Milady - Cengage Learning

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